Your child is a real go-getter; maybe they’re a straight-A student or a star athlete. Lately, though, they have trouble breathing during very inopportune times, like before a test or a big track meet. You have seen their primary care doctor and you have seen a pulmonologist. Maybe they are put on an inhaler, but it doesn’t seem to be working like you hoped. So what’s going on?

Have you heard of vocal cord dysfunction? Well, there is a new name for it: exercise-induced laryngeal obstruction (EILO) and inducible laryngeal obstruction (ILO). That’s a mouthful.

Whenever there’s a “trigger” (i.e. exercise, stress, certain odors), the vocal cords narrow and it feels like you can’t get a good breath in no matter what you try to do. It isn’t life-threatening because your vocal cords are actually still open, but they aren’t open enough to fill your lungs. It’s scary. Your child is panicking and now you are, too.

What are the symptoms of EILO/ILO?

• Chest/throat tightness
• Difficulty inhaling
• Noisy breathing
• Shortness of breath

That sounds an awful lot like asthma, doesn’t it? You’re right; EILO/ILO and asthma sound very similar, but there are a few differences. Let’s compare the two:

You have ruled out asthma with your physicians and ruled in EILO/ILO. 

What do we know about EILO/ILO?

Onset can occur at any age, but most commonly, EILO and ILO are diagnosed in 12 to 18-year-olds.

It is most prevalent in our young athlete population and it can lead to anxiety about playing sports because of the fear of not being able to breathe. The same thing can happen around stressful situations like an upcoming AP history test or a choir performance.

Speech Therapy

What can be done to help these kids get back into their sports, extracurriculars, and high-demand classes? Speech therapy and/or physical therapy is the answer! And it’s all about breath.

With speech therapy, we look at how the child is breathing and teach them a variety of strategies to make their breathing more efficient.

We work on rescue breathing techniques that will blow the airway open during an active EILO/ILO episode as well as preventative breathing strategies that will keep the airway open during exercise or stressful activities. We also focus on diaphragmatic breathing or belly breathing, so the child can optimize the amount of air they are getting into their lungs at rest and during physical activity.

With physical therapy, we can look at the athlete’s movement patterns, posture, endurance, and strength that may be impacting their breathing. Oftentimes, stiffness or weakness through the trunk and core changes a person’s breathing pattern, causing them to have difficulty controlling their breath (especially during high-intensity activities).

This can lead to increased fatigue, tension around the neck and/or shoulders, and EILO symptoms. Another area of focus is cardiovascular endurance training to avoid the feeling of “hitting a wall” during exercise.

Through guided exercises, improvements can be achieved by reducing compensations or our body’s way of cheating through movements, training the proper muscle groups, and supporting proper muscle use and form during athletic movements.

What is the common goal? To give the child the skills they need to get back to the activities they love. If your child is experiencing any of these symptoms, reach out to their primary physician to discuss a potential referral to an ENT (otolaryngologist) or pulmonologist for further diagnostic testing.

As a child, Rousey was diagnosed with Childhood Apraxia of Speech (CAS), a motor speech disorder. In recent interviews Rousey reports struggling with feeling of insecurity and inferiority following her diagnosis of CAS. During Rousey’s early years, there was question as to whether she would ever be able to use conversational speech. But with perseverance, intervention, and encouragement from her speech therapist and family, Rousey is now a well-spoken adult with a message to children with CAS: anything can be overcome with hard work no matter how insurmountable the odds seem.

Children with CAS have problems saying sounds, syllables and words in the absence of muscle weakness or paralysis. Basically, the brain has trouble telling the body parts necessary for speech how to move in order to form speech. Children diagnosed with CAS don’t follow normal speech sound development and won’t “catch up” to their peers without intervention.

So what causes CAS? Unfortunately, in most cases we don’t know. CAS is a motor speech disorder, meaning something is interfering with the brain’s ability to tell the mouth muscles how to make the right sounds. Possible causes include genetic syndromes, stroke, or brain injuries or abnormalities. While there is no cure, we know miraculous progress can be made given skilled intervention.

Not all children diagnosed with CAS will present the same way, but diagnostic signs or symptoms do exist. A child with CAS:

• May not babble or coo very consistently during infancy.
• Uses very few consonant and vowel sounds and has a hard time combining sounds to form words.
• Understands much more than he can tell us.
• May say a word clearly once or twice, but then doesn’t say it again.
• Struggles to imitate speech models. You may even be able to see him groping or struggling to coordinate his mouth when trying to talk.
• Has more difficulty saying long phrases and sentences than short ones.
• May have choppy speech with long pauses between sounds.
• Can be very difficult to understand, especially if you aren’t familiar with his speech patterns
• May have some difficulty eating

If this sounds like your child, an evaluation by a speech-language pathologist is imperative. A skilled therapist will help determine the best course of intervention. All children are so very unique, and therefore, treatment plans will be custom created based on several factors, including age, severity, and of course, your family’s schedule. However, research shows children diagnosed with CAS have a greater likelihood of success if they:

• Receive frequent and intensive intervention (think 2-4 sessions per week in a perfect world). It’s important to remember the age and tolerance of your little guy when scheduling therapy. Four sessions a week may be too much for him.
• Have the opportunity to work one on one with their therapist.
• Are exposed to a “multi-modality” approach to intervention. This is just a fancy way to say using many different cues and strategies to help them create the sounds, including touch (helping him move his lips to say “pa”), visual (looking in a mirror), and proprioceptive (pairing movement with sounds) cues. These kiddos need to learn and remember HOW to move their speech muscles so your therapist may encourage them to repeat a word or syllable many times.
• Practice, practice, practice at home! Even an intensive therapy program will give your child 3-5 hours a week AT MOST with his speech therapist, meaning he has 163-165 hours per week OUT of therapy room. Use those hours wisely and carve out time to practice everyday to see progress!

Resources for families:

Apraxia-kids.org

References:

ASHA.org - Childhood apraxia

*Photo from Ronda Rousey's Facebook page.

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

The obsessively clean freak with a dozen napkins at meals and the dust pan and broom standing by! I see the crumbs falling to the floor, the grape jelly graze the side of the chair, and the sticky fingers raking through the hair as my daughter enjoys her meal.

As a feeding therapist, I know as her skill in feeding develops so will the awareness of her fingers, hands, face and mouth. 

I MUST wait until she is finished before I attack with my arsenal of cleaning supplies. Sitting with her, eating with her, and having fun with her while she explores her dinner are the best things I can do as a parent.

Maybe you’re wondering, “Will my walls always be covered in food splatters?” or “Why does she continue to refuse foods I know she should be eating to have a well-rounded and varied diet?” “Does everyone’s baby require a bath after each and every meal?” “Is it normal for more food to be in her hair than in her mouth?”

Take comfort, mama. You are not alone in your exasperation when it comes to feeding your child while trying to maintain some semblance of tidiness in your kitchen.

Did you know that a baby’s mouth and hand have the highest number of sensory receptors per square inch than any other part of the human body?

That means the mouth and hands are the most sensitive parts of the body when it comes to what the brain can take in and learn.

So what does this all mean for your dinner table? Put away the fine china and good linens and get ready to embrace the mess. Researchers in the UK "found that playing with food may actually help kids overcome a fear of new flavors and eat a more varied diet, a small study suggests."

Children need the chance to explore new foods and textures with all five senses. In a perfect sensory world, your little one should have the opportunity to touch, smell, and taste new foods unabashedly. So, set the paper towels aside and join in the fun!

Your child will “learn” both good and bad habits depending on the mealtime experiences they are afforded.

For instance, if your child is given peanuts and experience an allergic reaction, he will most likely begin to refuse peanuts!

Alternatively, if broccoli and green beans are offered during a family meal in a way that is fun and supportive, you might find your little guy eating them with gusto! But, don’t be disheartened if he turns his nose up at beets the first time you present them.

Research has shown children may instinctively refuse new foods to survive simply because they are new. In addition, it can take up to 15 presentations before a food is deemed worthy in your child’s eyes. However, with good exposure, no illness or bad consequences, and repetition, children will learn many foods are safe to eat!

What can you do to help your child become a magnificently messy and healthy eater?

1. Make meal times a routine at the table, in their chairs, with NO distractions.
2. Allow your child to explore the foods that you’ve given him with the opportunity to say, “I don’t like this” without consequences.
3. Don’t set your sights on the spoon: allow him to eat with his hands!
4. Let him PLAY! Think finger painting with yogurt or building a tater tot tower.
5. Relax while he digs in and gets his hands dirty. He is learning about the different properties of the foods we eat when he touches, smells, tastes, and looks at the foods that are on his plate.
6. Keep offering the foods you desire him to eat. Remember, experts have found it may take your child 15 times of trying a food to decide how they really feel about it.
7. Lead by example! Tuck into the meal with your child. It is important for our littles to see us eating the same things we are asking them to eat.
8. Try to have as much fun at the table as possible while still enforcing the rules of “manners”. Talk about your day, talk about your food, smile, laugh, and make faces in your cheese. 

Your child may not have developed the oral motor or sensory skills to support a healthy, well-rounded, adult-like diet. Be on the lookout for the following feeding “red flags”:

• Drowsiness or sleepiness at every feeding.
• Poor oral tolerance (spits food out, shuddering, gagging, vomiting)
• Able to chew but prefers liquids
• Frequent gagging
• Coughing and/or choking

If one or more of these signs describes your child, consider talking with your pediatrician about your concerns and a possible feeding evaluation.

Satter, E. (1987). How To Get Your Kid To Eat…But Not Too Much. Boulder, CO: Bull Publishing Company

About the author

Melanie Van Noy is a speech pathologist at Cook Children's.Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.