Episode 47: Pediatric Wellness & Tongue Ties with Dr. Pejman Katiraei

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Families call him Dr. K., and on today's episode we have Dr. Pejman Katiraei to talk about a holistic approach to pediatrics with a focus on tongue ties. Specifically, we're discussing the domino effect they cause later in life--including failure to thrive, oral aversions/extreme picky eaters, sleep apnea, development of palate, and even what looks like ADHD and anxiety.

Dr. K graduated from his residency in 2006. From 2004-2005 he realized there has to be more to the story than what he was trained to do. He was fortunate to see a lot of complex cases, great training, but saw things that didn’t add up. One particular case was an 8-10 year old boy who had horrible colitis. Steroids didn’t work and doctors wanted to remove colon. Ultimately he knew there was more to the story than a major surgery.

Dr. K is an integrative pediatrician, with a focus on severe behavioral issues in children. He works with more than just diet, the gut, and supplements because his clinical experience has taught him that only 25% of kids got better with that approach. He was really awoken to what happens in the mouth 4 years ago.

Digestion begins in the mouth—chewing, breaking it down, swallow begins there. If you don’t know how to chew your food, how does the rest of digestion work? It’s not meant to work with unchewed food. The pancreas’ job isn’t to chew food—it’s to take already broken down food and further unpack that. Tongue tied children cannot chew food well (rotary chewing is lacking).

Can the child take a chunk of steak and chew it? If not, they have a “broken eating mechanism”. If eating is difficult or something isn’t happening properly, your brain learns those foods are dangerous. Then you have a picky eater.

Poor digestion and food intake means a lack of micronutrients, lack of fiber, changes in gut microbiome, lack of diversity. The immune system then becomes activated to these foods because they’re not more digested by the time they hit the gut. This ultimately causes a phenomenon known as “sickness behavior”—this is the brain’s response to immune activation—brain fogginess, feeling “sick”.

Once these kids are labelled with ADD, AHHD, depression, or anxiety, they lose their self-esteem and feel like they cannot function normally.

When parents know what to look for, it will become clear as day:

  • difficulty breastfeeding, sometimes shows up later once letdown calms
  • something is off early on
  • solid foods, from 12-24 months old other issues crop up—spitting out certain textures, higher density foods create struggles
  • 3-4 years old become very picky eaters, very established food preferences—soft foods that barely require chewing
  • colic/reflux—swallowing air, gassy—tissue pulling on esophageal sphincter causing reflux
  • difficult to put to sleep
  • speech problems

We shouldn’t approach this from fear or “doom and gloom”—tongue tie isn’t a damning diagnosis. How you approach this depends on how preventive you want to be. Tongue tie procedures are a surgery—risk/cost benefit.

What is it worth to prevent these issues? We must honor where the parents are at and supporting their choices and needs.

Lastly, the tongue helps us breathe—it pushes the palate and teeth out. Choking, gagging, snoring can all be related issues, and later in life we see sleep apnea or upper airway resistance syndrome.

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