When feeding therapy stalls, it is rarely because a clinician lacks exercises - it is usually because intervention began before the child’s foundational systems were fully understood. Trying to fix oral-motor mechanics without addressing postural stability, airway integrity, or sensory overload is like building a house on sand.

In this episode, Hallie Bulkin shares a structured, child-centered framework for pediatric feeding therapy that moves clinicians away from reactive "symptom chasing" and toward deep clinical reasoning. She breaks down the critical distinction between preliminary screening and comprehensive assessment, explaining how to connect isolated clinical observations into actionable patterns.

Hallie highlights why posture, breathing, and nervous system regulation must be evaluated before asking the mouth to perform. She also discusses how to prioritize barriers based on the whole child, collaborate effectively with medical providers, and implement proactive strategies that build lasting trust with families.

• Foundation Over Function: Why postural alignment, airway patency, and sensory processing must be stabilized before targeting oral-motor skill development.
• Pattern Recognition vs. Symptom Chasing: How to connect individual clinical observations into cohesive patterns that reveal the true root cause of feeding difficulties.
• Screening vs. Comprehensive Assessment: Understanding where screening ends and formal diagnostic assessment begins to avoid premature intervention plans.
• Proactive vs. Reactive Therapy: Shifting from session-by-session troubleshooting to a clear, milestone-driven roadmap.
• Interdisciplinary Medical Collaboration: How and when to bring in medical partners (ENTs, GI, bodyworkers, dentists) to address systemic barriers to progress.

"Feeding does not happen in a silo - it requires the synchronized support of posture, airway, sensory, and nervous system regulation."

"Assess the child's foundation before asking the mouth to perform. If the body is fighting for balance or air, feeding will always be secondary."

"Symptoms are information, not the starting point. Our job is to trace those symptoms back to the underlying root cause."

• 00:01:43 - The Need for a Structured Clinical Framework
• 00:02:35 - Case Example: Why Feeding Does Not Happen in a Silo
• 00:04:34 - Connecting the Dots in Feeding Evaluations
• 00:05:08 - Assessing the Child's Foundation (Postural, Airway & Regulation)
• 00:06:13 - Functional Feeding Assessment vs. Isolated Screening
• 00:07:36 - Prioritizing Barriers and Building a Clinical Plan
• 00:08:29 - Clinical Decision Examples (Posture, Airway, Trauma & Skill)
• 00:10:12 - Stop Chasing Symptoms: Ask What the Behavior is Showing
• 00:11:20 - Moving From Reactive Care to Proactive Care
• 00:12:02 - Building Pattern Recognition & True Clinical Confidence
• 00:14:42 - Key Takeaways for Feeding Therapists
• 00:15:18 - Feed The Peds Training Announcement & Waitlist

• FREE TRAINING: Learn how structural airway limits directly affect feeding in our free Screen The Peds to Feed The Peds Training.

• Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes.
• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference.

Hosted on Acast. See acast.com/privacy for more information.

When a child presents with sleep-disordered breathing, chronic mouth breathing, or persistent feeding challenges, evaluating the upper airway becomes a top priority. However, determining when conservative management is sufficient versus when surgical intervention - like a tonsillectomy or adenoidectomy - is required can be complex for both parents and providers.

In this episode, Hallie Bulkin sits down with pediatric ENT specialist Dr. Ariel Grobman to break down the clinical nuances of pediatric airway evaluation. Dr. Grobman shares expert insights into physical examination techniques, the practical role of nasoendoscopy, and when sleep studies are truly necessary versus when visual and functional markers dictate action.

Together, they explore post-surgical recovery expectations, adenoid regrowth, secondary causes of nasal obstruction like enlarged turbinates, and the critical link between airway dysfunction, ear infections, and feeding difficulties. Dr. Grobman also emphasizes the essential role of interdisciplinary collaboration between ENTs, myofunctional therapists, and airway-focused orthodontists.

Dr. Ariel Grobman is a board-certified Otolaryngologist (Ear, Nose, and Throat surgeon) specializing in pediatric and adult airway management, sinus disorders, and head and neck surgery. Dr. Grobman is dedicated to taking an integrative, patient-centered approach to airway health, helping families navigate complex decisions regarding tonsillectomy, adenoidectomy, and nasal airway procedures. He works closely with multidisciplinary teams of speech pathologists, myofunctional therapists, and dentists to ensure comprehensive, root-cause care.

• Airway Risk Assessment: Why establishing danger and the severity of airway restriction is the primary step in evaluating pediatric sleep issues.
• Surgical Indications & Outcomes: Understanding real-world expectations, recovery protocols, and regrowth potential following tonsillectomy and adenoidectomy.
• Interdisciplinary Collaboration: Why optimal patient outcomes rely on close coordination between ENTs, airway-focused orthodontists, and myofunctional providers.

"Assessing danger and functional impact is always the most important first step."

"A detailed physical exam combined with clinical history can often replace the need for a cumbersome sleep study."

"Nasal endoscopy is quick, minimally invasive, and gives us immediate answers about structural obstructions."

• 01:03 - Guest Introduction: Dr. Ariel Grobman
• 02:46 - Assessing Tonsils & Adenoids in Pediatric Patients
• 06:51 - Indications for Pediatric Sleep Studies
• 07:11 - Physical Examination & In-Office Nasal Endoscopy
• 15:54 - Adenoidectomy vs. Tonsillectomy: Procedures & Recovery
• 20:40 - Tissue Regrowth & Root Causes of Adenotonsillar Hypertrophy
• 22:13 - Addressing Persistent Mouth Breathing & Role of Myofunctional Therapy
• 36:56 - Managing Complex Pediatric Airway & Feeding Cases
• 40:29 - Indications for Middle Ear Fluid Drainage & PE Tubes
• 44:34 - Airway-Focused Orthodontics & Palatal Expansion
• 49:09 - Where to Find Dr. Ariel Grobman & Closing Remarks

• Connect with Dr. Ariel Grobman: Learn more about his practice and patient resources at Ariel Grobman MD.
• Fast Myo Screening Tool: Identify structural airway red flags and breathing compensations at FastMyoScreening.com.

• Don’t Ignore the Snore: The Hidden Link Between Airway, Sleep, and ADHD.
• Mouth Breathing vs. Nasal Breathing: Changing Lives Through Early Airway Intervention.

If Dr. Grobman's insights helped clarify your understanding of pediatric airway assessments and surgical indications, please take a moment to leave a review! Your support helps us share these vital clinical discussions with providers and families everywhere.

Hosted on Acast. See acast.com/privacy for more information.

For many speech-language pathologists, occupational therapists, and myofunctional providers, billing and documentation feel like navigating an ever-shifting maze. Between selecting appropriate CPT codes, justifying medical necessity, and adhering to strict scope-of-practice guidelines, clinicians often struggle to ensure proper reimbursement while remaining compliant.

In this episode, Hallie Bulkin breaks down the essential mechanics of billing for myofunctional therapy services. She addresses common points of confusion around core codes - such as CPT 92526 (treatment of swallowing dysfunction and/or oral function for feeding) and 92507 (speech/language treatment) - and offers practical strategies for documenting functional gains accurately.

Hallie also previews upcoming CPT code updates slated for 2027, shedding light on how these structural changes will impact private pay practices, electronic health records (EHRs), and clinical workflows. Whether you are navigating insurance reimbursement or operating an out-of-network practice, this episode equips you with the clarity needed to code with confidence and integrity.

• Deconstructing CPT 92526 vs. 92507: Clarifying the distinct clinical applications for swallowing/feeding dysfunction versus speech and language treatment.
• The 2027 CPT Code Shift: Preparing your practice, EHR templates, and clinical documentation for upcoming coding structure changes.
• Scope of Practice & Provider Eligibility: Understanding state licensing, board regulations, and billing qualifications across different therapeutic disciplines.
• Defensible Documentation: Crafting objective, function-focused clinical notes that justify medical necessity and withstand insurance audits.
• Out-of-Network & Private Pay Strategies: Equipping cash-pay practices with accurate super/ superbill documentation to help patients seek reimbursement seamlessly.

"A CPT code isn't just a billing number - it is a translation of your clinical documentation and direct scope of practice."

"When preparing for coding changes, proactive documentation systems protect both your practice and your patients."

"Bill for what you treat, document what you see, and ensure every note clearly establishes functional necessity."

• 00:00:00 - 3 Verification Steps Before Coding
• 00:04:23 - Deep Dive: Myo & CPT Code 92526
• 00:06:37 - Reporting 92526 & 92507 Together
• 00:09:45 - Provider Scope & License Boundaries
• 00:13:47 - Dental Hygienist (RDH) Reimbursement Reality
• 00:15:53 - Strong vs. Weak Documentation Examples
• 00:18:16 - Private Pay & Superbill Responsibilities
• 00:19:42 - 2027 Deletion of 92507
• 00:20:47 - Why 92507 Was Flagged by AMA/CMS
• 00:26:26 - Private Practice Transition Strategy
• 00:27:43 - Clinical Reasoning vs. Endless Exercises
• 00:29:01 - Immediate Action Plan

• Fast Myo Screening Tool: Streamline your intake documentation and baseline evaluations at FastMyoScreening.com.

• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference.
• How Root Cause Assessment Changes Feeding and Speech Outcomes.

💬 Join the Conversation: Catch behind-the-scenes business tips, billing insights, and daily clinical pearls on Instagram | Facebook | LinkedIn.

If this episode helped clarify your billing, documentation, or CPT coding practices, please take a quick second to leave a review! Your support helps us share these vital business and clinical insights with therapists everywhere.

Hosted on Acast. See acast.com/privacy for more information.

Maxillary expansion isn't just an orthodontic intervention - for adults navigating narrow palates, compromised airways, and chronic TMJ dysfunction, it can be a total health transformation.

In this episode, Hallie Bulkin sits down with Jeannie Nelson, MS, CCC-SLP, to share an unfiltered, first-hand account of their personal experiences undergoing MARPE (Minimally Invasive Micro-Implant Assisted Rapid Palatal Expansion). Together, they pull back the curtain on the procedure itself, comparing their treatment approaches, pain management strategies, and the physical and emotional realities of the recovery process.

Hallie and Jeannie dive into the profound functional benefits that go far beyond aesthetics—including drastic improvements in nasal breathing, sleep quality, reduced systemic inflammation, and even unexpected shifts in vision. They also discuss navigating speech challenges, dietary changes, lymphatic support, and essential tools to prepare if you or your patients are considering advanced expansion.

Jeannie Nelson, MS, CCC-SLP, is a licensed Speech-Language Pathologist, certified myofunctional therapist, and pediatric feeding specialist. With an extensive clinical background in evaluating and treating complex orofacial myofunctional disorders, pediatric feeding difficulties, and airway-centric cases, Jeannie brings both high-level clinical expertise and personal patient experience to the conversation. In this episode, she joins Hallie to share her first-hand journey navigating adult maxillary expansion (MARPE), shedding light on the intersection of structural anatomy, speech clarity, and whole-body functional recovery.

• The Functional Power of the Maxilla: Understanding why expanding the maxillary bone directly impacts nasal vault volume, airway capacity, and structural posture.
• Comparing Expansion Approaches: Exploring how individual anatomy influences protocol choices, appliance designs, and overall treatment timelines.

"Opening up my nose has been completely life-changing. You don't realize how much energy you spend fighting to breathe until that restriction is lifted."

"Breathing properly has drastically improved my sleep architecture, nervous system regulation, and daily recovery."

"The maxillary bone impacts everything—from your nasal airway and posture to how your vision, jaw, and neck organize."

• 00:00 – Introduction to MARPE and Personal Treatment Backgrounds
• 02:49 – Comparing Treatment Approaches, Protocols, and Individual Experiences
• 05:41 – Pain Management Realities and Practical Recovery Insights
• 11:36 – Navigating TMJ Issues, Jaw Alignment, and Airway Stabilization
• 21:21 – The Interconnectedness of Maxillary Structure, Oral Health, and Whole-Body Function
• 39:09 – Speech Clarity, Articulation, and Communication Challenges
• 42:47 – Pain Perception, Nervous System Response, and Emotional Recovery
• 51:43 – Preparing for Advanced Expansion: Essential Preparation Tools and Protocols
• 57:32 – Final Thoughts and Resources for Patients and Clinicians

• Fast Myo Screening Tool: Identify structural and airway red flags in your clinical practice at FastMyoScreening.com.
• Connect with Jeannie Nelson: Learn more about her practice, clinical services, and myofunctional expertise at Breathe Eat Sleep Talk. 

• Episode 137: The Evidence Based Research Behind Tethered Oral Tissues with Richard Baxter, DMD, MS.
• Don't Ignore the Snore: The Hidden Link Between Airway, Sleep, and ADHD.

💬 Join the Conversation: Catch behind-the-scenes insights, collaboration tips, and daily clinical pearls on Instagram | Facebook | LinkedIn.

If Hallie and Jeannie's personal MARPE journey gave you a clearer understanding of structural airway expansion, please take a moment to leave a review! Your support helps us bring these vital, transparent conversations to clinicians and patients everywhere. 

Hosted on Acast. See acast.com/privacy for more information.

Taking a weekend course can make you see tongue posture, restricted movement, and mouth breathing everywhere you look. But recognizing a pattern is vastly different from truly understanding it.

In this solo episode, Hallie Bulkin addresses "The Myo Gap" - the space between noticing an isolated anatomical finding and developing the clinical depth to understand how it fits into a child's connected, multi-system picture. She unpacks why a restricted frenulum or forward resting tongue is merely a data point rather than an automatic diagnosis or treatment plan, and explains how shallow understanding leads clinicians to jump directly to conclusions, quick referrals, or "cookbook" exercises.

Hallie breaks down how to conduct a deeper assessment by analyzing real-time compensations, motor coordination, sensory processing, and overall physical development. You'll learn why true clinical competence often leads to making fewer but far more valuable referrals, how to navigate honest parent conversations without false certainty, and why real clinical judgment requires mentored practice over quick information.

• The "Sensitization" Trap: How new clinical learning creates pattern-recognition bias where every finding looks like the primary root cause.
• Observation vs. Diagnosis: Why a restricted frenulum or forward tongue posture is an initial observation point, not an immediate reason to prescribe exercises or surgical releases.
• Reading the Connected System: How to evaluate tongue function relative to jaw mechanics, lip seals, nasal breathing, overall muscle tone, sensory processing, and motor coordination.
• Selective, Value-Driven Referrals: Why advanced clinical discernment leads to fewer automatic referrals for releases and results in clearer, function-based communication with ENTs, dentists, and surgeons.
• Honest Parent Conversations: The shift from presenting false certainty ("Your child has a tie, so they need a release") to leading transparent, nuanced clinical discussions.

"Recognizing a pattern can feel a lot like understanding it before the depth is actually there. An observation is not a diagnosis, and it's definitely not a treatment plan."

"Structure matters, but function matters more. Context determines what the structure actually means."

"Confidence isn't giving parents a quick, simple answer—it's being able to separate what you know from what you suspect."

001:04 - The Gap Between Knowing and Understanding Myo 

02:50 - Clinical Sensitization & Pattern Recognition 

04:23 - Case Study: 3-Year-Old with Low Tone 

06:23 - What Deeper Assessment Looks Like 

07:35 - Assessing a 2-Year-Old for Feeding Concerns

09:04 - Myo Does Not Replace the Rest of the Child 

10:20 - Structure vs. Function & Better Referrals 12:03 - Assessing Infants & The Feeding Dyad 

13:28 - Communicating Honestly with Parents 15:20 - Myo vs. Feeding Therapy & Multi-Disciplinary Care 

16:26 - How to Build True Clinical Competence

18:21 - The Myo Method & Closing Thoughts 

• The MYO Method: Elevate your clinical reasoning, bridge assessment gaps, and master orofacial patterns at TheMyoMethod.com.
• Fast Myo Screening Tool: Stop guessing during your intakes and download the checklist at FastMyoScreening.com.

• Episode 132: Feeding With A Twist of Myo with Hallie Bulkin, MA, CCC-SLP, COM.
• Episode 150: Where To Start And End With TOTS?.

💬 Join the Conversation: Catch behind-the-scenes insights, collaboration tips, and daily clinical pearls on Instagram | Facebook | LinkedIn.

If this episode challenged you to look deeper at the whole connected system on your caseload, please take a second to leave a review! Your support helps us share these critical clinical perspectives with the therapists who need them most.

Hosted on Acast. See acast.com/privacy for more information.

When we think about core stability, digestive efficiency, or functional breathing patterns, we rarely consider the foundational muscle group resting at the base of our pelvis. Yet, pelvic floor health directly dictates everything from diaphragmatic excursion to bowel regularity, posture, and systemic stress management.

In this episode, Hallie sits down with Dr. Svetlana Mehlman, a physical therapist specializing in pelvic health, back pain, and lymphatic drainage. Dr. Svetlana breaks down the complex anatomy and mechanics of the pelvic floor, explaining why a tight, tense pelvic muscle is often a hypertonic, weakened one rather than a strong one.

Dr. Svetlana Mehlman is a physical therapist specializing in pelvic health, back pain, and lymphatic drainage. She earned her Bachelor's degree in Human Development from Cornell University and completed her Doctorate of Physical Therapy at New York University. Her passion for pelvic floor physical therapy was ignited early in her career while treating pregnant and postpartum patients suffering from pain and pelvic dysfunction.

• The Pelvic Core Connection: Understanding how the pelvic floor acts as the true base of your deep stabilization system, working in tandem with the diaphragm and abdominal wall.
• Tightness vs. Strength: Demystifying the myth that a tight pelvic floor is a strong one, and why muscle hypertonicity restricts blood flow, movement, and functional length.
• Breathing and Digestive Motility: Exploring how diaphragmatic movement mechanically massages internal organs, directly impacting gut motility, constipation, and bowel transit time.

"The pelvic floor is an integral part of your deep core system. It cannot function in isolation from how you breathe or sit."

"Muscles need to move through a full range of motion. A tight pelvic floor is not a strong pelvic floor—it’s a fatigued, restricted one."

"When we fix the breathing mechanics at the top, we relieve the mechanical pressure on the pelvic floor at the bottom."

• 000:01:04 — Hallie Bulkin introduces guest Svetlana Mehlman (DPT, CSCS).
• 00:02:41 — What is the pelvic floor and how does it function as part of the core?
• 00:05:00 — The role and mechanics of using a Squatty Potty.
• 00:08:08 — The link between chronic constipation, bladder issues, and incontinence.
• 00:10:46 — Practical tips: The "I Love You" abdominal massage.
• 00:12:00 — How diaphragmatic breathing regulates the pelvic floor and nervous system.
• 00:15:16 — Why travel and routine changes trigger constipation.
• 00:22:30 — Common symptoms of pelvic floor dysfunction (and why tight doesn't mean strong).
• 00:29:31 — Why you should never "hover" or rely on "just-in-case" peeing.
• 00:32:14 — Postural Restoration Institute (PRI) principles and how posture connects to pelvic health.

• Connect with Dr. Svetlana: Explore specialized care programs, resources, and consultation details at Pelvic Harmony.
• If this episode changed how you see the body, that's just one case. Inside The Integrated Therapist™, you grow the clinical reasoning to spot the root cause, think past your own discipline, and feel sure about what to assess, treat, refer, and co-treat. Come join us at: https://theintegratedtherapist.com/

• Episode 233: Understanding Your Pelvic Floor with Britnie Hornsby, PT, DPT, Cert DIN, Cert VRS, PCES.
• Episode 185: Laura Glazebrook, DPT The Pelvic Floor and Jaw Connection.

💬 Join the Conversation: Catch behind-the-scenes insights, collaboration tips, and daily clinical pearls on Instagram | Facebook | LinkedIn.

If Dr. Svetlana's whole-body approach reframed how you look at the connection between breathing, posture, and pelvic health, please take a quick second to leave a review! 

Your support helps us bring these essential clinical conversations to more providers and families.

Hosted on Acast. See acast.com/privacy for more information.

When a child walks into your clinic presenting with a tongue thrust, a high-arched palate, or a complex feeding delay, what is your immediate clinical instinct? Is it to reach for a specific exercise in your toolkit, or is it to zoom out and analyze how the entire system is functioning together?

In this solo episode, Hallie Bulkin dives into the powerful paradigm shift of becoming an integrated therapist. She challenges the common trap of relying on isolated techniques and instead lays out a roadmap for evaluating children holistically.

Hallie breaks down how to run multiple clinical lenses simultaneously - from airway and breathing considerations to structural vs. functional anatomy, neurological diagnoses, and the sensory-motor layers of feeding.

• The Integrated Mindset: Why focusing too closely on a single tool or therapy protocol creates clinical blind spots, and how to zoom out to assess the whole child.
• Running the Airway Lens First: How structural issues (like mouth breathing and palate shape) directly impact downstream oral motor habits like a tongue thrust.
• Deconstructing the Feeding Layers: Organizing feeding challenges into clear mechanical, sensory, and behavioral tiers to know exactly where to begin treatment.

"Look at the whole connected system. If you only look at the mouth in a vacuum, you miss the structural foundation driving the compensation."

"We have to ask: what is the whole system doing? When you treat a symptom without treating the root cause, you're just chasing shadows."

"Find the fire, not just the smoke. Clinical discernment is about finding exactly where the dysfunction originates so we can intervene with precision."

• 00:00:00 – Intro Hook: The Feeding Lens vs. The Loudest Voice in the Room
• 00:00:29 – Welcome to the Untethered Podcast & Host Introduction
• 00:01:05 – What Separates a Good Clinician? Introducing the "Integrated Therapist"
• 00:01:48 – The Shiny New Tool Trap: Single-Lens vs. Whole-System Thinking
• 00:04:50 – Lens 1: The Airway Picture (Mouth Breathing & Tongue Thrust)
• 00:07:15 – Lens 2: Pediatric Feeding (Mechanical, Sensory-Motor, & Behavioral Layers)
• 00:08:03 – Case Study: 8-Month-Old Bottle Refusal & Cleft Lip Repair
• 00:09:56 – The Pain Differential (Reflux, Thrush, Torticollis)
• 00:11:53 – Lens 3: Neurological Frameworks (Apraxia, Dystonia, Dysarthria)
• 00:15:06 – Lens 4: Anatomy & Structure (High Narrow Palate Constraints)
• 00:17:49 – Mastering the Referral: How to Communicate Cross-Discipline
• 00:20:38 – Summary: The 6 Key Pillars of an Integrated Approach
• 00:22:31 – Outro: Join The Integrated Therapist Community & Disclaimer

• Become the clinician who finally sees the whole picture https://theintegratedtherapist.com/.
• Our Digital Home: Catch past episodes, resources, and show notes anytime over at The Untethered Podcast.
• Fast Myo Screening Tool: Stop guessing during your intakes and download the checklist at FastMyoScreening.com.

RELATED EPISODES YOU MIGHT LOVE

• Why Two Therapists Get Different Feeding Outcomes (And How to Fix It)
• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference

STAY CONNECTED

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⭐ Love the show? Leave a quick review — it means the world to me!

If this episode inspired you to step into an integrated mindset and analyze the whole connected system for your patients, please take a quick moment to leave a review! 

Your support keeps us climbing the charts to help pediatric therapists think more critically. 

Hosted on Acast. See acast.com/privacy for more information.

When a child exhibits behavioral challenges, facial recession, or struggles with sleep, the root cause is frequently hiding in plain sight: their breathing habits. Unfortunately, these vital signs of compromised airway health are often overlooked by traditional medical models.

In this episode, Hallie sits down with Dr. Leslie Pasco, an expert in airway health, pediatric development, and the author of The Great Contraction. Dr. Pasco breaks down the profound impact that mouth breathing, poor jaw development, and tongue-ties have on a child’s long-term physical and neurological growth.

About the Guest: Dr. Leslie Pasco, DMD, OFM, CBBI

Dr. Leslie Pasco is the visionary founder and President of MyoWay Centers for Kids. With almost three decades of experience in dentistry, Dr. Pasco has dedicated her career to understanding how airway health and muscle function deeply influence growth, sleep, learning, and overall health in children. 

Rather than simply addressing surface symptoms, she emphasizes early screening, thorough functional assessments, and close collaboration with other healthcare professionals to ensure her young patients receive truly comprehensive care. Her clear, driving mission is to help children grow right, breathe right, and live better.

Key Topics & Takeaways

• Mouth Breathing as a Danger Signal: Why mouth breathing should never be dismissed as a "phase," and how it actively derails midface growth, jaw position, and dental alignment.
• The ADHD & Sleep Link: How sleep-disordered breathing frequently mimics or exacerbates symptoms of ADHD, leading to misdiagnoses that could be resolved with airway support.
• A Call for Holistic Care: Understanding the environmental stressors driving facial recession and contraction, and why true patient healing requires organic, multidisciplinary collaboration.

Soundbites

"Mouth breathing is a danger signal. It is your body’s emergency backup system, not a functional way for a growing child to live and develop."

"Breathing therapy can change lives. When you restore nasal breathing and correct sleep architecture, you aren't just changing a habit—you're shifting a child's entire behavioral and developmental trajectory."

"Holistic care requires collaboration. No single provider can fix a contracted airway or a system-wide dysfunction completely on their own."

Timestamps 

• 00:00 - The Impact of Airway Health on Families
• 01:12 - Introducing Dr. Leslie Pasco
• 02:20 - Shifting from General Dentistry to Airway Care
• 07:23 - The Dangers of Chronic Mouth Breathing
• 12:04 - ADHD Misdiagnosis vs. Sleep Disordered Breathing
• 19:02 - The Connection Between Palatal Expansion and Myofunctional Therapy
• 28:44 - Functional Assessments for Tethered Oral Tissues (Tongue & Lip Ties)
• 30:53 - The Critical Role of Pre-Op and Post-Op Preparation for Releases
• 44:00 - What is the Buteyko Breathing Method? (Form, Function, Fuel)
• 52:39 - Breaking Down Medical Silos: A Holistic Approach
• 54:16 - The Great Contraction Book Overview
• 58:52 - Medical Disclaimer & Outro

Links & Resources

• Connect with Dr. Leslie Pasco: Learn more about her clinical work at https://buteykoclinic.com/pages/instructors/dr-leslie-pasco?srsltid=AfmBOoqEmYjR8y3SzFHFpgr-JpFWFgfyViaOItLvpazcPnDMqwDwd7w0.
• Facebook : https://www.facebook.com/DrLesliePasco/
• Linkedin:https://www.linkedin.com/in/dr-leslie-pasco-03a096a1/?isSelfProfile=false

RELATED EPISODES YOU MIGHT LOVE

• Dr. Richard Baxter on How to Know If a Tongue Tie Is Really the Problem
• Don’t Ignore the Snore: The Hidden Link Between Airway, Sleep, and ADHD

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⭐ Love the show? Leave a quick review — it means the world to me!

If Dr. Pasco's insights on pediatric breathing reframed how you analyze your complex developmental cases, please take a brief moment to leave a review! Your support helps us share these crucial airway answers with the clinicians and families who need them most.

Hosted on Acast. See acast.com/privacy for more information.

As therapists, it is easy to fall into the trap of protocol-based treatment—treating a clinical diagnosis like a strict recipe book. But true, transformative patient care requires us to step back from the "cookbook" approach and lean heavily into intentional clinical reasoning and pattern recognition.

In this episode, Hallie Bulkin takes the mic for an essential masterclass on the critical distinctions between screening, assessment, and treatment in clinical practice. She unpacks how blurring these clinical boundaries leads to stalled progress and directly impacts overall patient safety.

Hallie explores the delicate balance between structural anatomy and true muscle function, provides practical strategies for sustainable habit formation, and highlights why patient-centered decision-making is the key to successful therapy. If you are ready to confidently look at the whole patient, break out of professional silos, and elevate your interdisciplinary collaboration, this episode will completely reframe your daily practice.

Key Topics & Takeaways

• Unblurring the Boundaries: Clear, non-negotiable definitions separating screening, comprehensive assessment, and actual functional treatment.
• The Clinical Reasoning Shift: Why relying strictly on protocol-based "cookbook" therapy limits your growth as a clinician and slows down patient outcomes.
• Anatomy vs. Function: Understanding that structural differences (like a tongue-tie) are only half the battle—how the muscles actually move and compensate dictates the treatment plan.
• The Referral Strength: Normalizing interdisciplinary care and seeing specialized cross-referrals as a position of clinical strength rather than a limitation.
• Integrated Care Systems: A high-level look at breaking down professional silos to build a truly holistic, collaborative network for your patients.

Soundbites

"Screening is simply deciding if more evaluation is needed. It’s a decision point, not a roadmap for immediate therapy."

"Assessment is about understanding exactly why the dysfunction exists, looking at the entire system from the bottom up."

"Treatment is about fundamentally changing muscle function and building sustainable new habits, not just checking exercises off a list."

• 00:00:36 – Welcome to the Untethered Podcast
• 00:01:12 – Defining the distinction between screening, assessment, and treatment
• 00:02:43 – The primary purpose of a screening
• 00:06:23 – Why assessment requires clinical detective work
• 00:11:02 – Treatment: Changing function rather than just exercises
• 00:15:25 – Normalizing the non-linear path of progress
• 00:21:49 – The problem with collecting interventions without clinical reasoning
• 00:25:01 – Anatomy versus function: Why function must drive clinical decisions
• 00:30:13 – Shifting from rigid silos to integrated care
• 00:39:07 – Conclusion and final thoughts on serving patients

Links & Resources

• Fast Myo Screening Tool: Stop guessing during your intakes and download the checklist at FastMyoScreening.com.
• FREE TRAINING: Ready to bridge the gap between screening and assessment? Join the free Screen The Peds to Feed The Peds Training.

RELATED EPISODES YOU MIGHT LOVE

• Why Two Therapists Get Different Feeding Outcomes (And How to Fix It)
• Episode 145: The Missing Link In Your SLP & OT Screenings with Hallie Bulkin, MA, CCC-SLP, COM

STAY CONNECTED

💬 Join the Conversation: Catch behind-the-scenes insights, collaboration tips, and daily clinical pearls on

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⭐ Love the show? Leave a quick review — it means the world to me!

If this episode inspired you to take a closer look at the functional clinical reasoning behind your treatment plans, please take a quick moment to leave a review! Your support keeps us climbing the charts to reach the providers who need these exact answers. 

Hosted on Acast. See acast.com/privacy for more information.

When a child presents with complex speech or feeding challenges, it’s easy to focus solely on the surface-level behaviors. But true, long-lasting transformation happens when we dig deeper to look inside the mouth and assess the underlying muscle function.

In this episode, Hallie sits down with Galina Kislin, a pediatric speech-language pathologist and myofunctional therapist, to discuss her clinical journey and the shift that led her to prioritize root-cause assessments. Galina shares her experiences transitioning from Early Intervention into private practice, highlighting how a myofunctional approach became the "missing piece" for her stalled feeding and speech cases.

Together, Hallie and Galina dive into the critical importance of looking at a child from the bottom up, executing thorough oral-motor exams, and building local interdisciplinary care teams. Galina also shares actionable, naturalistic strategies to help families integrate therapy seamlessly into their daily routines without feeling overwhelmed.

About the Guest: Galina Kislin, M.A., CCC-SLP, CMT®

Galina Kislin is a bilingual (Russian/English) speech-language pathologist and Certified Orofacial Myologist (CMT®) with 28 years of rich clinical experience. Her journey began in Early Intervention, where an early exposure to oral-motor therapy ignited her lifelong passion for pediatric feeding. Over nearly three decades, Galina has served children across preschools, elementary schools, and multidisciplinary outpatient clinics.

Key Topics & Takeaways

The Missing Piece:

The Root Cause Approach:

Interdisciplinary Collaboration:

Soundbites

"Why has nobody else looked in the mouth? We cannot treat what we don't thoroughly assess."

"We need to look at everything from the bottom up. Understanding the underlying root causes completely changes your clinical outcomes."

"Therapy shouldn't feel like an extra burden for parents. When we integrate functional, naturalistic strategies into daily life, families feel truly empowered."

Timestamps

01:01 – Galina's Journey: From Early Intervention into Myofunctional Therapy

03:10 – Facing Structural Hurdles and Stalled Feeding Challenges in EI

04:46 – The Missing Piece: Embracing a Myofunctional Lens & Finding the Root Cause

09:40 – Intentional Parent Education and Functional, Hour-Long Sessions

10:58 – Crafting Naturalistic Home Strategies That Blend Into Daily Routines

14:03 – Navigating the Real-World Limitations and Rules of Early Intervention

16:33 – The Vital Importance of Thorough Oral Motor Exams Over Assumptions

24:22 – Boutique Service: Guiding Families Through the Treatment Process with Empathy

27:42 – The Clinical Value of True Root Cause Tracking (The Middle School "R" Case)

30:11 – Unpacking a Case: Speech, Feeding, and Myo Evaluation Integration

33:22 – Unlocking Speech Clarity and Intelligibility Without Traditional Targeting

37:58 – Private Practice Growth Mindset, Autonomy, and Overcoming Limitations

40:37 – Final Thoughts, Where to Connect with Galina, and Closing Resource

Links & Resources

Connect with Galina: Explore her courses and resources at www.Love2communicate.com and follow her updates on Instagram.

Clinical Assessment Tool: Easily screen for muscle patterns and oral dysfunction at FastMyoScreening.com.

RELATED EPISODES YOU MIGHT LOVE

• EP 343: Inside a Mission-Driven Pediatric Feeding Practice
• Episode 145: The Missing Link In Your SLP & OT Screenings with Hallie Bulkin, MA, CCC-SLP, COM

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