Parent insists on therapy despite expander interference

Q:

Good morning.  I need advice:

7 yo boy, mouth breather , interdental tongue posture at rest, speech and swallowing.

I’ve seen him for the last 2 months, and despite extremely hard and narrow palate he made great progress both on lip and lingual function.  Now the upper expander is finally placed, and a lower one will be probably placed as well. It is a barrier and I would normally stop most of the treatment, and continue only for lips as needed. Mom was encouraged to remind him about tongue placement at rest, taking in consideration the expander.

Although I explained how expander interferes with therapy and lingual placement for sound production, she insists to continue working to attack frontal lisp although sound won’t be “perfect”..  any extra strategies to continue working while expander is in place?

He will have it for at least 8 months and mom is afraid that he will lose what he has learned..

KZ

A:

We often get pressured by a parent to do something that we know is unlikely to work.  We don’t want to take up their time and money; yet, they might keep insisting.  From what you described, I can’t imagine that it would be a fair and reasonable thing to insist that the young man do what might be impossible.  Also, you said he is a mouth breather but it sounds like the cause was not targeted.  Why is he mouth breathing?  What airway issues does he have…or what former airway issues were addressed and left him with the mouth breathing habit?  That seems to be a bigger barrier than the expanders.  Airway is number one concern for this boy and treatment should not continue until and unless he is able to comfortably nose breathe.  I hope this helps.

 Q cont:

Thanks for answering.

Currently, Mouth breathing just became a habit. He underwent adenoidectomy and tonsillectomy last year. Per ENT, besides narrow palate there are no other issues. During the session, he has been able to maintain a closed mouth posture for periods of time. Not sure how often behavior is addressed at home.  So, even though the program won’t be addressed due to the barrier, my concern is if I still should target nose breathing, interdental lingual position at rest, and lingual approximation  for the /s/ production.

A cont:

Thanks for your response, K.  What a relief to know he had the T & A last year.  In this case, it might be ok to continue the nose breathing work and tts if the appliance has a tiny notch to note the location where the tongue should be.  He is not ready to work on his speech as it would be very unfair to him.  Honestly, it would be better to wait until the expansion is completed for all of it; however, if you think you can get him to habituate his nasal breathing, that aspect wouldn’t hurt at all.