WEBVTT 1 00:00:00.160 --> 00:00:06.400 The opinions expressed by Chayo Busquets are supported by his extensive experience as a family 2 00:00:06.839 --> 00:00:12.119 therapist and in the previous analysis of the cases presented here welcome, that is, 3 00:00:12.400 --> 00:00:21.000 Chayo Contigo in Joya. We begin to be all very welcome here in 4 00:00:21.199 --> 00:00:25.679 Chayo Contigo with this program that I have been announcing to you and that today 5 00:00:25.839 --> 00:00:33.840 in the morning I put you in networks because the truth is that a super 6 00:00:33.880 --> 00:00:38.079 program awaits us and we have two guests that last time you came together, 7 00:00:38.240 --> 00:00:43.280 you received them in a way that we had to repeat the program at a 8 00:00:43.280 --> 00:00:47.240 very close date. They' ve ordered the podcast everywhere. And the truth 9 00:00:47.280 --> 00:00:52.280 is that I told my companions a long time ago my guests have already arrived 10 00:00:52.439 --> 00:00:56.159 who come the dynamic do. So they said ah we' re going to 11 00:00:56.240 --> 00:01:04.200 tell them the dynamic DOE, because the truth is they both have really important 12 00:01:04.200 --> 00:01:08.920 resumes. And today, which is World Down Syndrome Day, we' re 13 00:01:10.519 --> 00:01:15.159 going to dedicate this program to talking about the implications of Down syndrome from the 14 00:01:15.239 --> 00:01:23.319 specialties of these two women. Since you' re the recent acquisition, Tita, 15 00:01:25.120 --> 00:01:30.640 I' m going to introduce you first because I ali already is from 16 00:01:30.760 --> 00:01:34.120 home and then give that kindness to you. Tita Miranda Meléndez is orthopedist, 17 00:01:34.359 --> 00:01:41.280 skull, maxillofacial and orthodontist. She graduated from the Hospital de la UNAM del 18 00:01:41.319 --> 00:01:46.120 Infantil de México, Federico Gómez and is certified by both specialties. It has 19 00:01:46.239 --> 00:01:51.280 a certification in São Paulo, Brazil, in preventing malocclusions in the baby, 20 00:01:52.239 --> 00:01:55.439 that is, it sounds like who knows what that truth is. Well let 21 00:01:55.480 --> 00:01:59.640 ' s know a little bit in Colombia. Diploma in orofacial functions for the 22 00:01:59.680 --> 00:02:05.480 neurodevelopment of the child, Diploma and certification in dental medicine of sleep, bruxism 23 00:02:05.560 --> 00:02:12.840 and dysfunction of temporomandibular joints post covid He has a master' s degree and 24 00:02:13.599 --> 00:02:17.479 is a PhD in science As much of what is dedicated is the importance of 25 00:02:17.560 --> 00:02:24.080 prenatal and postnatal dental diagnosis, in pregnant mother and in baby respiratory disorders of 26 00:02:24.080 --> 00:02:27.680 sleep in the child. And, on the other hand, good to dear 27 00:02:28.240 --> 00:02:31.560 Dr Joali, with whom we even spoke recently. You' ll tell us 28 00:02:31.560 --> 00:02:38.159 how they did at the Fest Slip Fest. She' s involved in sleep 29 00:02:38.199 --> 00:02:43.919 medicine. She is a clinical care coordinator, a PhD in biological and health 30 00:02:43.960 --> 00:02:47.759 sciences from the Metropolitan Autonomous University. He holds a master' s degree in 31 00:02:47.800 --> 00:02:53.319 medicine and dream physiology from the Pablo de ola Ola Vilde University in Seville, 32 00:02:53.520 --> 00:03:00.520 a master' s degree in human microbiota in monk from Spain and a diploma 33 00:03:00.520 --> 00:03:02.599 in polysopnography from the Mexican Society for Dream Research and Medicine. She is an 34 00:03:02.639 --> 00:03:08.560 oceanologist for the Latin American Federation of Dream Societies, which is certified by a 35 00:03:08.599 --> 00:03:15.199 research society in Europe related to this dream. Welcome both of you. Thank 36 00:03:15.280 --> 00:03:20.319 you very much, very good afternoon to all. This waits, I hope 37 00:03:21.000 --> 00:03:28.159 we leave something in you. Well it' s the day of the child 38 00:03:28.639 --> 00:03:35.680 down It' s a congenital disease, it' s called trisomia twenty- 39 00:03:36.919 --> 00:03:40.719 one and we know that they are very loved children and well, from what 40 00:03:42.759 --> 00:03:45.319 age, since when we can detect this from the prenatal stage. We can 41 00:03:45.360 --> 00:03:50.400 give that support when the gynaecologist gives the papillos that news which, of course, 42 00:03:50.639 --> 00:03:57.560 is not very pleasant. But from there we can work from motivation and 43 00:03:57.759 --> 00:04:02.120 prepare them emotionally for what there is much to do, much to study for 44 00:04:02.159 --> 00:04:08.759 when it arrives. That one should give you the best attention in the medical, 45 00:04:10.159 --> 00:04:13.400 psychological and mainly affective aspect and what it is, love. And we 46 00:04:13.439 --> 00:04:16.920 have many things to do to guide that growth and development the most harmonious, 47 00:04:17.279 --> 00:04:21.399 the most functional and for a better quality of life, without any doubt. 48 00:04:21.600 --> 00:04:27.120 No doubt, thank you very much, Tita. The reality is that a 49 00:04:27.240 --> 00:04:32.519 joali impact does not receive such news definitely because I greet first of all all 50 00:04:32.600 --> 00:04:35.160 those who listen to us. Thank you very much for the invitation. I 51 00:04:35.199 --> 00:04:39.839 ' m always delighted to be here on your show and, yes, today, 52 00:04:40.000 --> 00:04:44.800 the idea is to talk a little bit about sleep disorders in this population, 53 00:04:45.079 --> 00:04:48.879 in patients with down syndrome. Indeed, then, a strong news, 54 00:04:49.319 --> 00:04:55.040 but as well says, tita with a proper accompaniment, not a orientation, 55 00:04:56.040 --> 00:05:01.399 We can greatly improve the quality of life of the patient with Dawn syndrome as 56 00:05:01.439 --> 00:05:05.319 well as the family. No and from my trench, because if we get 57 00:05:05.360 --> 00:05:10.480 the patient to sleep well, also to have a positive impact on the whole 58 00:05:10.480 --> 00:05:17.800 family, without any doubt, today they asked me three questions that I shared 59 00:05:18.199 --> 00:05:26.839 on social networks. You knew that establishing normal orofacial and nasal functions improves the 60 00:05:26.879 --> 00:05:30.240 quality of life of the Dan child. We can intervene for these functions of 61 00:05:30.279 --> 00:05:38.720 these little ones and why the dream in the Dawn child is affected. Let 62 00:05:38.720 --> 00:05:46.319 ' s get into matter what are normal orofacial and nasal functions. What' 63 00:05:46.319 --> 00:05:50.920 s that good. All humans have these functions that are basic, which are 64 00:05:51.319 --> 00:06:00.199 nasal breathing, deglusion, suction, chewing and sleep, all two. This 65 00:06:00.279 --> 00:06:02.279 is going to reverberate into a good dream. That of tarme, swallowing, 66 00:06:02.720 --> 00:06:09.240 swallowing the breath is just inhaling and exhaling through the nose or aha. Chewing, 67 00:06:10.040 --> 00:06:13.839 which should be bilateral and alternating when already have teeth babies ok and that 68 00:06:14.000 --> 00:06:20.920 starts at six months with complementary feeding and and what sleep is. All this 69 00:06:21.040 --> 00:06:25.519 is going to reverberate into the dream. So, if one of these functions, 70 00:06:25.600 --> 00:06:30.199 mainly what is breathing and declusion, that are affected in this type of 71 00:06:30.240 --> 00:06:36.079 patients, of these little ones, if these two begin to work since they 72 00:06:36.120 --> 00:06:42.360 are born, they are going to damage all the other functions and they are 73 00:06:42.439 --> 00:06:46.439 going to have alterations in their sleep and in their neurodevelopment. Okay now, 74 00:06:46.720 --> 00:06:55.000 jolly, why those two are so important, I say in all, but 75 00:06:55.040 --> 00:06:59.279 in a child it consumes clearly that yes, well look. There are several 76 00:06:59.279 --> 00:07:02.879 factors. Let' s not leave after birth, once the little ones with 77 00:07:02.959 --> 00:07:09.439 daun syndrome are born they have this hypotonia characteristic of the first few weeks signs 78 00:07:09.439 --> 00:07:13.120 is of life, which have the muscle tone very very relaxed. I mean, 79 00:07:13.319 --> 00:07:15.399 they don' t have the same strength. This hypotonia will make it 80 00:07:15.439 --> 00:07:24.120 very difficult for them to breastfeed and get breast milk. And we already know 81 00:07:24.199 --> 00:07:28.920 what we talked about last time how the process of feeding us mother' s 82 00:07:28.959 --> 00:07:32.800 milk will strengthen many of the muscles and it will help to generate this proper 83 00:07:33.000 --> 00:07:39.879 structure so that a baby breathes through the nose not and can swallow. And 84 00:07:40.000 --> 00:07:44.839 all this that tells us is also another characteristic of these patients who have this 85 00:07:44.920 --> 00:07:48.399 apparent hypoglosia. They have a very large, apparent tongue because they actually have 86 00:07:48.439 --> 00:07:55.600 a deficiency in maxillary development. But this makes or locates a little little constanned 87 00:07:55.680 --> 00:07:59.839 even as you see it I am with open mouth yes and with the law 88 00:08:00.040 --> 00:08:01.480 or outside you can see their tongue, because it does not fit them. 89 00:08:01.879 --> 00:08:09.079 Then this big tongue also makes them impossible. They are very complicated, both 90 00:08:09.120 --> 00:08:15.160 breathing and breastfeeding. Not when I was being nursed, because it completely sticks 91 00:08:15.199 --> 00:08:20.920 to the mother' s breast and has to breathe through the nose and swallow 92 00:08:20.920 --> 00:08:22.319 not practically at the same time. Time if you can' t do this, 93 00:08:22.680 --> 00:08:26.879 then start making it difficult. And what unfortunately usually happens, is that 94 00:08:26.920 --> 00:08:33.919 we just give up. Not that we want to try, because it is 95 00:08:33.960 --> 00:08:39.080 very exhausting both for the baby and for the mother, not the not achieving 96 00:08:39.240 --> 00:08:43.200 this attachment to the maternal feeding, then it is like good, because I 97 00:08:43.240 --> 00:08:46.919 give it formula And unfortunately, because this will have repercussions in the medium and 98 00:08:46.080 --> 00:08:50.320 long term for this not vitor. Also, remember that little kids with Dawn 99 00:08:50.399 --> 00:08:56.200 syndrome can have congenital heart disease and then a respiratory disorder during sleep alone already 100 00:08:56.320 --> 00:09:03.080 presents us with a cardiovascul risk So, imagine if they also have this heart 101 00:09:03.159 --> 00:09:07.960 disease factor, because in reality we have to get the kids with syndrome to 102 00:09:09.480 --> 00:09:13.759 breathe properly not have respiratory disorders during sleep, because thus we will reduce the 103 00:09:13.799 --> 00:09:18.480 risk to the heart that is in itself a population that already has a risk 104 00:09:18.519 --> 00:09:24.519 to the heart. No. And finally, the theme as neurodevelopmental learning behavior. 105 00:09:24.840 --> 00:09:30.360 We don' t already know that in neurotypical children, that is, 106 00:09:30.799 --> 00:09:33.919 they don' t have down syndrome, because if they don' t sleep 107 00:09:33.960 --> 00:09:35.960 well they' re going to have delayed development in learning they' re going 108 00:09:35.960 --> 00:09:39.799 to be aggressive. The same is going to happen in a patient with down 109 00:09:39.879 --> 00:09:45.200 syndrome that in addition, are characteristics that by their own syndrome already suffer. 110 00:09:45.240 --> 00:09:50.759 Not then are they going to exacerbate this delay in neurodevelopment ok tita. At 111 00:09:50.799 --> 00:09:56.000 the time a baby is born, parents have previously known or are not born 112 00:09:56.039 --> 00:10:03.840 with down syndrome. The first tensions have to go in this sense of breathing 113 00:10:03.879 --> 00:10:09.360 and the handling of your tongue. Yeah, well, like Joali said, 114 00:10:09.639 --> 00:10:15.200 his muscles are flaccid. Aha We already call Him hypotonics by the term that 115 00:10:15.240 --> 00:10:20.159 it is already a central problem. But we can work that muscles both facial 116 00:10:20.679 --> 00:10:26.600 the chewing muscles from that first birth precisely so that it has and breastfeeding plays 117 00:10:26.879 --> 00:10:33.559 a very important role there for that development and that language we have to place 118 00:10:33.600 --> 00:10:37.360 in the normal position for everyone, which is the tongue on the palate. 119 00:10:39.279 --> 00:10:43.720 That same language is going to be an organ that will help your palate grow, 120 00:10:43.639 --> 00:10:48.559 but also that that face that they have eh they specific as submissive, 121 00:10:50.480 --> 00:10:56.320 allows a forward and transversal development so that you can have a change to those 122 00:10:56.399 --> 00:11:03.720 characteristics that you usually have that it is better. And then there are patients 123 00:11:03.759 --> 00:11:09.919 who have been cared for from birth to adolescence and have their faces changed. 124 00:11:11.240 --> 00:11:16.679 These facial characteristics are not so accentuated, that is, it helps part of 125 00:11:16.720 --> 00:11:20.320 the function, it helps its facial harmony and therefore, that gives some and 126 00:11:20.399 --> 00:11:24.480 realize others, to the same dads, they realize that facial change, which 127 00:11:24.519 --> 00:11:33.639 is aesthetic and also has to see eh for their social environment. No doubt 128 00:11:33.639 --> 00:11:37.320 about it. Well, let' s talk about the dream, as we 129 00:11:37.480 --> 00:11:43.039 said, all these skills and how they get better. And we had another 130 00:11:43.120 --> 00:11:48.519 question over here that we' re going to talk about. You knew that 131 00:11:48.559 --> 00:11:54.039 early attention helps your facial development and growth and neurodevelopment by improving facial traits. 132 00:11:54.480 --> 00:11:58.919 What were you saying? Yes and, therefore, impact needs social life. 133 00:12:01.120 --> 00:12:09.480 So we always have to look for the integral. And since I' m 134 00:12:09.519 --> 00:12:13.919 going in full to see I came out a little bit you' ve already 135 00:12:13.960 --> 00:12:22.000 made it perfectly clear to us in many programs that the dream has a shocking 136 00:12:22.080 --> 00:12:26.080 impact on people' s lives. It doesn' t have to be that 137 00:12:26.080 --> 00:12:28.399 we do when we finish all our earrings, but it would have to be 138 00:12:28.440 --> 00:12:31.799 part of the to- do list and fulfill its hours. And the last 139 00:12:31.799 --> 00:12:37.279 time they came, they were both talking about how that' s impacting the 140 00:12:37.320 --> 00:12:43.840 whole development of the children. Why, in particular or here we would have 141 00:12:43.879 --> 00:12:50.639 to with children with symnomes give a greater emphasis on sleep. Of course, 142 00:12:50.679 --> 00:12:54.159 Ochayo, because look at dendr I would tell you because they have more sleep 143 00:12:54.159 --> 00:12:58.919 disorders. If we compare a neurotypical population with children with dao syndrome, we 144 00:13:00.559 --> 00:13:03.919 will realize that there is a greater complaint about their way of sleeping. What 145 00:13:03.960 --> 00:13:09.000 ' s most important is insomnia. They are not little ones who cannot sleep 146 00:13:09.080 --> 00:13:13.440 mostly intermediate insomnia which means that they are waking up many times throughout the night. 147 00:13:13.960 --> 00:13:18.960 They will also have, as we already wish at the beginning, respiratory 148 00:13:18.000 --> 00:13:22.200 disorders during sleep that will condition them to have a lot of drowsiness during the 149 00:13:22.200 --> 00:13:26.879 day. Remember that if we' re snoring, if we don' t 150 00:13:26.919 --> 00:13:33.159 breathe well, we' re not really resting and then in the day these 151 00:13:33.159 --> 00:13:35.080 patients are going to refer to a lot of somnolence. And well, finally, 152 00:13:35.279 --> 00:13:41.279 we' re also going to see circadian rhythm disorders. There are many 153 00:13:41.799 --> 00:13:46.559 patients who are sleeping at inadequate times, especially if they may not be in 154 00:13:46.600 --> 00:13:50.360 school, who are fortunately more and more already in school. That' s 155 00:13:50.879 --> 00:13:54.639 a huge breakthrough. Our society before, because you will remember that it was 156 00:13:54.720 --> 00:14:01.240 not so, they did not have at home and then not having fixed activities 157 00:14:01.279 --> 00:14:05.720 combined with that they have alterations in the liberation of Melatonin, because it also 158 00:14:05.720 --> 00:14:09.519 makes this particular population have rhythm disorders, that is, they sleep at absolutely 159 00:14:09.679 --> 00:14:18.000 inadequate times. No, in addition to that part of his behavioral characteristics includes 160 00:14:18.120 --> 00:14:22.879 some features such as obsessive compulsive disorder. Then they are patients who start drawing, 161 00:14:22.919 --> 00:14:24.960 for example, No and suddenly, because they don' t want to 162 00:14:24.960 --> 00:14:28.320 stop doing it. And then the parents, because they also say well, 163 00:14:28.480 --> 00:14:31.080 nothing happens that entertained. All right, he likes it He enjoys it. 164 00:14:31.360 --> 00:14:35.879 No, and suddenly, then, we see patients sleeping at 3: 00 165 00:14:35.879 --> 00:14:39.799 in the morning and waking up at 1: 00 in the afternoon. Not 166 00:14:39.679 --> 00:14:43.840 all of this, in the end it' s going to be that sleep 167 00:14:43.879 --> 00:14:48.639 isn' t normal and that these little ones don' t get all the 168 00:14:48.639 --> 00:14:52.039 benefits of sleeping properly. So we know that, because of the characteristics of 169 00:14:52.039 --> 00:14:56.399 the syndrome, they' re going to be delayed in neurodevelopment. For example, 170 00:14:56.440 --> 00:15:00.159 the acquisition of language is going to be late, they will also walk 171 00:15:00.240 --> 00:15:05.000 a little bigger all in general the milestones of neurodevelopment that we normally measure in 172 00:15:05.159 --> 00:15:09.480 newborns until the first years of life, because they will acquire it yes, 173 00:15:09.919 --> 00:15:16.039 but a little later. If you have joined this, we add that you 174 00:15:16.039 --> 00:15:20.559 sleep badly. We have already talked about how when we do not sleep well, 175 00:15:20.159 --> 00:15:24.600 we affect our development. We affect the way our brain grows. Remember 176 00:15:24.639 --> 00:15:30.080 that during sleep new neurons are generated and these new neurons are connected in order 177 00:15:30.159 --> 00:15:35.639 to learn. No, then, if these patients don' t sleep well, 178 00:15:35.240 --> 00:15:41.759 in particular, the delay in neurodevelopment is going to be even more severe 179 00:15:41.919 --> 00:15:43.879 and the behavior isn' t a little too. They are also patients who, 180 00:15:45.039 --> 00:15:48.960 suddenly, may be a little more intolerant, more irritable, even in 181 00:15:50.120 --> 00:15:54.600 some cases, may be a little more aggressive when they are very tired. 182 00:15:54.759 --> 00:15:58.039 No. And so, finally, if they cannot sleep, because this intolerance 183 00:15:58.120 --> 00:16:03.159 will be exacerbated, then it must be resolved. Of course, Tita, 184 00:16:04.679 --> 00:16:10.120 yes, I' m getting it right, and what I said to us 185 00:16:10.120 --> 00:16:14.919 alli in one of the previous segments, this impression that people have when we 186 00:16:15.000 --> 00:16:17.720 meet a child council doesn' t give me that the language is very big. 187 00:16:18.440 --> 00:16:23.639 He was actually telling us it has nothing more to do with that structure 188 00:16:23.679 --> 00:16:26.279 and I don' t know what the right way is. You' ll 189 00:16:26.840 --> 00:16:33.279 say, it' s not wide enough for the tongue to fit everything. 190 00:16:33.360 --> 00:16:38.399 A child with Dawn syndrome is going to have these characteristics. Yes, those 191 00:16:38.480 --> 00:16:45.720 characteristics, because, as we know, they have the eyes of a type 192 00:16:45.720 --> 00:16:49.919 of almond, which is the part of the middle third, which is below 193 00:16:51.080 --> 00:16:55.279 the eyes. The lower third is submerged, there is a sinking, a 194 00:16:55.399 --> 00:17:03.440 lack of development and also a nose where it is from the in intrauterine stage 195 00:17:03.519 --> 00:17:07.920 and through ultrasound there is a flattening of the bones proper to the nose that 196 00:17:08.119 --> 00:17:14.920 this from there, therefore, will affect that breath. So, these characteristics 197 00:17:15.240 --> 00:17:22.240 of lack of development of the maxilla will affect both the functions that we commented 198 00:17:22.480 --> 00:17:26.559 on and by not having this maxilla in front of the jaw. As is 199 00:17:26.640 --> 00:17:32.359 normal, the jaw is the lower part. Sometimes, when inverted, that 200 00:17:32.359 --> 00:17:37.279 maxilla is trapped, that middle third and the jaw develops and the upper part 201 00:17:37.359 --> 00:17:44.519 is behind. So that' s gonna affect the fact that there' s 202 00:17:44.519 --> 00:17:45.640 no good breathing. In other words, you can see how prognates are seen, 203 00:17:47.920 --> 00:17:53.119 even sometimes a prognatism or pseudo prognatism develops. So, the earlier we 204 00:17:53.119 --> 00:17:59.839 start that job since we were born, from day one. We should work 205 00:17:59.880 --> 00:18:07.240 with neoanatologists to give this counseling, these stimuli, these functions of more of 206 00:18:07.359 --> 00:18:12.559 the soro facial and chewing muscles from that stage to precisely go guiding that, 207 00:18:12.920 --> 00:18:19.160 monitoring that growth and development so that it reaches the function as normal as possible. 208 00:18:21.599 --> 00:18:30.440 And if children have arrived that young twelve years, they started from neonates, 209 00:18:30.160 --> 00:18:38.240 where they have a facial harmony, a good chewing, good declusion, 210 00:18:40.400 --> 00:18:44.440 suction, a lip seal where there is no exit of saliva, where the 211 00:18:44.559 --> 00:18:48.359 tongue is in place, which are valves. We have in our facial cavity, 212 00:18:49.160 --> 00:18:56.920 facial valves that allow air in and out. So there' s also 213 00:18:57.359 --> 00:19:03.240 a device that just came out, where it handles all those valve functions and 214 00:19:03.240 --> 00:19:11.559 has them in order, we' re going to monitor that growth and development 215 00:19:11.559 --> 00:19:17.880 to the teen Tter. I' m a mother child down syndrome. My 216 00:19:17.960 --> 00:19:22.440 baby was born and beyond what is, offer me medical service or not. 217 00:19:25.119 --> 00:19:33.440 I have to be careful here. Yeah, well, yeah, it' 218 00:19:33.559 --> 00:19:37.000 s a job here. Ideally, they should go to counseling, Dad and 219 00:19:37.039 --> 00:19:41.319 Mom, because they' re the ones who are going to do all this 220 00:19:41.440 --> 00:19:48.480 work and they' re going to motivate that little one. You have to 221 00:19:48.680 --> 00:19:53.559 start from day one, as I had already commented, on what else I 222 00:19:53.640 --> 00:20:03.599 will observe in my little one with whether the child squeezes or grumbles the teeth 223 00:20:03.720 --> 00:20:07.880 we call bruxism. It' s not normal. Here we see that it 224 00:20:07.920 --> 00:20:12.200 is a problem of the central nervous system and here there are factors that predispose 225 00:20:12.200 --> 00:20:17.759 it. One breathing through the mouth, two that may have gastrointestinal alterations, 226 00:20:18.839 --> 00:20:26.359 such as chronic gastroesophageal reflux that also causes bruxism. Yes and besides, because 227 00:20:26.599 --> 00:20:32.720 the stress is true, then that will cause micro awakenings or night awakenings that 228 00:20:32.839 --> 00:20:37.960 will affect your sleep. So, there' s an alarm tip. What 229 00:20:37.079 --> 00:20:42.440 do we have to do as parents if they are in the prenatal stage and 230 00:20:42.640 --> 00:20:48.319 already told them, because they should not take advice to an prenatal dental diagnosis 231 00:20:48.400 --> 00:20:53.400 beyond the teeth where they will be informed what care they should have to go 232 00:20:53.839 --> 00:21:00.000 preparing for the baby to arrive in a harmonic space. Two of us have 233 00:21:00.039 --> 00:21:03.599 to encourage breastfeeding and, together with the neonatologist, work with various disciplines. 234 00:21:04.440 --> 00:21:11.240 Nothing else here is the function of one. We have to work transdisciplinaryly or 235 00:21:11.240 --> 00:21:18.319 torino, gynecologist, pediatrician and sleep medicine and we, as orthopedists and others. 236 00:21:18.119 --> 00:21:23.200 So, uh, get those functions back by sealing his lips. There 237 00:21:23.279 --> 00:21:29.519 are some exercises that we have to tell parents if they are giving them maternal 238 00:21:29.519 --> 00:21:34.160 dose, do a smooth movement of the chin and raise it when they are 239 00:21:34.279 --> 00:21:40.799 sleeping, so that that tongue has that seal on the palate that negative suction 240 00:21:40.920 --> 00:21:45.680 pressure and that same tongue gives function to it to develop, seal its lips 241 00:21:45.799 --> 00:21:49.200 gently, so that that muscle, which is like a donita the orbicular of 242 00:21:49.240 --> 00:21:53.759 the lips, has a better seal and does not allow saliva, saliva outflow, 243 00:21:53.960 --> 00:21:59.319 milk or food. All this is patience, because it is a slow 244 00:21:59.440 --> 00:22:07.200 job, but it gives very good benefits. Em also these children who do 245 00:22:07.599 --> 00:22:11.559 not sleep for this, this bruxism, since they have teeth, is going 246 00:22:11.640 --> 00:22:15.880 to damage so the teeth, muscles and temporomandibular joint and this generates pain, 247 00:22:17.319 --> 00:22:22.680 and that pain also generates awakenings and affects their sleep. So E, Dr 248 00:22:23.160 --> 00:22:29.200 Joalice is going to comment on this problem ahead. I of course, well, 249 00:22:29.759 --> 00:22:33.920 uh, I think the main point is to try to do and to 250 00:22:33.160 --> 00:22:38.160 have all the tools that can help us make the forecast better. No. 251 00:22:40.119 --> 00:22:42.359 However, well, despite this, because suddenly or already they are very big 252 00:22:42.440 --> 00:22:47.559 and the answer is no longer the same. Or anyway, though less severe, 253 00:22:48.000 --> 00:22:51.839 because these little ones are going to grow up and have some other sleep 254 00:22:52.000 --> 00:22:56.920 disorder or the same breathing disorder during sleep. Then what do we have to 255 00:22:57.000 --> 00:23:00.400 be alert to? Well, if I see that my child is very sleepy, 256 00:23:00.720 --> 00:23:03.799 very agitated, not to say that she is moving a lot, that 257 00:23:03.880 --> 00:23:08.799 she has sudden sudden sudden movements that she feels asleep. Not all of these 258 00:23:08.880 --> 00:23:15.000 are movements that indicate that he may be, he may not be breathing well 259 00:23:15.039 --> 00:23:19.000 at night, he may not be and he is changing his position, even 260 00:23:19.079 --> 00:23:22.920 to sit down, because it helps them breathe a little better. Of course, 261 00:23:23.000 --> 00:23:26.759 if he snores not this we' ve always been saying it. Broken 262 00:23:26.880 --> 00:23:30.680 is not normal at any age, no one, no one, no light 263 00:23:30.000 --> 00:23:33.319 or anything. So, well, if my little boy is snoring, then 264 00:23:33.440 --> 00:23:37.559 I know there' s a respiratory disorder I need to attend to. If 265 00:23:37.720 --> 00:23:41.920 you sweat a lot, if you pee at night, not if you don 266 00:23:41.000 --> 00:23:45.640 ' t have this Sfinter control. It is also related and we have other 267 00:23:45.640 --> 00:23:48.799 treatments that, although they are no longer preventive, because we will correct this 268 00:23:48.839 --> 00:23:56.279 mnea of sleep and we have to talk about them also now like what we 269 00:23:56.319 --> 00:24:02.680 have to do, what we have to avoid and what we have to do 270 00:24:02.880 --> 00:24:07.240 to maximize the development that each child given Now yes, that has given his 271 00:24:07.319 --> 00:24:12.039 syndrome of gives a personalized not that it can reach, that it cannot reach, 272 00:24:12.319 --> 00:24:15.200 but then within what it can achieve, that reaches as much as it 273 00:24:15.279 --> 00:24:19.599 can definitely and then looks just before the Court. We talk that sometimes they 274 00:24:19.799 --> 00:24:27.039 will need more specialized treatments to correct sleep disorders particularly children, adolescents and adults 275 00:24:27.359 --> 00:24:34.440 with down syndrome are patients who are candidates to use these positive pressure equipments that, 276 00:24:36.039 --> 00:24:37.960 perhaps they have ever heard them as if paps that are these equipment that 277 00:24:38.079 --> 00:24:47.960 help us breathe while we are asleep. It is a mask that is placed 278 00:24:48.039 --> 00:24:52.400 in the nose, ideally only in the nose, because you know that we 279 00:24:52.480 --> 00:24:56.039 promote nasal breathing, but there are also masks that cover nose and mouth and 280 00:24:56.200 --> 00:25:00.960 that connect to a team that makes air under pressure. It' s not 281 00:25:00.960 --> 00:25:04.759 oxygen, because it doesn' t have any restrictive problems, but it blows 282 00:25:04.880 --> 00:25:08.839 air in such a way that, mechanically, the airway is prevented from being 283 00:25:08.960 --> 00:25:14.519 obstructed while we' re asleep. It is very important that we consider many 284 00:25:14.640 --> 00:25:18.319 patients with Down syndrome. They' re going to have to use this equipment 285 00:25:18.079 --> 00:25:22.839 to sleep, but once they use it, it completely corrects the snoring of 286 00:25:23.000 --> 00:25:27.640 the mnea. They are going to rest better this drowsiness that I mentioned earlier, 287 00:25:29.200 --> 00:25:33.480 because it will diminish or even disappear. Then you will have more energy, 288 00:25:33.640 --> 00:25:37.799 more willingness to do things better, enthusiasm, mood, etcetera. So 289 00:25:37.880 --> 00:25:45.519 it is necessary to consider and also consider possible plans, possible surgical treatments to 290 00:25:45.559 --> 00:25:48.759 correct sleep m, not like, for example, migdallectomy, which is one 291 00:25:48.279 --> 00:25:52.119 of the techniques that is most used in children to correct sleep m obstructive. 292 00:25:53.640 --> 00:25:57.920 You have to be open to these possibilities, because that can change your life, 293 00:25:57.960 --> 00:26:03.079 not as if you' re talking good sleep, it changes everyone' 294 00:26:03.200 --> 00:26:07.200 s life and more patients. With this type of syndromes no yes, no 295 00:26:07.279 --> 00:26:12.920 doubt, eh what would you complete to estotita in relation to what to do 296 00:26:14.119 --> 00:26:18.200 or that you have to avoid doing good and what we have to do the 297 00:26:18.839 --> 00:26:26.599 nazar washing From little ones and even the otorrinos handle a nasal wash and bigger, 298 00:26:26.160 --> 00:26:33.279 teach them to give it the function of the nose, teach them to 299 00:26:33.359 --> 00:26:37.599 blow their nose and that out there they must inhale and exhale the other. 300 00:26:38.119 --> 00:26:45.920 E. This is becoming a habit. And we send signals to the brain 301 00:26:45.039 --> 00:26:52.839 because we have a neuroplasticity so that the child becomes aware that the breathing is 302 00:26:52.920 --> 00:26:59.160 nasal and not vocal. Chewing is fundamental in them and in the typical ones. 303 00:26:59.240 --> 00:27:03.599 One more throw of hard, fibrous foods, uh, not soft, 304 00:27:03.960 --> 00:27:10.599 because we do a lazy chewing. And then this bilateral, alternating, fibrous 305 00:27:10.680 --> 00:27:15.480 chewing is going to be for the muscles of chewing and facial muscles to develop 306 00:27:15.599 --> 00:27:19.279 properly, which are going to allow it to have a greater lip seal. 307 00:27:19.880 --> 00:27:26.000 So in them that have these flaccid muscles, because it' s more fundamental 308 00:27:26.319 --> 00:27:30.839 than not us, right, then that' s going to have a seal 309 00:27:30.960 --> 00:27:34.440 on uh, the lipstick and no food, no milk, no saliva. 310 00:27:36.440 --> 00:27:38.079 And the other, the tongue at rest, must be on the palate. 311 00:27:40.200 --> 00:27:42.599 Yeah, and that same tongue on the palate is gonna make this salt breath 312 00:27:42.720 --> 00:27:48.359 more effective. Coming back from the good cut, not from the music cut 313 00:27:48.400 --> 00:27:52.559 we have right now, uh, how it helps a mom, a dad, 314 00:27:53.000 --> 00:27:57.319 a kid when she realizes he' s asleep and has his tongue down 315 00:28:00.839 --> 00:28:08.599 and good at almost closing the TITA program. What would you add to what 316 00:28:08.960 --> 00:28:18.240 we have been commenting on, because we need to raise awareness not only about 317 00:28:18.759 --> 00:28:23.480 children but about most of our children. We have to have a great job 318 00:28:23.640 --> 00:28:30.359 as dads so they have a good breath and a good sleep. This will 319 00:28:30.359 --> 00:28:37.880 help neurodevelopment and its quality of life. We' ve been programming since we 320 00:28:37.160 --> 00:28:44.279 were pregnant, that organ formation, including the brain, the system, respiratory 321 00:28:44.519 --> 00:28:51.319 digestive. We have all this that we have discussed in this session. We 322 00:28:51.440 --> 00:28:56.240 have a lot to do because they are the future adults who are going to 323 00:28:56.359 --> 00:29:00.599 be snorers, who will be able to predispose to diabetes, hypertension, pro 324 00:29:00.720 --> 00:29:06.039 cardiovascular problems, vascular brain. Then you have to give him that courage. 325 00:29:06.359 --> 00:29:11.039 Our country is not yet conscious. We see these undervalued topics and hopefully, 326 00:29:11.559 --> 00:29:18.759 let us pay a lot of attention from pregnant women to older adults. That 327 00:29:18.799 --> 00:29:22.319 ' s Joali, so look, I' d like to share two ideas. 328 00:29:22.400 --> 00:29:26.759 The first is to seek help. Not if they' ve already had 329 00:29:26.839 --> 00:29:33.359 a prenatal diagnosis, and they' ve been told that their baby has down 330 00:29:33.359 --> 00:29:37.240 syndrome. I think it' s good to start looking for groups, looking 331 00:29:37.240 --> 00:29:41.359 for medical help, getting informed, because, if we know it well, 332 00:29:41.599 --> 00:29:47.039 if it' s sometimes not easy with neurokinetic babies, then imagine when there 333 00:29:47.039 --> 00:29:48.839 ' s a special syndrome. We don' t talk much about breastfeeding, 334 00:29:49.640 --> 00:29:53.720 but sometimes I insist with neurotypical children, it' s not easy to breastfeed 335 00:29:53.720 --> 00:30:00.759 and sometimes, because we decided to change it for formula, then imagine a 336 00:30:00.880 --> 00:30:04.079 mother who is even more difficult to achieve breastfeeding with a baby down syndrome than 337 00:30:04.240 --> 00:30:11.359 in addition, because she feels this obligation to feed her by this way to 338 00:30:11.359 --> 00:30:15.079 avoid future problems. The stress this can bring we have to be very empathetic. 339 00:30:15.240 --> 00:30:18.279 It is not easy and the reality is that there are many people who 340 00:30:18.519 --> 00:30:25.319 can guide them. You can help us from breastfeeding counselors to neonatologists who can 341 00:30:25.480 --> 00:30:30.039 offer us this information that we don' t have at hand and alone sometimes 342 00:30:30.119 --> 00:30:33.119 we can' t and you go to get help. And my second very 343 00:30:33.240 --> 00:30:37.799 quick point is although respiratory disorders in children with down syndrome are the most frequent. 344 00:30:37.880 --> 00:30:41.759 There are other sleep disorders. There is a lot of insomnia, many 345 00:30:41.839 --> 00:30:48.000 bad sleep habits that with a fairly simple behavioral intervention, that we work directly 346 00:30:48.119 --> 00:30:53.799 with parents, we can see radical changes in patients' behavior. Then also 347 00:30:53.839 --> 00:31:00.319 approach to look for sleep specialists to advise you according to what number you are 348 00:31:00.359 --> 00:31:07.440 found in. In fifty- five, forty- three, ninety, seventy 349 00:31:08.920 --> 00:31:14.160 - six, sixteen and fifty- five, thirty- four, fifty- 350 00:31:15.200 --> 00:31:18.279 five, seven, one, five, perfect. We' re putting it 351 00:31:18.359 --> 00:31:22.920 on social media. As always joali where they find you. Sure, I 352 00:31:22.960 --> 00:31:26.079 ' ll give you the phone from the Sleep and Neuroscience Center. Remember that 353 00:31:26.119 --> 00:31:30.720 there we have all the sleep medicine specialists that are required. It' s 354 00:31:30.799 --> 00:31:33.920 fifty- five, six, three, twenty- six, nine hundred, 355 00:31:34.079 --> 00:31:38.000 nine, four, six. For I thank them as always for their willingness 356 00:31:38.119 --> 00:31:41.759 to come to the program, because they are subjects to follow and follow and 357 00:31:41.759 --> 00:31:48.200 continue and continue to play and raise awareness to know, above all, and 358 00:31:48.640 --> 00:31:55.079 if you have a syndrome, it gives a good fence, because knowing that 359 00:31:55.160 --> 00:31:57.759 it is not that it was born and so it stays. We cannot enhance 360 00:31:57.839 --> 00:32:01.799 its development much more so that it has a much better quality of life. 361 00:32:02.359 --> 00:32:07.599 So I thank you infinitely and I leave you today and have a very good 362 00:32:07.680 --> 00:32:14.240 profit. We hear each other here tomorrow, tomorrow, Friday, the last 363 00:32:14.920 --> 00:32:19.720 day of school and, therefore, from today, a lot of patience for 364 00:32:19.720 --> 00:32:22.359 tomorrow until then. Audio Central