Are Purees Making Our Babies Jaws Weak? with Nicole Goldfarb, MA, CCC-SLP, COM

Katie Ferraro (0s):

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Katie Ferraro (44s):

I have a free feeding guide called 15 Foods Never to Feed That will help you recognize which foods aren't safe. Now most of the foods inside the 15 foods Never to Feed Guide we avoid because they're choking hazards. But I'm providing you with tips on how to modify those foods so they are safe for your baby to eat. You can download the 15 foods Never to Feed Free Feeding guide by going to babyledweaning.co/resources. Again, that's babyled weaning.co/resources to download your free feeding guide 15 foods Never to feed with the modification tips on how to make those foods safer.

Katie Ferraro (1m 25s):

Happy feeding.

Nicole Goldfarb (1m 26s):

That is probably one of the largest causes of the changing human face and they call it epigenetics. The changing human face has a lot to do with the way we're eating or not eating well. And it's not just the nutrition but the mechanics of eating mastication. So chewing builds and forms bone 3, 4, 500 years ago there was no malocclusion, there was no issues that needed orthodontics. The Jawbones fit all 32 adult teeth. But as the foods changed and foods became processed, pre industrialized revolution, foods became processed, sugars were added, foods became cooked, and soft human beings stopped using their jaw muscles as much.

Nicole Goldfarb (2m 9s):

And what happens is the Jawbones didn't grow enough.

Katie Ferraro (2m 13s):

Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in Baby-Led Weaning. Here on the Baby-Led Weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using Baby-Led Weaning. Our purees and pouches making our babies mouths lazy and their jaws weak. There's some evidence to support this idea that even as recently as a few centuries ago, reliance on a less processed diet that had a variety of textures that required active chewing of food earlier in the lifespan led to a stronger oral cavity and draw structure that could fit all of your adult teeth.

Katie Ferraro (3m 4s):

And there weren't all of these orthodontic problems and the airway and the sleep and the breathing issues that routinely plague both pediatric but particularly adult populations. Now my guest today is Nicole Goldfarb. Nicole is a speech language pathologist and an oral myofunctional therapist. So she's gonna explain what oral myofunctional therapy is, but essentially it involves the muscles of the mouth and the face and how they work or function or dysfunction. And I struggled a lot with breastfeeding, my oldest baby I, I remember going to every lactation consultant in town and I could not figure out why would my daughter latch perfectly but then transfer exactly zero breast milk.

Katie Ferraro (3m 44s):

I eventually got a referral to an oral myofunctional therapist and I remember I was like in a very dark place with regard to breastfeeding. I was willing to try anything and to be honest, I was not super impressed with, nor did I have much in the way of results from our few therapy sessions. But it turned out my daughter had pretty severe nerve damage due to a traumatic birth experience that no amount of therapy was going to undo. But once things got settled down, I switched to exclusive pumping. I felt like a little bit of a human being again and willing to venture out with my baby baby. I remember meeting my neighbor, Nicole had met a lot of neighbors. We were relatively new to our neighborhood. Nicole of all things happened to be one of the leading oral myofunctional therapists. Certainly in the United States.

Katie Ferraro (4m 24s):

We've become friends, we've stayed in touch personally and professionally over the years and I'm always, every time we chat, I'm like amazed how overlapping our fields are, even though they wouldn't sound related. 'cause Nicole specializes in airway and breathing and sleeping disorders which stem from oral mild dysfunctions. But there are also severe eating on implications here too, right? Because you don't just learn how to eat in your mouth or breathe in your mouth or speak from your mouth. These are all overlapping experiences that happen simultaneously. So recently I was a guest on Nicole's podcast, which is called Airway Answers by Airway Circle. And we were talking about Baby-Led Weaning, but we kind of like went off on this tangent about the detrimental effects of just relying on purees and allowing babies to only eat purees and how this is doing a disservice to both the muscular function as well as the jaw and the bone development.

Katie Ferraro (5m 10s):

So I wanted to have Nicole on my podcast to explore some more of these ideas and whether or not heavy reliance on Pouches and purees is indeed making our babies' mouths and jaws weak. So with no further ado, here is Nicole Goldfarb teaching us a little bit about what oral myofunctional therapists do and how we can help our babies have better and stronger jaw and bone structures by challenging them with trickier textures.

Nicole Goldfarb (5m 40s):

I went to Target, you know, 11 you 12 years ago with my son and hold off all the sucking Pouches and bought all those and oh that looks great. Like pureed apricots, all you know, I, it's easy and I thought that was normal. I would puree all the foods for him too and I was like, oh well I'm making it so it's better. So I would you know, blend it all up. I didn't know about this stuff back then. Pacifiers, sippy cups

Katie Ferraro (6m 4s):

And Nicole, you are a speech language pathologist but your area of expertise and specialty is so unique. How did you come to specialize in oral myofunctional therapy and and what exactly is that? Because I know I never even heard of that until my pediatrician referred me with my oldest daughter and then I was like, wait a minute. I think this is what Nicole does, which is like very, very rare 'cause not many SLPs do this. So what is it about and how'd you get involved?

Nicole Goldfarb (6m 28s):

Yes, an amazing, your pediatrician knew what it was and referred you. 'Cause that does not, that doesn't happen often. I wouldn't say in the majority of our, our referrals are from pediatricians. It's more dentists, orthodontists, some ear, nose and throat doctors. So oral facial myofunctional therapy is like the longest word ever or string of words. But I like to break it down for patients and people who aren't sure what it is into its components. So oral is mouth, facial is face, mayo is muscle and function is what those muscles do for chewing and swallowing of foods, liquids, saliva for speech sounds and oral rest posture.

Nicole Goldfarb (7m 10s):

So how our lips and our tongue rest when our mouth is not moving. So we work with patients who have oral facial myofunctional disorders. So any problem with the oral facial muscles and oftentimes it will be people who are undergoing orthodontic treatment. So most cases where somebody needs orthodontic treatment, it's actually caused by a oral facial myofunctional disorder or we call it soft tissue dysfunction. Now this is where it gets interesting. The mouth is supposed to rest in a certain way from even fetal development throughout childhood, throughout adulthood we should be resting with our lips closed, sealed, our tongue sucked up to the palate, sucked up to the roof of the mouth, front, middle back of tongue, gently suction to the roof of the mouth behind the front teeth and within the dental arch.

Nicole Goldfarb (8m 5s):

Okay, so our tongue should kind of fit up on the roof of the mouth with our lips closed and our teeth should be slightly apart. We should be nose breathing all the time except if we're congested or you're really breathing quickly because you're exercising and you're out of breath. But otherwise that's the normal healthy way for our mouth to rest and breathe. And our oral structures like our tongue and our lips are actually natural orthodontic appliances. So the pressure from the tongue on the roof of the mouth will help grow the roof of the mouth wide and forward the way it should grow and the lips close will help the teeth grow in a correct patterning to their genetic potential.

Nicole Goldfarb (8m 51s):

But when we have people, and this is a a very common thing, it's kind of like the human condition where people have allergies, enlarged tonsils, adenoids, all different issues, tongue tie, lip tie, that can cause the person to rest with their mouth open. So lips open, mouth breathing we might call it or the tongue low or forward in the mouth putting pressure on the teeth or between the teeth. This will impact the way the face grows and the jawbones grow. And if we wanna take it a step further, the way we breathe and how much space we have to breathe in our upper airway is determined by the shape of our jaws and how far forward they've grown, how wide they've grown and whether or not we're nose breathing.

Nicole Goldfarb (9m 37s):

And if there is oral facial dysfunction and our articulators aren't resting in the correct position throughout birth and growth and development, we're probably gonna get dental mal occlusion. So narrow palate, crowded teeth, crooked teeth, jaws that might be back or like an underbite or issues like that. And that can all impact our breathing, which impacts can further impact to the quality of our sleep. And that's a long discussion. I can get more into that if you're interested. But all of that is kind of like a cascade of events that can impact overall health and wellbeing. So I got interested in this because I was a speech pathologist for about seven years working in a school district.

Nicole Goldfarb (10m 17s):

And this is not in any speech therapy graduate training program, oral facial myofunctional therapy is not in any program. So although most people with speech articulation issues have an underlying oral facial myofunctional issue that was missed, that's like the underlying cause. And so when we see kids with a lisp or they say there are like a W like rabbit it instead of rabbit or a frontal lisp would be like the word bust, they might say bust with their tongue sticking forward or even on the sides kind of sound slushy like. But those, almost all of those cases, it's actually an oral facial myofunctional disorder.

Nicole Goldfarb (10m 57s):

And the symptom is you're hearing a lisp. Okay? So if you don't treat the underlying cause, those kids can be in speech therapy for years and years and years and it may never fully resolve or may take many, many years to resolve. So that's how I got interested was I worked in the schools pulling kids from class 30 minutes once or twice a week for years. I mean they're missing class to kind of do drill and kill work on their speech sounds like, say the word Sam sells socks three times in a row. You know, we're just drilling this and I see these kids, most of 'em are doing really well but it's not carrying over. It's they're getting better. And then when they were, they're ready to leave the speech session to tell me about their upcoming vacation, they all of a sudden have the lisp again.

Nicole Goldfarb (11m 43s):

And I also notice well wait, a lot of these kids are mouth breathers, their tongue is low in four, their tongue kind of looks large. And so that's when I went and got training in oral facial myofunctional therapy and my entire career and life changed. I did not look at anybody, patients, students, friends, family members the same because once you see this you can't unsee it. And that's kind of how where I shifted to be specialized in oral facial myofunctional therapy and even more focused on airway disorders, snoring and sleep apnea, things like that.

Katie Ferraro (12m 19s):

Hey we're gonna take

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Katie Ferraro (13m 54s):

I remember when my kids were little, I'd always be like, look at their mouth, what is this? Is this normal? Is this okay? And you like, you know, you kinda have to see it to believe and obviously you've seen more than almost anyone. Now tell me about what sort of underlying feeding related issues could cause oral facial dysfunction. Just some ideas that would, you know, you mentioned the tongue tie rather that got missed, that of course could infect. I mean in the child's case that you were telling us the story of that that person was on a feeding tube because of an inability to meet their nutrition needs from an oral diet alone. What are some other things besides a tongue tie that might lead to this oral facial dysfunction that you see in your clinic, in your practice,

Nicole Goldfarb (14m 31s):

In tongue tie and lip tie. So usually when there's a lip tie, like upper lip tie, nearly every case there's also a tongue tie And if that's not diagnosed and someone says Oh your child just has a lip tie, they probably missed the tongue tie. So we really need specialists who are specifically trained in evaluating lip and tongue tie to look at these issues. So we see lip and tongue tie premature babies. So prematurity is 37 weeks or earlier and most premature babies have not had, okay, this is actually really interesting. The last three months in utero are considered, the fetus is considered like an athlete.

Nicole Goldfarb (15m 16s):

So a sleep specialist in our field. The father of sleep apnea, Dr. Christian au, he's no longer alive but he describes these last three months in utero as like an athletic phase for the fetus. And I find this just so interesting because you just think like, oh I'm carrying this baby and it's gonna come out and we're getting started. But that's actually their train. The baby is training in oral motor reflexes in utero. So they're sucking and swallowing but not for nutrition. They're sucking and swallowing amniotic fluid to practice strengthening and working the muscles. They're breathing but not for oxygen 'cause they get the oxygen from the placenta but they're actually working the lungs and practicing breathing.

Nicole Goldfarb (15m 57s):

And if there's a tongue tie in utero, the tongue then is already resting low. So we already see the baby's gonna be born with some dysfunction. So premature babies, that training time in utero is actually cut short. So most babies have hypotonia of prematurity, they have low muscle tone. So that is one of the big populations where we're gonna see the babies being born that are gonna need extra support. They're gonna need stimulation of the oral facial muscles and could be an ot, it could be a speech language pathologist, but they need specific training in oral sensory motor for the early intervention. That infancy age group, which I don't have that and you don't want someone to just any speech therapist, right?

Nicole Goldfarb (16m 42s):

You need to be specifically trained working with that age group. So the low muscle tone, what happens is there's less sucking and swallowing going on, less of the muscular skills being used. And we need to stimulate the reflexes, stimulate the muscles. There are certain pacifier, certain programs that are gonna help trigger those reflexes so those babies can get caught up because when there's less of the sucking patterns that are good with good muscle strength and tone, that's going to impact the way the bones of the face grow. So we might see those types of issues.

Nicole Goldfarb (17m 22s):

Congestion is a big issue. So allergies, environmental allergies or even milk type allergies. Anything that's gonna cause the person to not be able to breathe through the nose is going to impact the how the muscles work. It's gonna trigger that mouth breathing. 'Cause if you have to breathe through your mouth because your nose is plugged, of course they're gonna have to breathe through your mouth. So that's gonna change the pattern of growth and development of the face. And that can contribute to feeding issues. Even simply chewing with the mouth open right there. There's when when kids are chewing with their, their mouth smacking with the mouth open, that's a sign we might wanna look at what's going on. Enlarged adenoids and enlarged tonsils that can contribute to feeding issues.

Nicole Goldfarb (18m 6s):

My son, he had issues when he was born and nursing is the catalyst for good oral facial growth and development. Now I know not every parent can nurse their baby. Not every mother can nurse but those who are able to nurse nursing is like oral facial myofunctional therapy for an infant. It's actually working the muscles. So the the peristaltic like that wavelike motion of the tongue when the baby's nursing is like a workout, it's like a muscular workout. Now if there's a tongue die they're gonna compensate and nurse differently and that's a different story. But babies who can't nurse or who are having a difficult time nursing who are making clicking sounds, having latch issues, milk coming outta the nose, reflux, spitting up, projectile vomiting, those are all signs of oral facial myofunctional issues that need to be investigated further.

Nicole Goldfarb (19m 1s):

Even mothers who have low milk supply, the breastfeeding is a dynamic, right? And it's it the mother's milk supply is dependent on the infant's ability to nurse effectively. And so it's not the mother's fault in most cases, but the infant might not be nursing with good oral motor skills that could impact how much milk is being drained from the breast. The whole variety of issues.

Katie Ferraro (19m 25s):

You mentioned those in utero studies that look at babies swallowing, amniotic fluid. I love, there's like these great flavor development studies and sometimes I'm like don don't know how rigorous the design is but like they basically look at what the mom eats when she's pregnant and then they analyze like how many times the baby swallows and try to like develop a scale for like, you know, how much does the baby like carrots or whatever the case may be.

Nicole Goldfarb (19m 44s):

But I thought that's really interesting. That's actually kind of.

Katie Ferraro (19m 46s):

I know it's kind of, it's cool and it's just like this idea of like yes you can study babies swallowing amniotic fluid in utero. But I've also seen these other studies by anthropologists that kind of are trying to tie links between like what the current structure of the mouth looks like and all the need for orthodontics that we have now. And they'll oftentimes tie it back to like, well we're talking about populations eating at this point like very highly processed and refined diets with minimal amounts of fiber. Which from a texture standpoint oftentimes means like things that are like highly pureed or that have been very processed to the point where like all the fiber's been obliterated. Are you, are you seeing that as well in your practice like a lower fiber diet or perhaps you know, over reliance on very soft textures, quote unquote makes the jaw weak.

Katie Ferraro (20m 28s):

I mean we're talking about exercise like we're not essentially exercising the mouth in the way that generations in millennia had in the past and the oral structure was stronger and more teeth could fit. Like I see those studies sometimes and I'm like this feels like it's like right up Nicole's alley are, is there any validity to those?

Nicole Goldfarb (20m 44s):

Oh completely. That is probably one of the largest causes of the changing human face and they call it epigenetics. It's not genetic changes 'cause genes take hundreds of thousands of millions. don don't know so many years to cause changes seen in a population. But epigenetic changes can be seen within one or two generations. And the changing, and you're probably, you could probably describe that really well too. From all the anthropological studies you've read, the changing human face has a lot to do with the way we're eating or not eating well and it's not just the nutrition but the mechanics of eating. So if you think of, it's called wolf's law of bone formation.

Nicole Goldfarb (21m 28s):

So muscle pressure. So muscle use triggers bone formation so that like mechanical strain on the bones causes a bones to strengthen and grow mastication. So chewing builds and forms bone and 3, 4, 500 years ago there was no malocclusion, there was no issues that needed orthodontics. The mouth, the jawbones fit all 32 adult teeth. But as the foods changed and foods became processed pre industrialized revolution, foods became processed, sugars were added, foods became cooked and soft, then human beings stopped using their jaw muscles as much.

Nicole Goldfarb (22m 9s):

And what happens is the jaw bones didn't grow enough and our teeth, we still have the same number of teeth but not enough space for the teeth. So then we start seeing crowding of the teeth, other issues of teeth being crooked, not fitting together well. And then environmental factors like toxins in the environment, allergies. So then people have to start breathing through their mouth 'cause they're congested. And then the face of human beings has changed from our cavemen days. When you think of like wide broad forward jaws to now we're like getting like these skinny long faces that are like retruded pushed back jaws. But what we really wanna do is make sure our kids are chewing.

Nicole Goldfarb (22m 53s):

So we don't want sucking of foods sucking, Pouches sucking is not the normal best way for us to be eating. So we don't wanna puree all the foods, we want textured foods, we want strain on the bones, we wanna use our muscles. I mean imagine if like you didn't walk and you just sat, I don't know if you can compare it to maybe let's say you didn't walk on the ground or run but you just like we're in a swimming pool your entire life. I bet that would impact, I bet you'd have these little skinny legs with no muscles, your bones wouldn't grow. Yeah,

Katie Ferraro (23m 26s):

It reminds me of like rickets and osteo milia. It's like due to vitamin D deficiency as a result of the industrial revolution, everyone spending time indoors with a low nutrient, highly refined diet. But it was the absence of sunlight, right? Vitamin D, strengthening those bones and then causing this physical malformation. There's a lot of similarities that I'm seeing or thinking from that

Nicole Goldfarb (23m 48s):

And picture like if you ever saw someone who maybe broke like their leg or their arm or something and they're casted for a while and they take the cast off and the muscles like totally atrophied the, the leg just looks skinny and different. You've got to be working the muscles to have those bones grow. Same thing for the face, right? Even this is kind of fascinating. So not just like chewing on harder textured foods on both sides of the mouth working those facial muscles, but even just breathing through your nose triggers growth of the midface. So it's kind of like use it or lose it.

Katie Ferraro (24m 18s):

Well I wanted to ask you, 'cause I know you said you're not a fading therapist, but as a speech language pathologist, you know you are uniquely qualified especially with this specialty that you have and if you see a baby like you are at the park, okay let's say you at our neighborhood park, we used to hang out there all the time and you're watching other kids and you see like are there certain behaviors where like ooh, that kid's smacking his food or his mouth is always open. Like what are the signs of these dysfunctions that parents can be looking for or should they not be looking for? Like are we making neurotic parents by being like if your baby's mouth is open they're gonna be a mouth breather and they have malfunctional disorder or there's certain things that you're like, oh wow, especially with your experience having been in the schools that you're like no that is indicative of a larger problem that to a parent might just be like, oh I thought he was just like a mouth breather.

Nicole Goldfarb (25m 0s):

Yeah, so the thing is I think it is good to identify these things early because that's when we can initiate the most change and have the least amount of therapy in the future. So things to look for would be mouth breathing, open mouth breathing. We don't, we should not be sitting, our babies should not be sitting with their mouth wide open, tongue low and forward sitting between the teeth, teeth. Both my kids did that. I have pictures after they were born. I look back on pictures, I'm like oh my gosh, mouth was wide open from birth and there's reasons why these things may occur and that's where the specialists can investigate. But we don't want our kids to be congested all the time. So yeah, if they're sick that's normal.

Nicole Goldfarb (25m 41s):

But if your kid's congested, stuffy nose, runny nose all the time breathing through their mouth, snoring is a really big factor that there's something wrong. And not to freak people out because you know a lot of people think, oh snoring iss normal, you know it might be common but snoring is a sign that there's a lot of airflow resistance when breathing and the airway is not large enough so everything's kind of vibrating. So our children should not be snoring, limited diet pocketing, food in the cheek, in the cheeks. A lot of the people, a lot of the children or adults who have tongue tied tend to pocket their food and store it in their cheeks, choking, gagging in during infancy.

Nicole Goldfarb (26m 24s):

I did talk about a few of the breastfeeding signs or even bottle feeding where they can't maintain that seal on the nipple either breastfeeding or a bottle feeding where you hear like a clicking sound.

Katie Ferraro (26m 34s):

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Katie Ferraro (27m 15s):

If you don't mind sharing more about your son, like if you're at a point where at two years old and you're down to one food, which is yogurt, I mean that is feeding therapy red flag, we need to get this child some help. But you went a different route, you did the oral myofunctional therapy. Without sharing too much about his medical history, did it resolve his eating issues? Was he able to broaden the number and the types of foods that he ate and what helped him along that trajectory?

Nicole Goldfarb (27m 41s):

Yeah, that's a great question. I don't mind sharing all the details about his case 'cause this is where I feel like I've learned so much is through personal experience, right? Both my kids and then you know, my whole family looking at all these sort of oral facial myofunctional issues.

Katie Ferraro (27m 53s):

You gotta be careful when you hang out in the cold because she's like always like this is wrong with your mouth. That's wrong with your mouth.

Nicole Goldfarb (27m 58s):

No one wants to be friends with me. No, no. But it's so funny like yeah sometimes people talk and I was like, oh my gosh I wasn't even listening 'cause I was looking at their tongue tie. No I'm just kidding. It's so hard to like I was looking at their teeth or their palate or their mouth. So no really though at the time it was part of my learning process because I was just getting into this at that time I was a speech therapist for many years but just getting into the myofunctional therapy realm. So I didn't realize all these things were not normal when the pediatrician recommended the webinar pacifier, which is that like it has

Katie Ferraro (28m 31s):

Like a two pound of something hanging out of it. That one, yeah.

Nicole Goldfarb (28m 35s):

Oh my gosh. Research just came out now about how damaging that can be to the teeth and the growing mouth because of the added weight. Not only are pacifiers in many cases not good beyond a certain age depending on the case, but in most cases we don't want to use pacifiers. But then when you hang the stuff lushy off of it below, that makes perfect sense why that would be even worse. But anyway, so I did all those things guilty, right? Like I did all that. I didn't know all these things were not normal or problems with my first child, but when he was two, I mean there were the breastfeeding issues from the start and I still nursed him till 18 months even though I had to clear his nose out with the nose Frida, you know that thing?

Nicole Goldfarb (29m 16s):

Yeah like snot outta their nose in order to nurse him because he was so congested milk and reflux was like going into his nose when I nursed him. So there was dysfunction there to begin with and he would choke a lot, you know, spit up. A lot of these kids have colic, quote unquote, which in many cases is actually aphasia induced reflux. They're swallowing air due to dysfunction of the tongue a lot of times from a tongue tongue. So when that tongue is restricted and the back of the tongue can't elevate all the way to the soft palate, air goes down, what happens is the belly becomes distended. Maybe not in all cases I, I look back on pictures of my son and his stomach was just sticking out and he was miserable crying all the time.

Nicole Goldfarb (30m 2s):

I mean you might've heard him across the street down the block screaming and crying. It was horrible. I'm like he would cry and they called it the witching hour. So I'm like, oh it's the witching hour. Like thinking that's normal to cry for four hours every night, right? So and then he would just project all vomit later I learned he was actually swallowing air milk would come out of his nose when he nursed, he'd make clicking sounds and I was told to actually he fall asleep when nursing, which is also another red flag because they're working so hard to nurse that they're exhausted. So I was told to put ice cold towels on his back like washcloths to keep 'em awake. You feel really bad putting an ice cold washcloth on your baby's back when they're falling asleep nursing.

Nicole Goldfarb (30m 45s):

And yeah, there was a whole array of things that I just persisted and kept moving on 'cause I didn't know that there was something causing that. I just thought, hmm, people have this, this is common. And so when he was two and there was snoring, mouth breathing, snoring got louder, he was a DHD all over the place, couldn't sit still. What's important to know is when children are sleep deprived, so either they're not sleeping enough or their sleep quality is not good, so their snoring or mouth breathing and their brain is waking up, maybe their body doesn't wake up but their brain on a, like if you did an EEG, their brain would wake up.

Nicole Goldfarb (31m 23s):

So maybe they toss and turn throughout the night. Children become hyperactive in response to sleep deprivation. Us adults, we take naps, usually fall asleep, can't stay awake. Kids tend to have the opposite effect. So 92 to like 97% of kids, I believe the number is, will become hyperactive in response to sleep deprivation or poor quality sleep. So I'm the mom with my first kid taking him to every class, music class, baby massage, all this stuff. 'Cause I'm you know, all gung-ho I'm gonna be the best mom. And I'm like why is my kid all over the place? Like we're in the music class and everybody's sitting there in the circle and my kid's running in circles around the room. So there were all these red flags and signs that I didn't know of until when he was two and the snoring got really loud and I took him to my mentor who's a myofunctional therapist and then to ear, nose and throat doctors who were totally on board that his tonsils and adenoids were large.

Nicole Goldfarb (32m 18s):

They need to be removed, tongue tti need to be released. But it wasn't everything. So it's a big journey and a big process. And he was two years, 11 months, so almost three years at that point. And what you need to do is these issues are multifactorial so we need to treat anything contributing, which were also allergies. We need to rehabilitate the muscles. At that point the jaws didn't grow so well. He had a narrow roof of the mouth so we had to do early orthodontic treatment. So it's kind of a big journey and process and we never went to a feeding specialist or a feeding therapist and maybe we should have and we probably still should because he is still a very picky eater.

Nicole Goldfarb (33m 1s):

There's still, we're not fully resolved with these issues.

Katie Ferraro (33m 2s):

And I know every time you and I talk we're always like okay we're from different areas of expertise but there is so much overlap and so much of what you do is supportive of the Baby-Led Weaning approach. And so much of what we do in Baby-Led Weaning would align with what you would recommend. Could you talk a little bit more like you kind of touched on it, like you in target with the pureed apricots and like you just think the only foods that babies can eat are purees. But we know from the Baby-Led Weaning approach that babies can eat a variety of different textures and in fact even the American Academy of Pediatrics recommends finger foods starting to be age appropriate at six months of age, which finger foods imply a variety of non puree textures. Could you talk a little bit about some of the benefits? 'Cause we have parents listening who are like, I'm just scared to death to give my baby anything except purees and I, we always point to the research that shows, look, babies who've had the least amount of experience with finger foods are actually at elevated risk of choking.

Katie Ferraro (33m 52s):

And we know that because of, you know, practice makes progress and they're learning how to use the muscles of the mouth. But could you maybe further encourage parents who are scared about anything except purees to as to the benefits of them from an oral facial standpoint?

Nicole Goldfarb (34m 6s):

Yeah, oral mechanical, I just thought of that right now we can even call it that because exactly it is like doing a workout of the facial muscles, the tongue, the lips, the cheeks, the master, the chewing muscles when we're actually using those muscles correctly. It is not normal to suck our food down at six months of age even that's when we move to open cup drinking and we want all drinking to be free flow at that point. We don't want babies to have to suck on sippy cups to get the liquid out. And I know you've talked about this before, we talked about it once too, like the the 360 cup or the well cup.

Nicole Goldfarb (34m 46s):

Just because a cup doesn't have a spout does not mean it's necessarily appropriate when a child has to suck or even an adult to suck to get the liquid out. That negative pressure that suction in the mouth will actually cause the cheeks to pull inwards on the teeth at the sides and can narrow the arch can narrow the roof of the mouth. So we want drinking to be free flow, which will encourage normal swallowing patterns. We want to be chewing on both sides using the muscles of the mouth. Food will start being chewed at the back teeth, not just munching with the front teeth but going to the back molars. All of this is sensory oral motor, mechanical, muscular development for the mouth.

Nicole Goldfarb (35m 28s):

And that is normal. Somehow we all got thrown off track I think when lives got really busy and we said, oh we could just put foods in little containers and our babies can eat in the car or wherever bring this to the park and they can just suck on this package and it's not gonna spill or it's maybe gonna be easier. So a lot of the things that make our lives easier are actually making things worse in the long run. Yeah

Katie Ferraro (35m 49s):

And if you've never had a baby, it's like well there's this whole aisle of Pouches at target. I guess this is what babies drink after breast milk or formula. And that's not necessarily true. I mean purees are an important texture for your baby to master. As I always say. They're just not the only texture that babies can handle. And I think beyond pure parents, like well shoot, how do I make those foods? It's like, hey you can't just buy those foods we need to make them, but I, I can show you how to do that so it's safe but we, we really do wanna be challenging our babies even from their first bites because you know we, I teach a purees for a few days approach. It's for parents who are particularly anxious about just making the leap from you know, a liquid only diet which is infant milk. Breast milk or formula. And like I don't think my baby can handle, you know, soft strips of avocado on day one and you're doing lamb on day four is like fine, let's do purees for three days, do three different varying degrees of thin puree with you know, breast milk or formula, a chunkier puree and then the soft solid drips of food and parents see that for three days and they're like, oh yeah my baby can swallow something besides purees.

Katie Ferraro (36m 43s):

And it's like yeah but you didn't, what if you waited three or four months to do that? What I'm hearing you say Nicole is that like these muscles are still actively forming and if we're not exercising them they're gonna get lazy or or get deformed, which I think is what you end up seeing a lot of the aftermath of that. Is that correct?

Nicole Goldfarb (36m 60s):

Yeah and just think it's the bones, the skeletal component, the bones that are getting impacted because the muscles aren't being used and the face grows significantly. So it in those first few years of life. So 60% of facial growth is reached by the age of four, 90% by the age of 11. So the face has done a lot of, its growing in those very early years. So we want to get those bones growing correctly by moving the tongue around, moving different textures in the mouth, putting some strain on the muscles and the bones. So I think it's great your program and how you can guide parents because I honestly wouldn't know what to do and that I you we think it's normal to just buy those sucking Pouches and it's scary to think, oh my baby might eat real foods, how do I do that?

Nicole Goldfarb (37m 54s):

So I feel like if I had you guiding me, I would maybe be in a different place now because I'm still having one child that's a very picky eater and he is 11 years old.

Katie Ferraro (38m 4s):

So Nicole, I'm interested to know your feedback or your thoughts about these concept of oral development tools. Like I know in the feeding space there's a lot of focus on pre feeding and exercises that parents can do for babies who are four and five months of age, of course they're not safe to start or eat anything except infant milk until six months of age. But they're now all these oral development tools out there that I think sometimes are developed by therapists but they cross over into the typically developing infant population. And I'm just curious if you think that these are beneficial for babies?

Nicole Goldfarb (38m 32s):

Yeah, definitely. So there's a group called Talk Tools and they're specifically geared for like speech pathologists and OTs. There's all different oral motor tools that are like teethers and chewies. There's like the Beckman try chew and chewy tubes and different things that your baby can chew on in different ages. And if you go on their website it'll tell you like what's age appropriate that could replace pacifiers or be used instead of a pacifier. And there's a lot of speech therapists and OTs where that's their specific area of expertise, expertise in guiding in that realm. And yeah, we want our babies work in the muscles and using appropriate chewy toys and chew, chew chewers are very good.

Nicole Goldfarb (39m 16s):

We even have our patients use a lot, they're like chewy tubes that are on that website and we have them chew to help strengthen the jaw muscles and there's even something called the myo munchie M-Y-O-M-U-N-C-H-E-E that they just about the bbe version BEB the baby version. But it's based out of Australia, I think it's age six months and beyond. And it's something that can promote lips, closed nose breathing and chewing and you put in the baby's mouth and you replace that with the pacifier, which the pacifier goes on top of the tongue narrows the palate pushes the tongue low and forward. This has nothing on the palate but it triggers lips, closed triggers, jaw motion and chewing.

Nicole Goldfarb (39m 58s):

So if you look up the Myo Munchy website and there's probably a bunch of videos of little babies using these, we recommend those all throughout childhood through adult, the adult years, there's different sizes to help as a tool to help with our goal of lips closed, tongue up and appropriate nasal breathing and jaw strength.

Katie Ferraro (40m 18s):

Hey,

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Katie Ferraro (41m 30s):

Nicole for parents who are listening like, okay, I've never heard of this oral myofunctional therapy and I know I don even like on your email signature, you're like, I'm one of three of these certified people in all of San Diego. Like if parents are like, I need to get this help for my baby or I wanna look into it because yes they, they are snoring or breathing with their mouth open or there is that weird clicking noise. How would parents get in touch with you or with the other people that you have trained or people who specialize in this because it is not as mainstream or widespread as I'm sure you would hope. What are your suggestions for referrals or for seeking further help?

Nicole Goldfarb (42m 2s):

Sure, yeah and lemme back up too. I'm not one of three in San Diego. I do have, I'm a speech pathologist and a certified or facial onologist. There's a small few that have both of those credentials or training, but there's

Katie Ferraro (42m 14s):

Not a lot, right?

Nicole Goldfarb (42m 16s):

But there's not a lot but it's growing. And there are some are dental hygienists, some are speech therapists, there's some OTs who are trained in bio functional therapy and some physical therapists. But I would say the majority are speech pathologists or speech therapists and dental hygienists. And where can you get more information? Look up orofacial, myofunctional therapy online and you will find tons of information. There's a lot of different resources, there's a lot of different groups that advertise about this. Have videos, you know, on what what this is. And if you're looking for a therapist trained in oral facial myofunctional therapy, there's a few different websites you can go to.

Nicole Goldfarb (42m 59s):

'cause there's different organizations that do trainings. There's directories on the IAOM, which is the International Association of Oral Facial. My, there's also the American Academy of Myofunctional Sciences has a directory. And I work with Airway Circle and I do a podcast with Airway Circle. It's called Airway Answers, expanding your Breadth of Knowledge and Airway Circle has an international directory of therapists who are trained in myofunctional therapy. And what you wanna do is look at what your child's issues, or even for parents, adults, what your issues are to find the right therapist.

Nicole Goldfarb (43m 39s):

Because sometimes you need that person to be a speech therapist, whereas other times it can be a dental hygienist do you know, so you wanna see kind of are there speech sound issues, feeding issues, swallowing issues, that's more of the speech pathologist realm when there's that dysphagia type type work. And then any children under the age, like birth to four, it's not really a myofunctional therapy program. And we can kind of think of myofunctional therapy as like physical therapy of the mouth before the age of four. The children are young, they can't imitate, they don't have the cognitive ability to know like, okay, my goals, my lips closed, my tongue sucked up breathing through my nose. Right? They don't get that they're too young.

Nicole Goldfarb (44m 20s):

They need foundational oral sensory motor skills and feeding therapy. And that's from somebody specifically trained in that. And with all the information I know and everything I can do and I think I do a great job, I don't claim to do that. So I don't work with that under 3-year-old population who has feeding issues or infant population with oral sensory motor issues. So you wanna find someone that's a speech pathologist specifically trained in the birth to three or that infant population and who has training in oral, sensory, motor and feeding. Okay. Because I think a lot of people get confused and like, oh, myofunctional therapy, my 2-year-old is doing myofunctional therapy and it's not really the same thing, it's not appropriate.

Nicole Goldfarb (45m 1s):

So when they're younger than four, you're usually gonna be using tools to help stimulate the muscles. You're going to use tools that might vibrate or different sensory type tools and you're gonna be triggering reflexes in the mouth and triggering muscles to work versus exercises like what we do with older children born up and adults if, does that make sense?

Katie Ferraro (45m 24s):

Yeah, absolutely. And I, I started listening to your podcast, it is fascinating because it's, I mean it makes sense when you say it like food and muscles and bone and sleep and speech. It's like it's all coming outta your mouth. But I think the sleep piece too is the part that especially adults are just starting to pay a lot more attention to sleep science. And I appreciate that there's credentialed experts in the space who are kind of leading the way on like, okay, well this is how these things are interrelated because of course we're not doing things in a vacuum like sleeping or eating or speaking that they're all happening in unison and, and if something goes wrong on one path, we see it affect so many other areas. So thank you for coming on today and talking about this issue, which again, I think we're gonna start hearing more about this and I know a lot of it is due to the work that you and your colleagues are doing.

Katie Ferraro (46m 8s):

So thank you Nicole.

Nicole Goldfarb (46m 9s):

And can I recommend a book for the families too? Absolutely. This is a relatively new book, just came out 2023 and it's called Breathe Sleep Thrive by Dr. Shereen Lim, who's a fabulous airway focused dentist in Australia. Every parent should read this book, breathe Sleep Thrive for their, for their child, and for that information for the child, the pediatric population, even therapists, professionals should be reading this. And then if you're interested in this information as an adult, there's a great book called Breath by James Nestor and it's very interesting entertaining book. Download it on Audible because then you can, he narrates it and it's, it's really great. So I think those are two great resources and thank you for spreading the awareness with the Baby-Led Weaning because that is the beginning, like how I said, nursing as a catalyst for good or facial growth and development.

Nicole Goldfarb (46m 57s):

I believe a Baby-Led Weaning approach where you're chewing, using muscles, using textures, moving the mouth is also a catalyst for good growth and development of the mouth and face. So thank you for all you do.

Katie Ferraro (47m 8s):

Thanks Nicole. Well I hope you enjoyed that interview with with Nicole Goldfarb. Again, she's a speech language pathologist. She is an Oro myofunctional therapist. That's definitely quite a mouthful, but if anyone is equipped to deal with, you know, mouth related stuff, it is Nicole. I'll put a link to all of her resources on the show notes page for this episode, which you can find at blwpodcast.com/446. And we are online at blwpodcast.com if you wanna check out some more resources. I also love that she provided this with some books and some different organizations. I know this topic will be of interest to a lot of people listening, so I'm so grateful that Nicole could come on. I also wanted to say a special thank you to our partners at AirWave Media. If you guys like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave.

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