Kayla Culbertson (00:00)

everybody learns

how to compensate and you don't grow out of things, you grow into things and you learn how to figure it out essentially

Courtney (00:17)

We've all heard the term tongue tie, and usually we think of it as a breastfeeding problem that babies eventually grow out of. But what if that tiny piece of tissue under the tongue was actually a signal for a much larger whole body event? What if it was the hidden reason behind your baby's chronic GI distress, fragmented sleep, or even their delayed

motor milestones? I'll be honest, I didn't even know I had a tongue tie until I was in my 30s. Looking back, I realized that for decades, my body had been building complex workarounds just to survive my own biology. This is the heart of our philosophy. Behavior and symptoms are just the tip of the iceberg.

Today I am joined by Dr. Culbertson, an occupational therapist and a specialist in tethered oral ties.

Dr. Kayla has been practicing in the pediatric world since 2017, but it was her own experience with her sons that led her to deep dive into the fascinating science of the frontal line, the fascia that connects our mouths all the way to our toes.

Today we are talking about why you don't grow out of ties, you grow into compensations. The sneaky symptoms every parent should look for and why the path to a regulated baby often starts with an evaluation of the mouth. Dr. Kayla, I'm so glad you're here. Let's dive in.

Dr. Courtney (01:36)

Good morning, Kayla. How's it going?

Kayla Culbertson (01:38)

I'm doing well, how are you?

Dr. Courtney (01:40)

doing pretty well. I'm really looking forward to our discussion today. Yeah, I know. I was actually thinking, I was walking into work today thinking about tongue ties and all of that kind of stuff that we're going to talk about in general. Because I never knew it existed until I got my tongue tie released in my 30s. And then thinking back, I sucked my thumb until I was in fifth grade and all of these.

Kayla Culbertson (01:45)

Same here.

Dr. Courtney (02:08)

know, issues that I had, but I never even knew what it was. So I'm looking forward to, for all of our listeners, shedding some light on this topic that they may also not know what it is. Well, can we start, because I know you fell into this and kind of becoming an expert in this area based on your own personal experience with your kids. So I'd love,

Kayla Culbertson (02:20)

Awesome. Okay.

Dr. Courtney (02:31)

yeah, to hear a little bit more about that and how you came to really

dive into knowing about all things oral ties and occupational therapy.

Kayla Culbertson (02:41)

Yeah, for sure. Yeah, so I have a four and a half year old and I have a 16 month old and both of my boys have had their ties released. But it was my first son who it was really, really an eye opening experience for me. I've been an occupational therapist since 2017 practicing in

pediatric world. At first I was at Children's Hospital of Michigan, so I was seeing birth to 18 and then I specialized in zero to three. So when I had him, was like, I know quite a bit about infant development and everything like And overall, he did really well feeding, primarily exclusively breastfed and he did well.

but he compensated and I didn't have a lot of experience in working with breastfeeding with babies. was primarily bottles and solids. So I was like, okay, all's good overall. But he did present with torticollis and torticollis is a diagnosis that commonly goes hand in hand with babies who have tethered oral ties.

and he presented where he kind of had a little bit of a head preference rotation and he had a little bit of a hiked up shoulder. And if you lay him down on the ground, he overall was pretty symmetrical with his trunk and his hips, but he was one of those babies who it was kind of like his ears were to his shoulders and you didn't see much of his And I addressed that, but little did I know that I needed to

address what was also going on inside of his mouth. So I said, okay, I'm going to address your outward appearance, what I'm seeing with your torticollis. We worked on his hips, we worked on his trunk, we worked on his neck, we worked on his shoulders. All in all, he did really well and the presentation of torticollis went away. as I learned, flow letdown rate changes as you

as your baby gets older and instead of them just drinking they now have to efficiently suck and he started to have some challenges with breastfeeding who I was working for at the time was very knowledgeable in this area she's an occupational therapist and I kind of expressed my concerns to her and at this time he was about three months and we did some work with him

And I took him to an occupational therapist who specialized in ties and incorporating a full body approach to it. And we learned, yes, he has ties. had buckles, cheek, which are cheek ties, and he had a lip tie and a tongue tie. So we did a few weeks of therapy, honestly, maybe a full month of therapy. And then he had his release done. And that night it was absolutely life-changing. And I was just like,

This is amazing. This is so amazing because one of his biggest issues was GI distress, which goes hand in hand with babies who have ties. He would go days without pooping and pediatricians will say, that's normal for a breastfed baby to go days and days without pooping. It's no big deal. No, like he would like, I think his max was about eight days. He went without pooping and that is not normal. It's

If you miss a day here and there, okay. But yeah, his GI system was definitely in distress and he was super gassy and all of that impacted sleep, which is another thing that we see with these little babies who have ties is they aren't sleeping super well all the time. So we got the tie released. That night he slept throughout the night.

He wasn't making grunting sounds like he was trying to fart or anything like that. He truly seemed comfortable sleeping in his own body. And as a mom, postpartum, you know, seeing your baby feel good, it was absolutely amazing. And it was such an eye-opener to me throughout the entire process of his release experience, because it's not just...

you go in and you get the release done and that's it. It's a really a pre-therapy, it's get the release and it's a post-therapy too, which we did. But throughout that entire process, I really, really learned so much as an occupational therapist where I was like, I need to deep dive into this because I want to be that therapist where I can help families navigate this piece of their puzzle because I just learned not a lot of therapists are crossed the board.

are very well educated in this. So yeah, so he's my reason why I took a big deep dive into specializing in TIS and going through a mentorship program, lots of reading courses and yeah, I love it.

Dr. Courtney (07:26)

Yeah, that's so great. Yeah, thanks for sharing all of that. It is interesting. You know, we don't know what we don't know until we know it. And then it just completely changes your life and your baby's life and other people's lives. It's really incredible. Can we back up a little bit? What is a tie? What is an oral tie? What is a tongue tie, cheek ties? I know you mentioned buckles as well. Can we kind of define what those things are so that it kind of

Kayla Culbertson (07:50)

Yeah.

Dr. Courtney (07:56)

can give a little bit of an understanding for parents who are listening, who maybe haven't heard these terms before.

Kayla Culbertson (08:00)

Yeah,

so ties are your frenulum. And your frenulum is a part of the frontal line, which the frontal line is a fascial piece that starts within your mouth and it goes all the way down to your toes. So when babies, when anybody has ties, I say babies because I work with babies, but when anybody has ties, if they have a lip tie, they will have a tie.

right underneath there and there's different which are important and relevant. However, the biggest thing is function. We can have a mild tongue tie or a posterior tongue tie or an anterior tongue tie, but the biggest thing is how is that tie impacting your baby's function? So sometimes providers will look

and they'll look at the anatomical feature, which is the frenulum, which is underneath your tongue, which is underneath your upper lip, which can be also the lower lip as well. And then buckles are the cheek ties, which would be inside above the molar area where you could have cheek ties as well.

Dr. Courtney (09:15)

All right, so you're saying, you know, if we were to lift up our lip or lift up our tongue, if the little fascia, is that what you called it? That's there. If it's maybe the frenulum, okay. If it's in the wrong place or too far forward or too tight, that is what we would consider a tie.

Kayla Culbertson (09:15)

That's OK.

the frenulum.

Yeah, and the thing is too is there's also like a posterior tongue tie. So for example, a posterior tongue tie, the frenulum, when you lift the tongue up, that frenulum line, that like stretchy piece that would come up, that super skinny typically, however it can be thick, that may not even be present. And that's...

That's the kind of the confusing part for some providers because they'll say, ⁓ I looked and I don't see a tie. It's not just about what you can see. And I think that's the most important thing is it's really about function. So oftentimes you can see it, but sometimes you can't necessarily see a tie that's present.

Dr. Courtney (10:22)

That makes a lot of sense, because I'll ask parents, and I think we'll get to this next in terms of like sneaky symptoms, you know, to know how a tie might be present. But I'll ask parents, you know, oh, does your child have a tongue tie? You know, they're, it's just mostly if they're having difficulty with sleep, which we'll talk about. And often they'll say, oh no, like they can stick their tongue out or their doctor, you know, looked for it and said everything was fine. But to your point, it's really about

function and how everything is functioning, not just whether or not something is visible to the eye that we see. So what are some of the sneaky symptoms? I know you work with babies. So what are some of the sneaky symptoms that we might see with babies that would kind of cue us into at least getting an evaluation for a tie to see if that is part of what is going on?

Kayla Culbertson (10:51)

and

Thank

Mm-hmm.

feeding, whether it's breastfeeding or bottle feeding for these itty bitty babies. If they're having any type of challenges with feeding, hopefully mom has decided to see an IBCLC or a therapist such as an OT, a PT or a speech therapist who specializes in feeding.

But oftentimes if a baby is having feeding difficulties, we're going to assess their oral motor skills. And in doing that, we should also assess to see if they have ties. We would also see challenges in baby's ability to suck on a pacifier. I'll sometimes have parents tell me, just don't take a pacifier. They can't suck on it. We put it in their mouth and they just spit it out.

That could be a sign of ties potentially, or it could just be motor education. It could be due to weakness. The thing is with ties, it's tricky because there's no hard yes and there's no hard no. It could be due to other reasons potentially, but we have to rule out these other reasons as well. So yeah, feeding difficulties, difficulties with taking a pacifier.

When you lay baby down, what do they look like? Do they have that C-shaped curve where they're maybe one hip is hiked up and closer to that shoulder? Do they have a head preference rotation? Do they have one shoulder that's a little bit higher or maybe both shoulders are really high and you don't see much of their neck? I often see in those cases,

When we do work on neck extension and opening up that frontal line, a lot of times those babies have red creases. And sometimes parents will say, I just thought that was like their fat rolls or something like that. And no, those red creases, whether they're at the front or whether they might be at the side of their neck or right in here, those are signs of tension within the body that could be related to tethered oral ties.

really fisted hands, really fisted toes. Like I said, the frontal line goes from your mouth all the way down to your toes. And then maybe sometimes babies are already showing a preference for, geez, they only like to do side lying on one side, or, geez, they're already starting to roll. And a four week old baby should not be rolling just yet. If they're rolling, that's...

signs of tension within their body. It's not a sign of strength or early motor skills or anything like that. We shouldn't be rolling just yet. And if they're already rolling into one side, they might have some tension in that body that could relate to tether or world ties. We could also see just difficulty being in different positions.

If a baby maybe doesn't like tummy time at all or doesn't like sidelining at all, we could also see some of those GI signs where, hey, we see reflux. They're just a really colicky baby or they're really gassy or they're straining so hard to have a bowel movement. Those are definitely signs along with just some of the basic like the resting open mouth posture.

versus being a nasal breather. Possibly even getting like nitty gritty with it, but like having the recessed jaw. Whereas if you look from a side profile, where is the lower jaw in that baby's development? And where is their tongue when they're crying? Is their tongue doing a really nice job elevating to the palate of their mouth? Or when they cry, is their tongue...

down low versus being able to come up and elevate. And ideally, that's what we want. We want the tongue to be able to come up even when they're sleeping, even when they're nasal breathing, we want the tongue to make contact with the palate of the mouth as far as like facial development and having forming like the nasal cavity and everything like that. So yeah, all of those little things can show.

hey, I'm having some challenges with feeding for babies. And then if you even wanna take it to the next step of not just bottle and breasts, but hey, my baby is having a really hard time with solids. They're always gagging. Like yeah, there's gonna be some significant gagging maybe within the first week or two when we're exposing to different solids and textures and that kind of thing. But what is their...

What does it look like when they're feeding? Are they always gagging? Are they always spitting it out? Are they always having a hard time swallowing? And I know you mentioned two people will say, my baby can stick their tongue out. Oftentimes it's out, but it's low. Can they get it out? And can they get it up and to the side and that kind of movement as well? So honestly, lots of things to look for and sometimes just difficulty with sleep.

Like, hey, my baby doesn't sleep well. They're moving around a lot when they sleep. They fall asleep for 30 minutes and then they wake up. Is it because their body is always in the state of fight or flight? Can we put it into rest and digest? And getting super deep with it, the tongue resting at the palate of the mouth is providing input to the vagus nerve. And as we know, the vagus nerve helps put your body into rest and digest.

So it's really a lot to unpack and I kind of went on a ramble, but.

Dr. Courtney (16:49)

No, it's great. As you were talking, was like, OK, I'm imagining your evaluations when you see families are very in-depth because there are so many things to look for and so many different ways that this can be presenting. ⁓ It's funny. I was also thinking, I know you work with a lot of babies, and I had this done as an adult. But for several years,

Kayla Culbertson (17:04)

Mm-hmm.

Dr. Courtney (17:12)

It was kind of this ongoing joke in our family, my partner's kids, like whenever I would eat, they're like, what is wrong with you? You like choke every time you eat. Like every time you eat, you're choking on something. And we just, it was like a funny joke. like, I don't know. You know, like I'm just always choking on something, but it has not happened since, I got my tongue tie released, but it's interesting to see how, all of these symptoms just impact.

Kayla Culbertson (17:19)

⁓ geez. Yeah.

Dr. Courtney (17:37)

your whole life, right? And like, you know, can go on for a long time, kind of unnoticed because our bodies do compensate and kind of figure out ways, you know, to still be able to function. ⁓ Okay, so let's say, go ahead.

Kayla Culbertson (17:42)

Yep.

Yeah, and that's what that's a really good

point like you said your body compensates and figures out ways to function and I think that that's super important because one thing families always ask me is In regard to ties and in regard to getting a release done Which is a huge discussion? But they always say will this just go away No, it won't go away everybody learns

how to compensate and you don't grow out of things, you grow into things and you learn how to figure it out essentially

and that's like what your body was doing. You're like, okay, well, I'm gonna swallow in this really funky way to swallow this food down because I need to eat to survive.

Dr. Courtney (18:34)

just laughing. I would drink my water. I'd put it in my cheeks. I learned this. So I put it in my cheeks and then like squeeze my cheeks to get it to the back. And it was again, like another funny joke in our family. Like, why do you drink like that? Like you look so silly drinking. I'm like, I don't know. I don't know any other way to drink. I learned different ways to drink now. But yeah, it's just funny to think back on, you know, all of the things. So.

Kayla Culbertson (18:38)

boy.

Yeah.

Dr. Courtney (19:02)

I'm curious. All right, so let's say, you know, a baby's having trouble feeding. They, you know, see a great provider that refers them to get an evaluation by you or someone, you know, who's really well versed in this area. And you're like, yep, you know, there I'm seeing, you know, you have some ties, you have some cheek buckles or whatever that looks like. What are next steps? Cause I know you said, you know, just getting it.

released is a big decision for a family. There's a lot that goes into that. So after an evaluation, what would be the next steps?

Kayla Culbertson (19:36)

So typically next steps for me look like therapy.

I never like to rush into saying we need to get this release done right away. It's usually not urgent. So we're usually doing a few weeks of therapy because we need to say, need to prep the nervous system. We need to make sure that the baby overall is well regulated because we don't want them to go into a procedure where their central nervous system is dysregulated. So we're gonna take a

a few weeks and families always ask me how long and I always say I can't give like an exact timeline because I don't know how each baby is going to respond and it's a unique experience. But we're definitely gonna do therapy and therapy is going to address individual concerns but oftentimes with these little babies it's saying we're looking at your whole body. Oftentimes these babies are tense, not always, but

Oftentimes these babies hold a lot of tension. So we're incorporating a lot of body work to help release tension in the body. And then in doing that, releasing tension, we're also working on motor skills throughout the body because sometimes tension can impact proper development of motor skills. And sometimes it can impact

asymmetries and imbalances within the body. If you're always being pulled to one side and you're not really using your right arm during exploration when you're on the floor, you're not really kicking your left leg, we need to help your body unwind, release that tension, and then get your body moving the way that it's supposed to. Or if you're always looking over to the left, we need to say, hey, we really need to release this tension, get you in midline.

and get you visually tracking in both directions, get you on your tummy, looking up, visually tracking both ways, up, down, all of that. So we're gonna work on typical development for a baby. And then we're also going to work on oral motor skills as well. So we're gonna work on kind of creating space in the mouth through what I use as oral play therapy. Everything is positive.

but we're in baby's mouth with clean hands and with teethers and we're working on creating space, decreasing some of that tension, increasing mobility, doing some neuromotor reeducation, working on sucking, teaching the tongue how to suck as efficiently as it can with a tie. Maybe we're working on positioning with breastfeeding and bottle feeding and we're working on.

flow rate and how we hold the bottle and with the IBCLCs bringing them in and kind of their specialty with helping mom and that aspect of it if they're breastfeeding. If they can't suck on a pacifier, we're working on sucking on a pacifier and a certain pacifier because not all pacifiers are created equal. Same with bottles, not all bottles are created equal. So we're kind of looking at really

full picture. We're discussing GI, we're discussing how they sleep, all of that so that we can say this baby's body is so prepped and so ready and then at that point, where are they at? Are they doing well? Do they have enough range of motion? Do they have enough function in their tongue? Can they cup? Can they have that peristolic wave-like movement in their tongue?

to be able to suck and swallow efficiently, are they moving symmetrically? And then at that point, we say, do we still need a release? Or have we achieved optimal function? If we have not, then we say, okay, let's go and get our consult for a release. And if family is happy and satisfied with the baby's function and where they're at and we've met their goals, then.

then we're good, we're done, we've met our goals. So it's always up to the family and what they want to do. But yeah, so I try to take it as like a, this is what we're gonna work on, we're gonna take a few weeks to do this and maybe we don't even have to get a release.

Dr. Courtney (24:04)

Well, and I think you're pointing to such a good, something that's so important is the like releasing that tension from the body, figuring out how to, you know, function optimally at that point to then decide if a release is going to be helpful or the next step. because as you were even saying that, think there's a lot that goes into that goes into it, right? Like just jumping to maybe having a release.

Kayla Culbertson (24:25)

Yeah.

Dr. Courtney (24:29)

You know, we can kind of equate it to, don't know, like getting a knee surgery and not doing any prep for the surgery and then doing no PT afterward, right? Like we might keep walking in the same way that injured our knee to begin with. So yes, the tongue and the cheeks maybe seem like just a small part of our body, but they really do impact everything, you know, like you were saying, like the way that we move and kids development, it's a big, big piece of it.

Kayla Culbertson (24:38)

Yeah.

Yes.

Truly.

Yeah,

yeah and another piece too is really like where is the family at? Because you can't just get a release and then say okay good we're good we got the release all is good. It's work after as well it's continuing therapy continuing to work on those oral motor skills teaching that I like to say like new tongue how to work properly but also

Can the family manage and juggle the post six week stretches that have to occur? if you can't and you can't do those stretches that the release provider gives you, you're going to have reattachment and then it was kind of all for nothing, you know?

Dr. Courtney (25:38)

Yeah. Absolutely. Yeah. You have to kind of keep up with it. It's like taking care of a wound. know, like you want to make sure that you're continuing to stretch everything and do your post surgery exercises so that you don't have to do it again. One of my nephews, I think had it done twice. And you know, I think for what you're saying, I don't know if they even gave them any stretches to do. I think it was like, we'll remove it, you know, with a dentist or someone and then.

he ended up having to get it done again. So I think the, it's really important what you're saying to do the therapy beforehand and afterward as well.

Kayla Culbertson (26:09)

Yeah.

Yeah, and I've, I found that not all release providers are created equal as well. but honestly, sometimes two releases are necessary where they say, you know, like we do the best we can with what we have right now. And maybe depending on where your child is at around five or six or seven or eight, then we come back and we do another release to.

Dr. Courtney (26:27)

Right.

Kayla Culbertson (26:43)

really have the perfect scenario. So each case is so different. But I also think it depends on your provider too and who you're working with.

Dr. Courtney (26:52)

Yeah, yeah. And shout out to your Instagram page, because I know you have a bunch of videos of doing some of these stretches, because I'm thinking about people listening like, my goodness, mouth stretches and tongue stretch it. Like, what are we doing here? I think you have some really great examples to demystify what all of that looks like for families. Yeah. OK, so let's say you do all of the therapy and stretching and tension release and nervous system regulation and all of the things.

Kayla Culbertson (27:10)

Thank you.

Dr. Courtney (27:22)

and there are still some functional difficulties, feeding, sleep, those kinds of things going on, and families decide to do a release. What does the process look like? I know it can be different, and the post-process, because I know you already mentioned some stretches and things that happen afterward.

releases?

Kayla Culbertson (27:40)

yeah, there

are different kinds. The providers that I work with do a laser, a CO2 laser release, and it's very, very quick. Typically, what it looks like, because I've personally gone through it with my boys, but then also I've observed the dentist release providers do it as well, but they'll do their intake where they're looking at, they have a huge

Dr. Courtney (27:46)

Okay.

Kayla Culbertson (28:04)

form that they have you fill out which asks a bunch of functional questions, which I really love because they're not just saying like, boom, let's look. ⁓ yeah, I can see it and the tongue comes up, but you know what I'm saying? They're really looking at the full picture. So they're gonna look at that, but then they are going to assess oral motor skills. Like for example, they'll feel how a baby is sucking to see what that feels like on their finger.

And then they'll look at the anatomical features and take in all of the history. And then they will do the CO2 laser. then honestly, they bring baby back to the caretakers and typically I've found babies respond really well when they say, if baby is nursing and they say like, let's try to nurse just for some comfort.

The tongue doesn't always super well, I guess you could say, at first. But sometimes babies start nursing and it's okay. And sometimes they're just looking for comfort in that skin-to-skin contact to calm their bodies. But that's kind of what it looks like. And then as far as therapy, I like to try to see the little ones.

like 48 to 72 hours after is ideal. I like to see how parents are doing with the stretches. And then we're going to continue working on whatever we need to work on, honestly, whether it's saying like, okay, let's continue to work on suck training, let's continue these positive oral play experiences, because honestly, the stretches typically become negative. So I try to keep them separate.

Dr. Courtney (29:36)

Mm-hmm.

Kayla Culbertson (29:38)

so that they're having positive experiences in their mouth instead of just mom or dad is going in and we're stretching and I cry and I become upset. So yeah, so we're doing suck training, continuing with that, or play therapy if we still are working on tummy time or any just like general play-based activities that a baby would do. And then like I said, the post six weeks that the...

release providers give of the stretches.

Dr. Courtney (30:06)

What would be the risks of not doing any of that? Of like just going in, getting everything, you know, getting all the ties removed and then just going back to life as is.

Kayla Culbertson (30:18)

without doing any of the stretches or any therapy, you would just have reattachment. Honestly, you would have reattachment. You would have a baby who is honestly probably uncomfortable, because they've had this done, it's been released. And I guess you could say it's confusing to them. Like, yeah, people say, it's just a baby, but that's a human being and they are learning and they know what feels good and what doesn't feel good.

Dr. Courtney (30:21)

Yeah. Yeah. Okay. Okay.

Kayla Culbertson (30:47)

We have to have respect for these babies and we have to know that they know their bodies. I just, honestly, it makes me sad to think about people when they're just like, yeah, let's just go in and boom, boom, and it's done. It's like, no, there is so much work. And you could potentially cause trauma too. Like that's just very negative. And then going back to feeding and that sounds like a hot mess.

Dr. Courtney (30:50)

I'm ready.

Okay? I feel like there's so many things wrong with that. I don't even know. It's not good. All in all, it would not be good to do that. Okay?

Kayla Culbertson (31:15)

You

Yeah. Yeah. Yeah. The only

time like where I feel like someone would say, let's just get a release done is if a baby truly can't feed because maybe they have a, what they call an anterior tongue tie where it's all the way to the front and they cannot nurse and they cannot take a bottle. And then it's like, then I think that those cases become very urgent.

but my hope is that they're seeing a release provider who's saying, hey, I'll do this release and we will get the best result that we can get with you following up immediately with an IBCLC, with a therapist who specializes in this so that we can make the best of this journey as we can.

Dr. Courtney (32:06)

Totally. Okay, so like, let's say they're choking and needing to, I don't know, go to the hospital because they're choking and they can't feed at all. That might be more of an urgent situation, you know, to get the release. But then like you're saying, for sure, follow up, because at that point they're still going to need to learn, you know, all sorts of different movements and everything.

Kayla Culbertson (32:18)

Yeah.

for sure.

Yeah, and the biggest thing too that people don't think about is someone will say, well, it's just a two week baby. So they've only been sucking for two weeks. No, they're sucking in the womb. So they've laid down this motor plan, this foundation of them sucking while they're in utero. So you're really making up more time and teaching than you think about. You know what I'm saying?

Dr. Courtney (32:37)

Right, right.

no, that makes sense. just doesn't happen overnight. We got here, you know, it takes a while to get there. OK, what would, because I know in the beginning you mentioned like a bunch of different things that you do, you know, during your eval. What are your like top three things for parents listening right now? You know, if they're like, well, I've been told my kid doesn't have a tongue tie, but I don't know some of the things that you're talking about. I remember when they were a baby, you know, that.

Kayla Culbertson (32:57)

Yes.

Dr. Courtney (33:19)

there were some concerns going on. What are the top three things that you want parents to look for?

Kayla Culbertson (33:25)

if this is an older baby, maybe say six to 12 months in that realm or even four to 12 I would say let's look at their movement. Are they moving symmetrically? And what I mean by that is when they're rolling, do they have a preference to roll to one side?

When they are reaching for toys, do they already show a hand preference? Because at this point they should not. When they're kicking, when they're playing and they're laying on the floor and they're kicking, is one leg moving more than the other? ⁓ Or maybe we have a baby who is crawling and they have what they call like a janky crawl where their legs aren't moving symmetrically and maybe like one

Dr. Courtney (34:06)

Mm-hmm.

Kayla Culbertson (34:11)

leg is like hitched out.

or even say pulling to stand. They always lead with the same foot to pull to stand or they maybe always cruise the same way. Or even just babies who have a difficult time like I mentioned before in different positions. Like some people will say, well, my baby just has never liked tummy time. Or my baby will be in tummy time, but they have a hard

hard time looking up or they're on there, they're crawling and they're always looking down and they're never looking up or to the side or anything like that. So just looking at your baby's movement and seeing if their entire body moves efficiently, fluidly to where everything is equal, if that makes sense. I would say look at movement across the board like that.

Dr. Courtney (34:53)

Okay. for sure.

Kayla Culbertson (34:59)

I would also say let's look at feeding. How are they doing if this is a little bit of an older baby and maybe you've started solids around six months because they're sitting independently now. That's a huge piece when you're starting solids. I'll just throw that in. Babies should be sitting independently for a few seconds. But maybe they're starting solids and it's just not going well. And they have a history of, they didn't breastfeed very well so we just switched to bottles and... ⁓

They, put them on, they didn't do well with the slow flow or the level one. So we jumped to the level two. Those are signs to me in my head is there could be some oral dysfunction going on and also potentially ties. And then another thing would just also be babies who, kids who are just overall just dysregulated. Like I've seen babies who always seem ⁓

kind of anxious in fight or flight. Because we also think about like reflexes developing properly. And also we think about, where is our tongue resting? We talked earlier in this about like, are we in fight or flight or are we in rest and digest? Are these babies like scared to go into different positions? Are they gravitationally insecure? So just kind of looking at the demeanor of your baby and

where they're at. I would say that's what I would do for babies.

Dr. Courtney (36:24)

Yeah, it's so interesting that just a tongue can impact all of those things from crawling to feeding to mood regulation. Yeah, it's a lot. What I'm also thinking, you know, this probably isn't the first thing a family would try. Maybe they just had a baby and they're listening now and they're like, ⁓ let me, you know, get this evaluated because I'm seeing some of these concerns. But I imagine.

Kayla Culbertson (36:30)

I know.

Mm-hmm.

Dr. Courtney (36:51)

you see families who have tried many things and parents who are also really overwhelmed and feeling like they're not getting the answers. And, you know, maybe there's something wrong with them that this, you know, isn't working. They're doing something wrong. So what is, yeah, some, I don't know, compassion that you can offer to parents because I feel like this is such a nuanced thing that is not, you know, extremely well known.

At least, I don't know, in my experience, maybe, you know, it might be different. yeah, I don't know. I just, what are some compassionate words that you would have for parents who are really struggling?

Kayla Culbertson (37:31)

Honestly, I really feel for those parents because they're trying really, really hard and they just really want the best for their baby.

Dr. Courtney (37:37)

you.

Kayla Culbertson (37:42)

and I always just say like, it's okay. Like, let's just take a breath. It's okay. Let's look at all of the good in your baby because this is just, this is just a piece of the puzzle and there is so much that is going really well that you can enjoy and we can't always hyper focus on this one thing that isn't perfect. Obviously this one thing.

can impact so many different aspects of this baby's life. But sometimes I find that parents get so zoned in and focused on that, that they miss all of these beautiful life experiences with their baby. So that's my thing, it's like, it's okay, let's take a deep breath, especially if they've gotten to me or to another provider who does great work in this area. And I'm like, I'm here to help you, it's okay, we're on this journey together. ⁓

Things aren't going to be perfect right away, but we're going to work through it and we're going to make the best of it. And at the end of the day, that's all you can do is be honest with yourself and saying, I am doing the best I can for me and for my baby.

Dr. Courtney (38:50)

no, I think that's great. And it's so hard because I think a lot of times parents know, right, something feels off and they know that in their gut that feeding feels off or something's going on with sleep. They know that their baby is uncomfortable. They can feel that something is off. And so to your point, like also being able to trust that too, you know, and when, you know, maybe you feel kind of dismissed by providers.

Kayla Culbertson (38:56)

Mm hmm. Yes.

Yeah.

Dr. Courtney (39:19)

that finding someone who really listens and looks at the whole baby, I think, is also helpful. Yeah.

Kayla Culbertson (39:25)

⁓ 100%. Yeah, there's a lot

of providers who just dismiss and I always, you know, I really applaud parents who continue to push and find somebody who is going to listen and who is going to understand and support their concerns and help them because, yeah, a lot of providers do just dismiss it.

Dr. Courtney (39:45)

Well, thank you so much, Kayla. This was so informative and hopefully life-changing for some families to kind of hear this information and to think about their own children. So I really appreciate you taking the time today.

Kayla Culbertson (39:58)

Yeah, of course, I had so much fun, thank you.

Courtney (40:03)

My biggest takeaway from Dr. Kayla today was that clinical mic drop moment. You don't grow out of developmental hurdles, you grow into compensations. Whether it's a baby who rolls too early because of tension or an adult who chokes on their food because their tongue can't lift, our bodies are brilliant at finding workarounds. But those workarounds take a toll on our nervous system. If you are listening today and you feel flooded by your child's feeding or sleep struggles, I want you to take a breath and find your anchor.

As Dr. Kayla said, have compassion for yourself and your baby. You are doing the best you can with the information you have. If you're noticing those redneck creases or fisted hands we discussed, please check the show notes for links to connect with Dr. Kayla or to find a specialized provider in your area. Remember.

You don't have to be perfect to be a great parent. We are all learning about how to raise kids these days.