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June 24, 1998

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: burksnar@netins.net (JBS, MA, IBCLC)
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.

From: Nursmargie
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

From: MilkyWay54
Dr. William Sears, a pediatrician has done extensive research on sids and Breastfeeding.

...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: burksnar@netins.net (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!

From: Dcgardener
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!!!!! YES!!!!!]

From: R2Hib
[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!

From: Vicbeach1
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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