The opinions expressed by Chayo Busquets are supported by his extensive experience as a family
therapist and in the previous analysis of the cases presented here welcome, that is,
Chayo Contigo in Joya. We begin to be all very welcome here in
Chayo Contigo with this program that I have been announcing to you and that today
in the morning I put you in networks because the truth is that a super
program awaits us and we have two guests that last time you came together,
you received them in a way that we had to repeat the program at a
very close date. They' ve ordered the podcast everywhere. And the truth
is that I told my companions a long time ago my guests have already arrived
who come the dynamic do. So they said ah we' re going to
tell them the dynamic DOE, because the truth is they both have really important
resumes. And today, which is World Down Syndrome Day, we' re
going to dedicate this program to talking about the implications of Down syndrome from the
specialties of these two women. Since you' re the recent acquisition, Tita,
I' m going to introduce you first because I ali already is from
home and then give that kindness to you. Tita Miranda Meléndez is orthopedist,
skull, maxillofacial and orthodontist. She graduated from the Hospital de la UNAM del
Infantil de México, Federico Gómez and is certified by both specialties. It has
a certification in São Paulo, Brazil, in preventing malocclusions in the baby,
that is, it sounds like who knows what that truth is. Well let
' s know a little bit in Colombia. Diploma in orofacial functions for the
neurodevelopment of the child, Diploma and certification in dental medicine of sleep, bruxism
and dysfunction of temporomandibular joints post covid He has a master' s degree and
is a PhD in science As much of what is dedicated is the importance of
prenatal and postnatal dental diagnosis, in pregnant mother and in baby respiratory disorders of
sleep in the child. And, on the other hand, good to dear
Dr Joali, with whom we even spoke recently. You' ll tell us
how they did at the Fest Slip Fest. She' s involved in sleep
medicine. She is a clinical care coordinator, a PhD in biological and health
sciences from the Metropolitan Autonomous University. He holds a master' s degree in
medicine and dream physiology from the Pablo de ola Ola Vilde University in Seville,
a master' s degree in human microbiota in monk from Spain and a diploma
in polysopnography from the Mexican Society for Dream Research and Medicine. She is an
oceanologist for the Latin American Federation of Dream Societies, which is certified by a
research society in Europe related to this dream. Welcome both of you. Thank
you very much, very good afternoon to all. This waits, I hope
we leave something in you. Well it' s the day of the child
down It' s a congenital disease, it' s called trisomia twenty-
one and we know that they are very loved children and well, from what
age, since when we can detect this from the prenatal stage. We can
give that support when the gynaecologist gives the papillos that news which, of course,
is not very pleasant. But from there we can work from motivation and
prepare them emotionally for what there is much to do, much to study for
when it arrives. That one should give you the best attention in the medical,
psychological and mainly affective aspect and what it is, love. And we
have many things to do to guide that growth and development the most harmonious,
the most functional and for a better quality of life, without any doubt.
No doubt, thank you very much, Tita. The reality is that a
joali impact does not receive such news definitely because I greet first of all all
those who listen to us. Thank you very much for the invitation. I
' m always delighted to be here on your show and, yes, today,
the idea is to talk a little bit about sleep disorders in this population,
in patients with down syndrome. Indeed, then, a strong news,
but as well says, tita with a proper accompaniment, not a orientation,
We can greatly improve the quality of life of the patient with Dawn syndrome as
well as the family. No and from my trench, because if we get
the patient to sleep well, also to have a positive impact on the whole
family, without any doubt, today they asked me three questions that I shared
on social networks. You knew that establishing normal orofacial and nasal functions improves the
quality of life of the Dan child. We can intervene for these functions of
these little ones and why the dream in the Dawn child is affected. Let
' s get into matter what are normal orofacial and nasal functions. What'
s that good. All humans have these functions that are basic, which are
nasal breathing, deglusion, suction, chewing and sleep, all two. This
is going to reverberate into a good dream. That of tarme, swallowing,
swallowing the breath is just inhaling and exhaling through the nose or aha. Chewing,
which should be bilateral and alternating when already have teeth babies ok and that
starts at six months with complementary feeding and and what sleep is. All this
is going to reverberate into the dream. So, if one of these functions,
mainly what is breathing and declusion, that are affected in this type of
patients, of these little ones, if these two begin to work since they
are born, they are going to damage all the other functions and they are
going to have alterations in their sleep and in their neurodevelopment. Okay now,
jolly, why those two are so important, I say in all, but
in a child it consumes clearly that yes, well look. There are several
factors. Let' s not leave after birth, once the little ones with
daun syndrome are born they have this hypotonia characteristic of the first few weeks signs
is of life, which have the muscle tone very very relaxed. I mean,
they don' t have the same strength. This hypotonia will make it
very difficult for them to breastfeed and get breast milk. And we already know
what we talked about last time how the process of feeding us mother' s
milk will strengthen many of the muscles and it will help to generate this proper
structure so that a baby breathes through the nose not and can swallow. And
all this that tells us is also another characteristic of these patients who have this
apparent hypoglosia. They have a very large, apparent tongue because they actually have
a deficiency in maxillary development. But this makes or locates a little little constanned
even as you see it I am with open mouth yes and with the law
or outside you can see their tongue, because it does not fit them.
Then this big tongue also makes them impossible. They are very complicated, both
breathing and breastfeeding. Not when I was being nursed, because it completely sticks
to the mother' s breast and has to breathe through the nose and swallow
not practically at the same time. Time if you can' t do this,
then start making it difficult. And what unfortunately usually happens, is that
we just give up. Not that we want to try, because it is
very exhausting both for the baby and for the mother, not the not achieving
this attachment to the maternal feeding, then it is like good, because I
give it formula And unfortunately, because this will have repercussions in the medium and
long term for this not vitor. Also, remember that little kids with Dawn
syndrome can have congenital heart disease and then a respiratory disorder during sleep alone already
presents us with a cardiovascul risk So, imagine if they also have this heart
disease factor, because in reality we have to get the kids with syndrome to
breathe properly not have respiratory disorders during sleep, because thus we will reduce the
risk to the heart that is in itself a population that already has a risk
to the heart. No. And finally, the theme as neurodevelopmental learning behavior.
We don' t already know that in neurotypical children, that is,
they don' t have down syndrome, because if they don' t sleep
well they' re going to have delayed development in learning they' re going
to be aggressive. The same is going to happen in a patient with down
syndrome that in addition, are characteristics that by their own syndrome already suffer.
Not then are they going to exacerbate this delay in neurodevelopment ok tita. At
the time a baby is born, parents have previously known or are not born
with down syndrome. The first tensions have to go in this sense of breathing
and the handling of your tongue. Yeah, well, like Joali said,
his muscles are flaccid. Aha We already call Him hypotonics by the term that
it is already a central problem. But we can work that muscles both facial
the chewing muscles from that first birth precisely so that it has and breastfeeding plays
a very important role there for that development and that language we have to place
in the normal position for everyone, which is the tongue on the palate.
That same language is going to be an organ that will help your palate grow,
but also that that face that they have eh they specific as submissive,
allows a forward and transversal development so that you can have a change to those
characteristics that you usually have that it is better. And then there are patients
who have been cared for from birth to adolescence and have their faces changed.
These facial characteristics are not so accentuated, that is, it helps part of
the function, it helps its facial harmony and therefore, that gives some and
realize others, to the same dads, they realize that facial change, which
is aesthetic and also has to see eh for their social environment. No doubt
about it. Well, let' s talk about the dream, as we
said, all these skills and how they get better. And we had another
question over here that we' re going to talk about. You knew that
early attention helps your facial development and growth and neurodevelopment by improving facial traits.
What were you saying? Yes and, therefore, impact needs social life.
So we always have to look for the integral. And since I' m
going in full to see I came out a little bit you' ve already
made it perfectly clear to us in many programs that the dream has a shocking
impact on people' s lives. It doesn' t have to be that
we do when we finish all our earrings, but it would have to be
part of the to- do list and fulfill its hours. And the last
time they came, they were both talking about how that' s impacting the
whole development of the children. Why, in particular or here we would have
to with children with symnomes give a greater emphasis on sleep. Of course,
Ochayo, because look at dendr I would tell you because they have more sleep
disorders. If we compare a neurotypical population with children with dao syndrome, we
will realize that there is a greater complaint about their way of sleeping. What
' s most important is insomnia. They are not little ones who cannot sleep
mostly intermediate insomnia which means that they are waking up many times throughout the night.
They will also have, as we already wish at the beginning, respiratory
disorders during sleep that will condition them to have a lot of drowsiness during the
day. Remember that if we' re snoring, if we don' t
breathe well, we' re not really resting and then in the day these
patients are going to refer to a lot of somnolence. And well, finally,
we' re also going to see circadian rhythm disorders. There are many
patients who are sleeping at inadequate times, especially if they may not be in
school, who are fortunately more and more already in school. That' s
a huge breakthrough. Our society before, because you will remember that it was
not so, they did not have at home and then not having fixed activities
combined with that they have alterations in the liberation of Melatonin, because it also
makes this particular population have rhythm disorders, that is, they sleep at absolutely
inadequate times. No, in addition to that part of his behavioral characteristics includes
some features such as obsessive compulsive disorder. Then they are patients who start drawing,
for example, No and suddenly, because they don' t want to
stop doing it. And then the parents, because they also say well,
nothing happens that entertained. All right, he likes it He enjoys it.
No, and suddenly, then, we see patients sleeping at 3: 00
in the morning and waking up at 1: 00 in the afternoon. Not
all of this, in the end it' s going to be that sleep
isn' t normal and that these little ones don' t get all the
benefits of sleeping properly. So we know that, because of the characteristics of
the syndrome, they' re going to be delayed in neurodevelopment. For example,
the acquisition of language is going to be late, they will also walk
a little bigger all in general the milestones of neurodevelopment that we normally measure in
newborns until the first years of life, because they will acquire it yes,
but a little later. If you have joined this, we add that you
sleep badly. We have already talked about how when we do not sleep well,
we affect our development. We affect the way our brain grows. Remember
that during sleep new neurons are generated and these new neurons are connected in order
to learn. No, then, if these patients don' t sleep well,
in particular, the delay in neurodevelopment is going to be even more severe
and the behavior isn' t a little too. They are also patients who,
suddenly, may be a little more intolerant, more irritable, even in
some cases, may be a little more aggressive when they are very tired.
No. And so, finally, if they cannot sleep, because this intolerance
will be exacerbated, then it must be resolved. Of course, Tita,
yes, I' m getting it right, and what I said to us
alli in one of the previous segments, this impression that people have when we
meet a child council doesn' t give me that the language is very big.
He was actually telling us it has nothing more to do with that structure
and I don' t know what the right way is. You' ll
say, it' s not wide enough for the tongue to fit everything.
A child with Dawn syndrome is going to have these characteristics. Yes, those
characteristics, because, as we know, they have the eyes of a type
of almond, which is the part of the middle third, which is below
the eyes. The lower third is submerged, there is a sinking, a
lack of development and also a nose where it is from the in intrauterine stage
and through ultrasound there is a flattening of the bones proper to the nose that
this from there, therefore, will affect that breath. So, these characteristics
of lack of development of the maxilla will affect both the functions that we commented
on and by not having this maxilla in front of the jaw. As is
normal, the jaw is the lower part. Sometimes, when inverted, that
maxilla is trapped, that middle third and the jaw develops and the upper part
is behind. So that' s gonna affect the fact that there' s
no good breathing. In other words, you can see how prognates are seen,
even sometimes a prognatism or pseudo prognatism develops. So, the earlier we
start that job since we were born, from day one. We should work
with neoanatologists to give this counseling, these stimuli, these functions of more of
the soro facial and chewing muscles from that stage to precisely go guiding that,
monitoring that growth and development so that it reaches the function as normal as possible.
And if children have arrived that young twelve years, they started from neonates,
where they have a facial harmony, a good chewing, good declusion,
suction, a lip seal where there is no exit of saliva, where the
tongue is in place, which are valves. We have in our facial cavity,
facial valves that allow air in and out. So there' s also
a device that just came out, where it handles all those valve functions and
has them in order, we' re going to monitor that growth and development
to the teen Tter. I' m a mother child down syndrome. My
baby was born and beyond what is, offer me medical service or not.
I have to be careful here. Yeah, well, yeah, it'
s a job here. Ideally, they should go to counseling, Dad and
Mom, because they' re the ones who are going to do all this
work and they' re going to motivate that little one. You have to
start from day one, as I had already commented, on what else I
will observe in my little one with whether the child squeezes or grumbles the teeth
we call bruxism. It' s not normal. Here we see that it
is a problem of the central nervous system and here there are factors that predispose
it. One breathing through the mouth, two that may have gastrointestinal alterations,
such as chronic gastroesophageal reflux that also causes bruxism. Yes and besides, because
the stress is true, then that will cause micro awakenings or night awakenings that
will affect your sleep. So, there' s an alarm tip. What
do we have to do as parents if they are in the prenatal stage and
already told them, because they should not take advice to an prenatal dental diagnosis
beyond the teeth where they will be informed what care they should have to go
preparing for the baby to arrive in a harmonic space. Two of us have
to encourage breastfeeding and, together with the neonatologist, work with various disciplines.
Nothing else here is the function of one. We have to work transdisciplinaryly or
torino, gynecologist, pediatrician and sleep medicine and we, as orthopedists and others.
So, uh, get those functions back by sealing his lips. There
are some exercises that we have to tell parents if they are giving them maternal
dose, do a smooth movement of the chin and raise it when they are
sleeping, so that that tongue has that seal on the palate that negative suction
pressure and that same tongue gives function to it to develop, seal its lips
gently, so that that muscle, which is like a donita the orbicular of
the lips, has a better seal and does not allow saliva, saliva outflow,
milk or food. All this is patience, because it is a slow
job, but it gives very good benefits. Em also these children who do
not sleep for this, this bruxism, since they have teeth, is going
to damage so the teeth, muscles and temporomandibular joint and this generates pain,
and that pain also generates awakenings and affects their sleep. So E, Dr
Joalice is going to comment on this problem ahead. I of course, well,
uh, I think the main point is to try to do and to
have all the tools that can help us make the forecast better. No.
However, well, despite this, because suddenly or already they are very big
and the answer is no longer the same. Or anyway, though less severe,
because these little ones are going to grow up and have some other sleep
disorder or the same breathing disorder during sleep. Then what do we have to
be alert to? Well, if I see that my child is very sleepy,
very agitated, not to say that she is moving a lot, that
she has sudden sudden sudden movements that she feels asleep. Not all of these
are movements that indicate that he may be, he may not be breathing well
at night, he may not be and he is changing his position, even
to sit down, because it helps them breathe a little better. Of course,
if he snores not this we' ve always been saying it. Broken
is not normal at any age, no one, no one, no light
or anything. So, well, if my little boy is snoring, then
I know there' s a respiratory disorder I need to attend to. If
you sweat a lot, if you pee at night, not if you don
' t have this Sfinter control. It is also related and we have other
treatments that, although they are no longer preventive, because we will correct this
mnea of sleep and we have to talk about them also now like what we
have to do, what we have to avoid and what we have to do
to maximize the development that each child given Now yes, that has given his
syndrome of gives a personalized not that it can reach, that it cannot reach,
but then within what it can achieve, that reaches as much as it
can definitely and then looks just before the Court. We talk that sometimes they
will need more specialized treatments to correct sleep disorders particularly children, adolescents and adults
with down syndrome are patients who are candidates to use these positive pressure equipments that,
perhaps they have ever heard them as if paps that are these equipment that
help us breathe while we are asleep. It is a mask that is placed
in the nose, ideally only in the nose, because you know that we
promote nasal breathing, but there are also masks that cover nose and mouth and
that connect to a team that makes air under pressure. It' s not
oxygen, because it doesn' t have any restrictive problems, but it blows
air in such a way that, mechanically, the airway is prevented from being
obstructed while we' re asleep. It is very important that we consider many
patients with Down syndrome. They' re going to have to use this equipment
to sleep, but once they use it, it completely corrects the snoring of
the mnea. They are going to rest better this drowsiness that I mentioned earlier,
because it will diminish or even disappear. Then you will have more energy,
more willingness to do things better, enthusiasm, mood, etcetera. So
it is necessary to consider and also consider possible plans, possible surgical treatments to
correct sleep m, not like, for example, migdallectomy, which is one
of the techniques that is most used in children to correct sleep m obstructive.
You have to be open to these possibilities, because that can change your life,
not as if you' re talking good sleep, it changes everyone'
s life and more patients. With this type of syndromes no yes, no
doubt, eh what would you complete to estotita in relation to what to do
or that you have to avoid doing good and what we have to do the
nazar washing From little ones and even the otorrinos handle a nasal wash and bigger,
teach them to give it the function of the nose, teach them to
blow their nose and that out there they must inhale and exhale the other.
E. This is becoming a habit. And we send signals to the brain
because we have a neuroplasticity so that the child becomes aware that the breathing is
nasal and not vocal. Chewing is fundamental in them and in the typical ones.
One more throw of hard, fibrous foods, uh, not soft,
because we do a lazy chewing. And then this bilateral, alternating, fibrous
chewing is going to be for the muscles of chewing and facial muscles to develop
properly, which are going to allow it to have a greater lip seal.
So in them that have these flaccid muscles, because it' s more fundamental
than not us, right, then that' s going to have a seal
on uh, the lipstick and no food, no milk, no saliva.
And the other, the tongue at rest, must be on the palate.
Yeah, and that same tongue on the palate is gonna make this salt breath
more effective. Coming back from the good cut, not from the music cut
we have right now, uh, how it helps a mom, a dad,
a kid when she realizes he' s asleep and has his tongue down
and good at almost closing the TITA program. What would you add to what
we have been commenting on, because we need to raise awareness not only about
children but about most of our children. We have to have a great job
as dads so they have a good breath and a good sleep. This will
help neurodevelopment and its quality of life. We' ve been programming since we
were pregnant, that organ formation, including the brain, the system, respiratory
digestive. We have all this that we have discussed in this session. We
have a lot to do because they are the future adults who are going to
be snorers, who will be able to predispose to diabetes, hypertension, pro
cardiovascular problems, vascular brain. Then you have to give him that courage.
Our country is not yet conscious. We see these undervalued topics and hopefully,
let us pay a lot of attention from pregnant women to older adults. That
' s Joali, so look, I' d like to share two ideas.
The first is to seek help. Not if they' ve already had
a prenatal diagnosis, and they' ve been told that their baby has down
syndrome. I think it' s good to start looking for groups, looking
for medical help, getting informed, because, if we know it well,
if it' s sometimes not easy with neurokinetic babies, then imagine when there
' s a special syndrome. We don' t talk much about breastfeeding,
but sometimes I insist with neurotypical children, it' s not easy to breastfeed
and sometimes, because we decided to change it for formula, then imagine a
mother who is even more difficult to achieve breastfeeding with a baby down syndrome than
in addition, because she feels this obligation to feed her by this way to
avoid future problems. The stress this can bring we have to be very empathetic.
It is not easy and the reality is that there are many people who
can guide them. You can help us from breastfeeding counselors to neonatologists who can
offer us this information that we don' t have at hand and alone sometimes
we can' t and you go to get help. And my second very
quick point is although respiratory disorders in children with down syndrome are the most frequent.
There are other sleep disorders. There is a lot of insomnia, many
bad sleep habits that with a fairly simple behavioral intervention, that we work directly
with parents, we can see radical changes in patients' behavior. Then also
approach to look for sleep specialists to advise you according to what number you are
found in. In fifty- five, forty- three, ninety, seventy
- six, sixteen and fifty- five, thirty- four, fifty-
five, seven, one, five, perfect. We' re putting it
on social media. As always joali where they find you. Sure, I
' ll give you the phone from the Sleep and Neuroscience Center. Remember that
there we have all the sleep medicine specialists that are required. It' s
fifty- five, six, three, twenty- six, nine hundred,
nine, four, six. For I thank them as always for their willingness
to come to the program, because they are subjects to follow and follow and
continue and continue to play and raise awareness to know, above all, and
if you have a syndrome, it gives a good fence, because knowing that
it is not that it was born and so it stays. We cannot enhance
its development much more so that it has a much better quality of life.
So I thank you infinitely and I leave you today and have a very good
profit. We hear each other here tomorrow, tomorrow, Friday, the last
day of school and, therefore, from today, a lot of patience for
tomorrow until then. Audio Central