Email Survey Responses
Thanks to all who responded to the
e-mail surveys I sent out....here are just some of your
responses to the original questions listed at the bottom.
From: Auntie Jan
I work both in the PICU at XXXXX and in the Pediatric
ward at XXXXXX (both northern California). I have noticed
over the years a dependable corellation between teething
(i.e. gum swelling, increased drooling, potentially
decreased sinus and nasopharyngeal airflow area) and
1) pneumonia [esp. RUL], 2) bronchiolitis, and 3) otitis.
What I have not determined is if oral cavity shape determines,
or is determined by, feeding pattern.
From: firstname.lastname@example.org (JBS,
I did my master's thesis on Variation in Infant Palatal
Structure and Breastfeeding. My literature review may
be of particular interest to you. I reviewed approximately
3,050 citations via medline searching for information.
I had the luxury as a student of supposing a lot and
probably have more questions than answers. I reformatted
it for resale and if you'd like I can sent you a copy.
The cost is $25.00 payable to Latch-On Services P.O.
Box 492 Indianola, Iowa 50125. I would love to help
you in anyway I can. Did someone introduce you to Brian
Palmer a DDS in KC, Mo. who is doing similar work? If
not I will gather his information for you.
I just received this month's issue of Journal of Human
Lactation. You must obtain a copy of this. There is
an article by Brian Palmer, DDS titled "The Influence
of Breastfeeding on the Development of the Oral Cavity:
A Commentary" He has a special interest in the
treatment of snoring and obstructive sleep apnea. For
over 20 years he has been observing and documenting
the collapse of the oral cavity and airway. Address
correspondence to BP, 4400 Broadway, Suite 514, Kansas
City, MO 64111. The Journal of Human Lactation is the
official Journal of ILCA, published quarterly in March,
June, Sept. and Dec. Individual subscriptions are $65.00
a year. I'm not sure about individual copies of the
magazine. Address: ILCA Business Office, 4101 Lake Boone
Trail, Suite 201, Raleigh, NC 27607
Dr. William Sears, a pediatrician has done extensive
research on sids and Breastfeeding.
From: RN 2AMEDIC
...a friend, a pediatric nurse practitioner student
seems to think that there are studies relating to oxygenation
and nose/mouth breathing, though I haven't seen any.
[yes they exist] We don't routinely do lots of ABG's,
but rely on pulse oximetry very heavily, so as for actual
oxygenation, I really can't comment. As far as saturation
goes, the pattern of change we usually see is a gradual
decline, followed by a rapid drop in saturation over
time when there is compromise. We have been able to
see this on our graphic trends monitors, but have never
officially documented it. I haven't really noticed any
variations associated with demographic differences,
however I will pay more attention in the future.
From: email@example.com (JBS)
<<mouth breath effect which occurs with bottle
feeding>> The seal on the bottle is different
than the seal on the breast. On the bottle they can
breathe around the bottle teat through the mouth. I
was taught that at breast the intra-oral pressure is
positive. There is debate in the literature over this.
I recently began to ponder this and I wonder if the
pressure at breast doesn't switch from positive to negative
with the change in the rate of milk flow. I am thinking
I want to understand pressure more fully. Smith, Erenberg,
and Nowak say "Our data suggest rather that nipple
compression may draw milk into the ducts by that actual
stimulus for release is a vacuum phenomenon caused by
the rapid enlargement of the oral canity. I am alas
a soft scientist not a hard one!!!! That is another
great article ADDC - Vol 142, Jan 1988 "Imaging
Evaluation of the Human Nipple During Breast-feeding."
<<There is also the hard teat
which tends to be fed the baby anteriorly at the premaxillary
area.>> and I understand infant often sort of
"munch" on the rubber which would place more
force in the very forward premaxilla region. - ABSOLUTELY
<<tongue thrusting..object upward...alter
the shape of the palatal arch.>> I think of thrusting
as aberrant swallowing vs. pushing or pumping of teat...yes?
YES - when the baby is at breast and sucking correctly
the tongue produces a repetative peristaltic wave.
From: PLove77113 (PL C.C.C.-ASP,M.A.)
I have been a speech pathologist for the deaf in Champion
Local Schools for 15 years. My students that I service
are from ages 6-15 and come from a 2 county radiius
in Ohio. The answers to your questions are: 1. sometimes
but not often. 2. yes - all have hearing problems according
to the Ohio blue book regulations. 3. yes - there is
a direct correlation between ear infection/absence of
hearing aid and the degree of speech intelligibility
in my students! 4. sometimes but not often. 5. sometimes
but not often. 6. more often than the narrow hard palate!
7. some but not the majority. 8. some but not the majority.
9. A few - for instance, I have a deaf student who stutters
(rare). You may want to also check I.Q. of students.
The lower the I.Q. the more of a mouth breather the
student is! 10. Yes, I am interested in your findings!
I am a Speech/Language Pathologist in the greater Kansas
City area. I have a small part-time private practice
(so that I can be an "at home" mom in the
after school hours.) I have been practicing for 25 years
in different settings. Currently I am working primarily
with the birth to three
population, so many of the questions you have asked
do apply to the kids I see for therapy. It is funny
that I received your e-mail today. I am seeing an 18
month old for therapy and just today during our session
his mother and I had this very discussion. She told
me that doctors have mentioned his narrow, high vaulted
palate and a bi-fed uvula. He had not allowed me near
his mouth previously, but today, I played a little game
where he lay back and laughed, so I got a good view.
This child has an extremely small narrow "V"
shaped palate. He has demonstrated delayed language
and speech skills due very likely to multiple ear infections
and fluid in his ear (chronic fluid over the last year).
Had antibiotics for the first 14-16 months of life at
each infection. He finally had tubes placed a few months
ago, and all of a sudden is showing big leaps in speech
development. He is a mouth breather and still drools
heavily, indicating poor oral motor tone. His teeth
are already crowded. He was bottle fed (adopted by these
parents). For the first 6 months I saw him, EVERYTHING
went into his mouth, along with the drooling. He still
does some of that, but not nearly as much. Shortly after
birth, this boy was seen for swallow study because the
doctors were fearful he was aspirating. Also had food
and drink coming out nose as a young baby, but no more
feeding difficulties mainly something I will be monitoring.
Have I answered all the questions on this child? [WOW!!!!!
[and a good number of others requested the same:] I
recieved your E-mail although I have just recently graduated
and have had limited experience with the speech population
you have discussed. Most of my experience is in geriatrics.
However please keep me updated with regard to your findings!
1.Small palates are present in only about 1/4 of the
pop I work with., 2. Yes, decreased hearing perception
is often a problem regardless of test results., 3. Often
couldn't hear when they needed to, and now have decreased
expressive vocab. or artic problems. 4. and 5. Often
have children who appear to keep URI, and about 1/2
are mouth breathers. (all of my Down Syndrome pop.)
6. I see 0-3yrs. often don't see tooth erruption. I
have had some apraxic children with very straight teeth.
Just depends. I also have some with subtle cranio-facial
abnormalities who have unusual dentintion 7. I'd like
to see the proof for that statement. 50% for either.
I see no evidence that bottle vs. breast has in terms
of impact on speech and feeding, but more HOW they were
bottle fed or breast fed.(positioning of baby and nipple)
ex. 45% angle vs. lying flat or more reclined. 8. No,
only a few 9. Just that many of the pediatricians in
my town do not see the correlation between middle ear
problems and speech delays. Trying to educate my parents
so they can be more assertive when it comes to referrals
to outside sources
I've used the questions you originally sent, and they'll
go in the "Research" section starting June
30. Since you have no deadline, I'll run it about once
a month or so. I added the paragraph below to it: 6/12/98
QUESTIONS: Sent to Lactation Consultants and Pediatric
RNs 1) How long will MATERNAL ANTIBODIES help an infant
as 100% BREAST FEEDING stops...and how fast would this
"help" decrease as "supplements"
were being introduced? 2) Do you know of any studies
comparing BOTTLE FED vs. BREAST FED infants as related
to Growth & Development (G&D) of the pre-maxilla
and palate region as well as length of the mandible?
3) Do you know of any studies comparing showing any
relationship between BOTTLE FED vs. BREAST FED infants
and the 20-30% of them that will go on to have 90+%
of otitis episodes? 4) Do you know of any studies that
show the effects of LOWER BLOOD OXYGEN and/or HIGHER
HISTAMINE POTENTIALS to generalized and/or specific
child health? 5) Do you know of any studies that evaluated
TEETHING ILLNESS quantified as related to BOTTLE FED
vs. BREAST FED infants? 6) Are you aware of any studies
that show a specific age that BOTTLE FED babies might
start to have OTITIS problems? 7) Do you know of any
studies comparing SIDS and cot death mortality to BREAST
vs. BOTTLE fed infants? 8) What factors do you think
play in predisposing the 20-30% of kids that have 90+%
of otitis media episodes?
6/22/98 QUESTIONS: Sent
to Speech Therapists and Speech Pathologists 1) Are
small narrow "V" shaped palates often present?
(small palate affects tongue speaking space) 2) Is decreased
hearing perception irregardless of test results often
present? (current tests don't alway show reality) 3)
Is parallel chronic ear disease often present? (can't
hear...can't speak) 4) Is impaired airway or breathing
often present? (obstruction seems often present in ear
disease) 5) Is "mouth breathing" often present?
(seems common in those with ear disease) 6) Do you see
many with wide "U" shaped arches and very
straight teeth? (bet this is rare) 7) Were many of your
patients breast fed (vs. bottle) for more than 8 months?
(bottlefeeding makes "V" palates) 8) Were
many of your patients dumby suckers (finger, pacifier)?
(they have narrow palates and more ear disease) 9) Do
you see any PARADOXES or CONFLICTS between your clinical
observations and current theories of etiology regarding
either speech impairment or chronic ear disease? 10)
Please advise me if you DO NOT want updates on what
I find in surveys.
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