Unlocking Pediatric Incontinence: A Revolutionary Approach (f Kiley Gibbs)

WEBVTT

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I mean, it's such a non,

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like not common world, right?

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Nobody knows about it.

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Even professors are like, wait,

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what do you do?

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And so it's really unfortunate.

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I think we got like an hour

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of pelvic health in general

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in our PT program.

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And I graduated in 2014.

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Like it's not that long ago.

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Let's dig in.

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Are you ready?

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I guess so.

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I'm ready.

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Here we go, brewing up another episode.

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Kylie Gibbs is on the show.

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Kylie, welcome to the program.

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Thank you.

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I'm excited to be here.

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When I was doing my research, and I do,

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on purpose,

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try to do as little research

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as possible because I like

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to come at topics with sort

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of like this real perspective, right?

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I don't want to... Because

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then I feel like I skip

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over some of the things.

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I'm like, well,

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everybody probably knows

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that because I just researched it,

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but I don't want to do that.

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When I was looking at the topic,

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at least...

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I was like, okay,

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when I hear pelvic health,

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I think most people think

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the same way I do because

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that's how people work.

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We always just figure we're

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like everybody else.

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I think of females first.

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And then probably males.

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Because then you're like, well,

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males also have pelvises.

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But then I don't even know

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if I've ever thought of

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pediatric pelvic health.

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So I'm guessing nobody else did.

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And we were just talking

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before I hit record,

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like we didn't get much

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education in that.

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No, not at all.

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It wasn't until I did a

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residency program after PT

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school that I even was aware of it.

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And so I started observing some sessions.

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We had actually three or

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four providers in our

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office at University of

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Michigan that treated

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pediatric pelvic health or

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were learning and starting

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to treat pediatric pelvic health.

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So I observed and said, wow,

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this is really cool.

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We can make a huge impact, not only on the

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But on the whole family unit,

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because you will find these

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parents that their life

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revolves around when their

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child has a bowel movement.

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If their child needs a change of clothes,

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they have to pack three or

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four or five changes of

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clothes every day because

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these kiddos are just going

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through them because

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they're having accidents all the time.

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So that's only when I first

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started learning about it

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was during a residency.

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Yeah.

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Where'd you do that residency?

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You said in Michigan?

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Yeah.

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University of Michigan.

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Nice.

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All right.

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So who do you get to work with?

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Because you got like a cool practice model,

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right?

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You're sort of like you have

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a home office or your remote office,

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which you mentioned was your car.

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Who do you get to work with?

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So describe the kiddos and

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the families that you interact with.

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So actually about 30% of my

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caseload are kiddos of

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healthcare providers.

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Funny enough,

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I see a lot of kiddos of PTs.

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I've treated surgeons, kids,

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lots and lots of healthcare

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providers bring their

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kiddos in because they know

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that they're missing something.

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And it's not logical the way

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that these things come about.

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And so they're saying, well,

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I need some help, found you.

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So the kiddos that I treat, yeah,

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range anywhere from

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know eight or nine months

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old they have just

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transitioned onto solids

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and maybe they're having

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some constipation from that

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and moms and dads just want

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to learn what they can do

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all the way up until 18 19

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is really where I stop um

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unless they're having any

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sort of internal issues um

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then I refer them out to an

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adult pelvic health

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therapist 19 years old

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right not 19 months yeah 19

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years old yeah

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Yeah,

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so right now the oldest I have in

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caseload is 18.

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I get confused a lot when

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people go from months and

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then they go to years.

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I'm like,

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are we still talking in months here?

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How old are we?

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Are we months or are we years?

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Got it.

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Yeah.

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All right.

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So the goal here was,

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I think I saw you on

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Instagram and you were like

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sort of sharing information.

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Is that right?

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Is that where we kind of crossed paths?

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Yeah.

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So the goal was like, I remember,

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I love just like how the

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internet works where you

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just kind of swipe and

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flick and whatever.

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And then you come across something like,

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huh, I didn't even know that was a thing.

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And that's sort of what I

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thought and really started

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to kind of like, you know,

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go down that rabbit hole.

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And I was like, well,

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then we got to have Kylie on the show.

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So the goal is by the time

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we're done talking,

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the audience is at least

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going to know six things,

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maybe four of them they

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didn't know before.

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I feel like because, as you mentioned,

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I mean,

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we weren't even thinking about

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pelvic issues in kids.

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But also,

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as you explain the families that

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you're working with,

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that sort of makes sense

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when you start to put it that way.

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When you start to put a face to it,

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it does.

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So the first thing I want to talk to you,

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you did mention kids.

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But you mentioned that

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incontinence is often a

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symptom of constipation.

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Help me figure out how that works.

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Yeah,

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so whenever kiddos are having any

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sort of urinary

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incontinence or fecal incontinence,

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it's normal because there's

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some sort of backup

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happening in the rectum of poop.

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So either they're not

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getting everything out

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every single day or they're

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only having one bowel

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movement every two weeks.

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Those are kiddos that I see a lot.

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But any time that you're

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having any sort of urinary

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fecal incontinence,

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it's because for urinary,

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the bladder is being

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squished by the rectum that

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is full of poop.

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And so it cannot fill to

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what it normally would or

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what it needs to.

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and then the bladder

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contracts and lets

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everything out um with poop

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you know the the newer poo

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and yeah we're definitely

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gonna get right in and talk

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about poo the newer poo

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just goes it goes right

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around the older hardened

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poop that's in the right place

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And that's what's called, yeah,

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and that's what's called encoparesis.

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So these kiddos who are

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having fecal leakage have

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some sort of blockage, if you will,

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that newer poop that's more

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liquid will just go right around.

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And I always use the analogy for parents,

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it's sort of like pouring

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pudding over ice.

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So it will slowly just make its way around,

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not for a gross graphic,

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but it will slowly make its way around.

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And what sneaks out is still really soft.

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So they think there's no way

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my kid can be constipated.

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The poop that's coming out is super soft,

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but that's because it's

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just leakage coming around.

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I love how your analogies

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are food-based and very

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pediatric food-based.

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You understand your audience.

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Always food-based.

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That sort of makes sense in

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terms of incontinence and constipation.

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So many might believe kids

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are always aware of when they have,

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we'll call it an accident.

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But you actually think this

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is a misconception.

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From your experience,

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you know this is a misconception.

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So this is something we need to dispel.

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So walk me through this.

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Definitely.

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So when kiddos have the

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backup of poop in their rectum,

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what happens is when we get

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poop that comes down into the rectum,

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it stretches the rectum.

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It sends the signal up to

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the brain that says, okay,

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it's time to go poop.

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We've got enough in there.

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Let's go ahead and let it out.

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If a kiddo is on the

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playground or in class or just says,

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no way,

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I am scared of that automatic

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flush toilet.

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definitely not going here at

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school I don't like going

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at grandma's house if they

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find whatever reason and

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they shut that signal down

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the brain tells the body

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hold it in and the pelvic

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floor muscles contract

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everything stays right up

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in there and once they do

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that enough once they keep

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deferring those signals the

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brain and the bottom stop

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talking to each other so we

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really get this disconnect

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And there's the converse side of it too,

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that when there's always

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poop sitting in the rectum,

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just like if you are having

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your glasses on all day long,

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or you're wearing a watch all day long,

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you become numb to it.

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So those sensations don't

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matter anymore when there's

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always poop backed up in there.

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So if you go back and you think about,

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okay, I'm driving in my car.

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Oh my gosh, I've got to go poop.

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I can't go in the car.

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I don't want to pull over.

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I'm 10 minutes from home.

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I'll just go when I get home.

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When we get home,

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normally 10 or 15 minutes later,

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we'll get a much stronger signal.

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Kiddos that continue to

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defer those signals

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repeatedly don't get that signal,

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that second, a little bit louder signal.

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The one that they get is the

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emergency signal.

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When the body goes ready or not,

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here it comes and starts to let it out.

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So we can retrain those

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signals and bring them back.

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But it does take a long time.

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The signals in my practice

00:08:30.685 --> 00:08:32.326
have been the last thing

00:08:32.346 --> 00:08:33.586
that I have experienced

00:08:33.628 --> 00:08:34.967
that will come back for a kiddo.

00:08:35.268 --> 00:08:36.269
So it does take a lot of time.

00:08:36.889 --> 00:08:38.009
When you're saying, you know,

00:08:38.049 --> 00:08:39.190
worked on or retrained,

00:08:39.250 --> 00:08:40.610
what are your sessions like look like?

00:08:40.630 --> 00:08:41.351
Like describe them.

00:08:41.412 --> 00:08:42.072
And I'm sure there's some

00:08:42.091 --> 00:08:43.153
sort of food analogy coming,

00:08:43.192 --> 00:08:43.893
so I can't wait for it.

00:08:44.533 --> 00:08:44.894
Yeah.

00:08:45.474 --> 00:08:47.455
So what we do is normally I

00:08:47.495 --> 00:08:48.456
will train the parents

00:08:48.535 --> 00:08:49.635
because most kiddos don't

00:08:49.655 --> 00:08:50.336
want to talk to me.

00:08:50.796 --> 00:08:51.856
They have been doctored out.

00:08:52.017 --> 00:08:53.476
So when I was in person,

00:08:53.496 --> 00:08:55.217
I do all my sessions virtually right now.

00:08:55.677 --> 00:08:56.538
When I was in person,

00:08:56.599 --> 00:08:58.058
kiddos would hide behind the couch.

00:08:58.119 --> 00:08:58.198
They

00:09:00.325 --> 00:09:01.304
I've had a couple of kiddos,

00:09:01.404 --> 00:09:02.225
one girl in particular,

00:09:02.285 --> 00:09:04.047
I saw her off and on for like two years.

00:09:04.226 --> 00:09:06.427
She never spoke a word to me directly.

00:09:06.908 --> 00:09:08.688
She was the most beautifully compliant,

00:09:08.729 --> 00:09:10.129
like six-year-old I've ever seen,

00:09:10.708 --> 00:09:11.809
but she was done.

00:09:12.070 --> 00:09:13.711
She just voiced everything

00:09:13.750 --> 00:09:15.250
to her mom and mom voiced it to me.

00:09:15.350 --> 00:09:16.432
So I'm really training the

00:09:16.451 --> 00:09:17.471
parents in what to do.

00:09:17.491 --> 00:09:18.932
We have a homework chart.

00:09:19.835 --> 00:09:20.696
they check off different

00:09:20.735 --> 00:09:22.437
activities that they have capacity for.

00:09:22.537 --> 00:09:23.898
So retraining the signals,

00:09:24.337 --> 00:09:25.318
we use sort of an old

00:09:25.379 --> 00:09:27.320
school proprioceptive tool of vibration.

00:09:27.799 --> 00:09:30.062
So I have kiddos when they're home,

00:09:30.182 --> 00:09:32.123
sit on a vibrating pad and

00:09:32.182 --> 00:09:34.323
that can reawaken some of those signals.

00:09:34.605 --> 00:09:36.004
So if you think back to, um,

00:09:37.173 --> 00:09:38.854
some neuromuscular recruitment techniques.

00:09:38.874 --> 00:09:39.874
You use vibration on a

00:09:39.913 --> 00:09:41.433
muscle to wake it up and

00:09:41.693 --> 00:09:42.695
regain those signals.

00:09:43.195 --> 00:09:44.195
Same thing with the bottom.

00:09:44.595 --> 00:09:45.155
So if you think of,

00:09:45.296 --> 00:09:46.336
if you were to sit on your

00:09:46.375 --> 00:09:47.535
cell phone and you didn't

00:09:47.596 --> 00:09:48.636
realize you were sitting on

00:09:48.657 --> 00:09:49.677
it and somebody called you

00:09:49.716 --> 00:09:51.157
and it was on vibrate, you go, whoa,

00:09:51.618 --> 00:09:52.298
what's going on?

00:09:52.778 --> 00:09:53.937
So we're trying to make that

00:09:53.957 --> 00:09:55.678
happen with those signals.

00:09:56.655 --> 00:09:57.798
If you haven't already started,

00:09:57.857 --> 00:09:59.600
I could feel the beginnings of an app,

00:10:00.541 --> 00:10:00.860
Kylie,

00:10:00.941 --> 00:10:02.923
that you could somehow code or work

00:10:02.943 --> 00:10:04.566
with a coder to create for

00:10:04.846 --> 00:10:05.447
just that thing.

00:10:06.227 --> 00:10:06.849
A little upset that there

00:10:06.869 --> 00:10:08.090
was no food analogies in that one,

00:10:08.110 --> 00:10:09.552
but I'm sure we still have some coming up,

00:10:09.972 --> 00:10:10.192
all right?

00:10:10.293 --> 00:10:11.274
We do.

00:10:11.534 --> 00:10:13.758
So here's a misconception that I think

00:10:15.066 --> 00:10:16.768
I think I was also on the

00:10:17.427 --> 00:10:18.249
wrong side of this.

00:10:18.269 --> 00:10:19.750
You tell me you've observed

00:10:19.791 --> 00:10:20.711
that pelvic floor muscles

00:10:20.750 --> 00:10:23.594
and children are often tight, not weak.

00:10:23.734 --> 00:10:25.054
And that's where the issue comes in.

00:10:25.135 --> 00:10:26.197
So walk me through that.

00:10:26.216 --> 00:10:27.037
And then how does that sort

00:10:27.057 --> 00:10:28.018
of like guide your approach?

00:10:29.119 --> 00:10:29.440
Yeah.

00:10:29.500 --> 00:10:30.461
So with kiddos,

00:10:30.480 --> 00:10:33.243
if they are trying to hold everything in,

00:10:33.263 --> 00:10:34.563
so think back to those signals,

00:10:34.745 --> 00:10:35.765
I'm deferring the signal

00:10:35.785 --> 00:10:37.067
that I need to go to the bathroom.

00:10:37.559 --> 00:10:38.541
I don't want to go.

00:10:38.561 --> 00:10:40.001
I don't have time to go.

00:10:40.022 --> 00:10:41.423
I don't want to stop doing what I'm doing.

00:10:41.442 --> 00:10:42.722
The pelvic floor muscles

00:10:42.764 --> 00:10:44.284
have to tighten up and hold

00:10:44.365 --> 00:10:45.024
everything in.

00:10:45.544 --> 00:10:46.725
So we often see that this

00:10:46.806 --> 00:10:48.527
repeated behavior shortens

00:10:48.567 --> 00:10:50.107
those muscles and tighten, tighten,

00:10:50.128 --> 00:10:50.469
tighten,

00:10:50.489 --> 00:10:52.549
tighten so that when they need to

00:10:52.610 --> 00:10:54.110
go and they're trying to

00:10:54.150 --> 00:10:54.892
let everything out,

00:10:54.932 --> 00:10:55.792
the pelvic floor muscles

00:10:55.851 --> 00:10:57.793
aren't able to relax and

00:10:57.913 --> 00:10:59.394
fully help to evacuate

00:10:59.495 --> 00:11:00.816
either the bowel or the bladder.

00:11:01.735 --> 00:11:04.158
And so instead of doing contractions,

00:11:04.217 --> 00:11:05.357
I've had so many families

00:11:05.418 --> 00:11:06.259
come to me and say, well,

00:11:06.298 --> 00:11:07.379
our pediatrician just told

00:11:07.419 --> 00:11:08.279
us to do Kegels,

00:11:09.100 --> 00:11:10.682
just start contracting the pelvic floor.

00:11:10.721 --> 00:11:12.162
And that's not what we want to do.

00:11:12.582 --> 00:11:14.864
We do want to retrain the

00:11:14.903 --> 00:11:16.585
muscles and tell them how

00:11:16.664 --> 00:11:18.846
to contract but relax

00:11:18.986 --> 00:11:20.326
properly because that's

00:11:20.346 --> 00:11:21.187
what we need to do.

00:11:21.842 --> 00:11:23.322
So we do a lot of stretching.

00:11:23.342 --> 00:11:24.364
It depends on what

00:11:24.403 --> 00:11:25.943
activities they're involved in.

00:11:26.403 --> 00:11:28.524
I've treated different figure skaters,

00:11:28.605 --> 00:11:29.544
hockey players,

00:11:30.826 --> 00:11:32.846
and even just some kiddos that, you know,

00:11:33.186 --> 00:11:35.167
W sit, their core is super weak.

00:11:35.547 --> 00:11:37.187
So figuring out what other

00:11:37.427 --> 00:11:38.567
parts of their body are

00:11:38.607 --> 00:11:39.628
contributing to that

00:11:39.749 --> 00:11:40.788
tightness in the pelvic

00:11:40.828 --> 00:11:43.149
floor is what we also address too.

00:11:44.009 --> 00:11:45.009
But they're just super,

00:11:45.029 --> 00:11:46.250
super tight because they're

00:11:46.270 --> 00:11:47.071
trying to hold it in.

00:11:47.530 --> 00:11:48.571
And for most kiddos that

00:11:48.630 --> 00:11:50.331
have any sort of accidents

00:11:50.371 --> 00:11:51.011
during the day,

00:11:51.529 --> 00:11:53.932
they're so afraid of having

00:11:53.991 --> 00:11:55.472
another accident that they

00:11:55.493 --> 00:11:57.114
are constantly clenching

00:11:57.333 --> 00:11:59.775
and trying their hardest to hold it in.

00:11:59.796 --> 00:12:02.097
And it's pretty logical on their part.

00:12:02.138 --> 00:12:02.278
Like,

00:12:02.357 --> 00:12:03.899
why wouldn't I try and squeeze and

00:12:03.938 --> 00:12:04.480
hold it in?

00:12:04.899 --> 00:12:06.701
But then everything just gets super tight.

00:12:07.701 --> 00:12:08.842
One analogy I tell parents

00:12:08.863 --> 00:12:09.702
is that if you've ever been

00:12:09.722 --> 00:12:11.125
driving and you have your

00:12:11.164 --> 00:12:13.426
hands on the steering wheel in traffic,

00:12:13.546 --> 00:12:14.466
and then all of a sudden

00:12:14.586 --> 00:12:15.607
you're out of traffic and you go,

00:12:16.128 --> 00:12:16.528
whoa,

00:12:16.869 --> 00:12:19.530
I had no idea I was clenching the

00:12:19.571 --> 00:12:21.032
wheel like that.

00:12:21.192 --> 00:12:22.192
It's sort of like that with

00:12:22.212 --> 00:12:23.293
the pelvic floor muscles.

00:12:23.354 --> 00:12:25.375
We have to retrain them how to relax.

00:12:26.096 --> 00:12:27.496
How do you educate parents

00:12:27.557 --> 00:12:29.677
in terms of spotting when

00:12:29.717 --> 00:12:30.778
these things are going on?

00:12:30.798 --> 00:12:32.900
I mean, I know from indirect experience,

00:12:32.961 --> 00:12:35.283
there's some behavior changes or things.

00:12:35.302 --> 00:12:36.663
I mean, and parents are just crazy.

00:12:36.683 --> 00:12:36.884
I mean,

00:12:36.903 --> 00:12:38.585
some parents are crazy in tune with

00:12:38.605 --> 00:12:39.004
their kids.

00:12:39.024 --> 00:12:39.826
Like they know exactly

00:12:39.865 --> 00:12:40.927
what's going on in their kid's brain.

00:12:42.323 --> 00:12:42.663
Yeah.

00:12:42.803 --> 00:12:43.144
And, you know,

00:12:43.164 --> 00:12:43.924
I have a two and a half year

00:12:43.965 --> 00:12:45.746
old and I can tell you exactly, you know,

00:12:45.787 --> 00:12:46.667
what she's going to do

00:12:46.826 --> 00:12:47.868
before she does it.

00:12:48.148 --> 00:12:50.789
And, you know, even before she farts,

00:12:50.809 --> 00:12:53.432
like if you think of the homunculus,

00:12:53.711 --> 00:12:55.072
the genitalia sits right

00:12:55.113 --> 00:12:57.335
next to toes and feet.

00:12:57.534 --> 00:12:59.376
And so a lot of kiddos will

00:12:59.596 --> 00:13:00.758
go up on their tippy toes

00:13:00.898 --> 00:13:02.318
and try and contract everything.

00:13:02.399 --> 00:13:03.178
Or you see them do

00:13:03.278 --> 00:13:05.221
completely straight leg or

00:13:05.280 --> 00:13:06.402
slam their legs together,

00:13:06.461 --> 00:13:07.783
trying to hold everything in.

00:13:08.423 --> 00:13:09.484
And they don't even realize

00:13:09.524 --> 00:13:10.443
they're doing it a lot of

00:13:10.484 --> 00:13:11.384
times or they'll get in

00:13:11.404 --> 00:13:12.345
different positions.

00:13:12.804 --> 00:13:14.385
I've got one kiddo who will

00:13:15.466 --> 00:13:16.606
completely like get into a

00:13:16.667 --> 00:13:19.187
ball if he is watching TV or something.

00:13:19.248 --> 00:13:20.349
And his mom's like, dude,

00:13:20.389 --> 00:13:21.428
you need to go poop.

00:13:21.548 --> 00:13:22.289
He's like seven or eight.

00:13:22.309 --> 00:13:23.070
He's like, no, I don't.

00:13:23.110 --> 00:13:23.409
She's like,

00:13:23.509 --> 00:13:25.191
you are in a ball trying to

00:13:25.270 --> 00:13:26.552
hold yourself together.

00:13:27.011 --> 00:13:28.052
You need to go poop.

00:13:29.072 --> 00:13:30.354
So they don't even realize a

00:13:30.394 --> 00:13:31.573
lot of times that they're

00:13:31.634 --> 00:13:32.774
doing these things.

00:13:33.115 --> 00:13:33.835
And if you've ever seen a

00:13:33.875 --> 00:13:34.875
kiddo do a pee pee dance,

00:13:34.916 --> 00:13:36.375
they're wiggling side to side.

00:13:36.416 --> 00:13:37.297
They're holding it together.

00:13:37.697 --> 00:13:39.018
We've all done a pee pee dance, yeah.

00:13:39.057 --> 00:13:40.558
We've all done a pee pee dance for sure.

00:13:41.559 --> 00:13:42.380
And they're just trying to

00:13:42.441 --> 00:13:43.441
hold it in so much.

00:13:43.520 --> 00:13:45.783
So lots of parents would be like, oh,

00:13:46.062 --> 00:13:47.464
that's what's going on.

00:13:47.484 --> 00:13:50.326
Or kiddos getting really uncomfortable.

00:13:50.346 --> 00:13:51.807
They can also have spasms

00:13:51.868 --> 00:13:52.807
happening too if their

00:13:52.847 --> 00:13:54.690
pelvic floor muscles are super tight,

00:13:55.169 --> 00:13:57.471
especially if there's gas coming out too.

00:13:57.652 --> 00:13:59.932
And yeah, they can spot the signs.

00:14:00.013 --> 00:14:01.434
Once you bring it to their attention,

00:14:01.654 --> 00:14:03.196
they can spot the signs really easily.

00:14:03.697 --> 00:14:04.697
So a lot of the things

00:14:04.716 --> 00:14:05.357
you're talking about in

00:14:05.378 --> 00:14:06.118
terms of talking to the

00:14:06.158 --> 00:14:08.057
parents feels like a lot of

00:14:08.077 --> 00:14:08.798
this is going to be

00:14:09.538 --> 00:14:11.239
psychological behavior change.

00:14:12.639 --> 00:14:14.080
You did advanced education on this.

00:14:14.179 --> 00:14:15.581
How much were you taught?

00:14:15.660 --> 00:14:16.780
How much do you refer out?

00:14:16.841 --> 00:14:18.581
How much do you learn yourself?

00:14:18.620 --> 00:14:19.442
Because it feels like this

00:14:19.481 --> 00:14:22.001
is a lot of behavior on top

00:14:22.042 --> 00:14:23.523
of physical and biomechanics.

00:14:24.480 --> 00:14:26.120
Yeah, so I did learn a lot myself.

00:14:26.140 --> 00:14:28.081
I also have a bachelor's in psychology,

00:14:28.181 --> 00:14:29.302
so I've studied.

00:14:30.062 --> 00:14:31.442
Yeah, it does help.

00:14:32.243 --> 00:14:33.003
But I definitely didn't

00:14:33.023 --> 00:14:34.243
learn any of this in my

00:14:34.283 --> 00:14:35.524
bachelor's degree either.

00:14:35.543 --> 00:14:38.144
But I do have a couple of

00:14:38.205 --> 00:14:39.085
psychiatrists and

00:14:39.105 --> 00:14:40.346
psychologists that I refer

00:14:40.405 --> 00:14:41.365
out to when needed.

00:14:42.186 --> 00:14:43.187
And there I've been really

00:14:43.206 --> 00:14:44.947
thankful to network in my area.

00:14:45.008 --> 00:14:46.269
And I have two in particular,

00:14:46.428 --> 00:14:47.590
one just retired and she

00:14:47.610 --> 00:14:48.890
was more play-based therapy.

00:14:49.350 --> 00:14:52.052
Another one is more talk therapy.

00:14:52.092 --> 00:14:53.614
So I send older kids to him,

00:14:54.533 --> 00:14:55.495
but it really does help

00:14:55.514 --> 00:14:56.855
with those behavioral strategies.

00:14:57.035 --> 00:14:58.976
But as physical therapists

00:14:59.177 --> 00:15:00.197
in our peds realm,

00:15:01.081 --> 00:15:02.061
We are trained in those

00:15:02.101 --> 00:15:03.042
behavioral strategies.

00:15:03.101 --> 00:15:04.081
So if you think of working

00:15:04.121 --> 00:15:05.322
with kiddos who have any

00:15:05.363 --> 00:15:07.144
sort of attention issues,

00:15:07.344 --> 00:15:09.565
either ADHD or autism,

00:15:10.065 --> 00:15:11.666
we know how to work with those kids.

00:15:11.725 --> 00:15:12.605
If you apply those

00:15:12.645 --> 00:15:13.687
behavioral adjustment

00:15:13.746 --> 00:15:16.548
principles to any kiddo, any adult too,

00:15:16.947 --> 00:15:18.489
you're going to see great

00:15:18.528 --> 00:15:19.570
behavioral changes.

00:15:19.789 --> 00:15:22.791
So with my kids, I will do, for example,

00:15:22.831 --> 00:15:23.630
this one little girl,

00:15:24.231 --> 00:15:25.471
she was always fighting her

00:15:25.532 --> 00:15:26.793
parents and she was,

00:15:27.523 --> 00:15:29.004
five years old at that point,

00:15:29.803 --> 00:15:30.683
she was always fighting

00:15:30.703 --> 00:15:31.764
them when it was time to

00:15:31.825 --> 00:15:32.504
sit on the potty.

00:15:32.904 --> 00:15:34.605
So would you have a chart,

00:15:34.625 --> 00:15:35.525
a schedule chart?

00:15:36.005 --> 00:15:38.407
And so they added in, okay, we do lunch,

00:15:38.626 --> 00:15:41.168
we do playtime, we sit on the potty,

00:15:41.548 --> 00:15:42.708
then we do whatever else.

00:15:42.869 --> 00:15:44.068
And by adding that in,

00:15:44.568 --> 00:15:45.970
she then was able to know

00:15:46.110 --> 00:15:47.250
what came next and she

00:15:47.309 --> 00:15:48.230
stopped fighting them.

00:15:48.870 --> 00:15:50.392
She also, the same little girl,

00:15:50.471 --> 00:15:51.991
her breakthrough and her

00:15:52.052 --> 00:15:53.952
last ability to go potty

00:15:54.013 --> 00:15:55.253
every single day by herself

00:15:55.312 --> 00:15:56.673
was adding in a help chart.

00:15:57.739 --> 00:15:58.899
So school wanted her to be

00:15:58.980 --> 00:15:59.960
independent with bowel

00:15:59.980 --> 00:16:01.900
movements on the potty and

00:16:01.941 --> 00:16:02.961
cleaning herself up and

00:16:02.981 --> 00:16:04.082
just pottying in general.

00:16:04.182 --> 00:16:05.243
She was good for pee,

00:16:05.322 --> 00:16:06.464
but not great for poop,

00:16:07.485 --> 00:16:09.846
which I mean at age five is

00:16:09.885 --> 00:16:10.586
pretty common.

00:16:11.407 --> 00:16:12.447
So what we did was a help

00:16:12.506 --> 00:16:14.128
chart and she had four options.

00:16:14.288 --> 00:16:15.328
She could pick her help.

00:16:15.828 --> 00:16:17.029
So if she wanted mom or dad

00:16:17.049 --> 00:16:18.390
to stand in the bathroom with her,

00:16:18.571 --> 00:16:20.072
if she wanted help undressing,

00:16:20.491 --> 00:16:21.993
wiping or redressing,

00:16:22.052 --> 00:16:23.994
then she got to pick which help she got.

00:16:24.514 --> 00:16:26.775
And for her, that gave her control.

00:16:27.355 --> 00:16:28.697
So the one things,

00:16:28.758 --> 00:16:29.817
if you think about kiddos,

00:16:30.099 --> 00:16:31.259
what can they actually

00:16:31.360 --> 00:16:34.902
control in their life?

00:16:35.663 --> 00:16:36.884
How much they put in and how

00:16:36.923 --> 00:16:38.384
much they get out, essentially.

00:16:38.404 --> 00:16:41.288
So they can close the top and the bottom,

00:16:41.327 --> 00:16:41.967
and that's about it.

00:16:42.948 --> 00:16:43.489
But otherwise,

00:16:43.528 --> 00:16:44.710
they don't have a lot of control.

00:16:44.789 --> 00:16:46.491
So giving these kiddos more control...

00:16:47.010 --> 00:16:48.532
can sometimes help with these issues.

00:16:48.871 --> 00:16:50.052
I've also had kiddos that

00:16:50.211 --> 00:16:51.452
that was the only time they

00:16:51.513 --> 00:16:54.193
got one-on-one with parents.

00:16:54.693 --> 00:16:56.114
And so we had to find

00:16:56.173 --> 00:16:58.335
another avenue for kiddos

00:16:58.375 --> 00:16:59.716
to spend more quality time

00:16:59.775 --> 00:17:00.975
rather than 20 minutes

00:17:01.035 --> 00:17:01.897
sitting on the toilet,

00:17:02.376 --> 00:17:03.897
trying to have a poop or saying, wait,

00:17:03.917 --> 00:17:05.218
I don't think I got everything out.

00:17:05.698 --> 00:17:07.239
just so mom would stay longer.

00:17:07.259 --> 00:17:09.400
There was one boy I treated

00:17:09.440 --> 00:17:10.740
in Michigan who I think he

00:17:10.780 --> 00:17:12.821
had like six or seven older siblings.

00:17:14.082 --> 00:17:16.042
And he, they ended up, it was pretty sad.

00:17:16.063 --> 00:17:17.443
They took the doors off the

00:17:17.483 --> 00:17:18.483
bathroom because he would

00:17:18.503 --> 00:17:20.085
spend over an hour in there

00:17:20.184 --> 00:17:20.785
trying to poop.

00:17:21.125 --> 00:17:22.185
But he finally told me,

00:17:22.205 --> 00:17:23.987
that's the only alone time that I get.

00:17:24.406 --> 00:17:26.407
So that's why I stay in there for so long.

00:17:27.509 --> 00:17:29.809
So trying to find the root

00:17:29.950 --> 00:17:31.049
of some of these issues can

00:17:31.089 --> 00:17:32.330
be really psychological.

00:17:32.351 --> 00:17:32.431
Yeah.

00:17:32.778 --> 00:17:34.382
I was going to say, is this a psych?

00:17:34.442 --> 00:17:36.003
So you're going to say it

00:17:36.044 --> 00:17:37.185
depends because everybody's different.

00:17:37.707 --> 00:17:40.030
But is this more often a

00:17:40.090 --> 00:17:41.313
psychological issue that

00:17:41.353 --> 00:17:42.674
manifests physically or a

00:17:42.734 --> 00:17:43.355
physical issue that

00:17:43.395 --> 00:17:44.196
manifests and then does

00:17:44.217 --> 00:17:45.219
some psychological things

00:17:45.358 --> 00:17:46.580
or it's chicken and egg?

00:17:47.800 --> 00:17:48.842
It's definitely chicken and eggs.

00:17:48.902 --> 00:17:50.063
So it's both.

00:17:50.483 --> 00:17:52.144
It's always both.

00:17:52.484 --> 00:17:55.688
So whether it starts as psychological,

00:17:55.768 --> 00:17:57.328
I have one little girl I'm seeing now,

00:17:57.449 --> 00:17:58.630
they started on a road trip

00:17:58.670 --> 00:17:59.570
moving from the West coast

00:17:59.611 --> 00:18:01.051
to the East coast and they

00:18:01.092 --> 00:18:02.212
took like a week and a half

00:18:02.333 --> 00:18:03.994
and she refused to poop for

00:18:04.035 --> 00:18:05.296
that entire week and a half.

00:18:05.736 --> 00:18:07.298
She was perfectly fine and regular.

00:18:07.458 --> 00:18:08.818
And then that snowballed

00:18:08.858 --> 00:18:10.259
into more physical issues.

00:18:11.320 --> 00:18:12.561
I have other kids who have,

00:18:13.018 --> 00:18:14.699
these physical issues, right?

00:18:14.759 --> 00:18:15.900
So they are not getting

00:18:15.940 --> 00:18:17.040
everything out each time.

00:18:17.480 --> 00:18:20.041
Maybe they went from pooping

00:18:20.082 --> 00:18:20.863
on the toilet and

00:18:20.903 --> 00:18:23.044
biomechanically they're not set up well.

00:18:23.525 --> 00:18:25.246
And so they couldn't get everything out.

00:18:25.425 --> 00:18:27.247
So now this little 20 to 30%

00:18:27.247 --> 00:18:28.768
that they're not getting out,

00:18:29.420 --> 00:18:30.540
backs up and up and up and

00:18:30.621 --> 00:18:31.941
up in the colon.

00:18:32.401 --> 00:18:33.541
And now they have a

00:18:33.761 --> 00:18:35.262
psychological issue because

00:18:35.883 --> 00:18:36.502
when they're pooping,

00:18:36.563 --> 00:18:38.523
it's like a huge brick, right?

00:18:38.624 --> 00:18:40.345
And they are having so much

00:18:40.384 --> 00:18:41.625
pain and discomfort and

00:18:41.885 --> 00:18:43.425
trauma from getting out

00:18:43.445 --> 00:18:44.567
this constipation that's

00:18:44.586 --> 00:18:45.207
been building up.

00:18:46.740 --> 00:18:46.921
All right.

00:18:46.941 --> 00:18:48.122
Well, you brought up biomechanics.

00:18:49.324 --> 00:18:52.446
How much of the potty posture, right?

00:18:52.467 --> 00:18:53.768
We've all seen the videos, right?

00:18:53.807 --> 00:18:54.387
Squatty potty.

00:18:54.428 --> 00:18:56.851
How much of this potty posture, you know,

00:18:56.911 --> 00:18:58.092
what is good potty posture?

00:18:58.112 --> 00:18:58.913
Is it different for kids

00:18:58.932 --> 00:18:59.794
than it is for adults?

00:18:59.814 --> 00:19:01.115
But how much of that posture

00:19:02.435 --> 00:19:04.077
does that affect pediatric incontinence?

00:19:05.123 --> 00:19:05.522
A lot.

00:19:05.823 --> 00:19:07.344
So if we aren't positioned

00:19:07.403 --> 00:19:08.284
well on the toilet,

00:19:08.324 --> 00:19:09.304
we can't get everything out.

00:19:09.744 --> 00:19:11.045
So if you think of a kiddo

00:19:11.164 --> 00:19:13.385
who is four feet tall, right?

00:19:13.425 --> 00:19:14.965
And you put them on one of our toilets,

00:19:15.465 --> 00:19:17.346
the toilets now are huge.

00:19:17.767 --> 00:19:19.228
Their feet are going to be dangling.

00:19:19.248 --> 00:19:21.087
I don't know if you can

00:19:21.107 --> 00:19:22.388
think about sitting on like

00:19:22.429 --> 00:19:23.669
a bar height stool,

00:19:24.169 --> 00:19:25.210
your feet are dangling.

00:19:25.309 --> 00:19:26.170
You kind of feel like you're

00:19:26.190 --> 00:19:27.430
going to fall off if you

00:19:27.450 --> 00:19:28.490
don't have some foot support.

00:19:29.290 --> 00:19:29.991
And that's the same with

00:19:30.011 --> 00:19:30.811
them on the toilet.

00:19:31.172 --> 00:19:32.833
So they clench or they hold

00:19:32.972 --> 00:19:34.253
on with their hands to try

00:19:34.294 --> 00:19:36.454
not to fall in or to try not to fall off.

00:19:36.955 --> 00:19:39.356
And that clenching of all of their muscles,

00:19:39.416 --> 00:19:40.096
their glutes,

00:19:40.278 --> 00:19:41.838
everything will prevent the

00:19:41.858 --> 00:19:43.700
pelvic floor from being able to relax.

00:19:43.859 --> 00:19:45.961
So it's more important in kiddos

00:19:46.468 --> 00:19:48.269
to be positioned properly on the potty.

00:19:48.549 --> 00:19:49.770
So getting them a footstool,

00:19:49.871 --> 00:19:51.272
getting them a toilet topper,

00:19:51.333 --> 00:19:52.093
ring reducer,

00:19:52.614 --> 00:19:53.734
whatever it takes for them

00:19:53.775 --> 00:19:55.175
to be super comfortable or

00:19:55.355 --> 00:19:56.517
using a small potty at

00:19:56.576 --> 00:19:57.718
first and then

00:19:57.778 --> 00:19:59.220
transitioning to the bigger potty.

00:20:00.361 --> 00:20:01.622
I had one client that I saw

00:20:01.701 --> 00:20:03.682
that they bought their

00:20:03.721 --> 00:20:05.423
child a fully functioning,

00:20:05.502 --> 00:20:07.143
just miniature toilet in

00:20:07.202 --> 00:20:09.163
her room because she had an

00:20:09.223 --> 00:20:10.064
en suite bathroom,

00:20:11.285 --> 00:20:12.865
which was pretty posh for a

00:20:12.924 --> 00:20:13.505
three-year-old.

00:20:13.525 --> 00:20:15.066
It's great.

00:20:15.105 --> 00:20:16.246
But they bought her a

00:20:16.767 --> 00:20:19.487
biomechanically sized model

00:20:19.646 --> 00:20:22.188
for her when she started potty training,

00:20:22.288 --> 00:20:23.288
which was amazing.

00:20:23.308 --> 00:20:24.009
Wow.

00:20:25.278 --> 00:20:26.659
It's going above and beyond for the kid,

00:20:26.679 --> 00:20:27.038
right?

00:20:27.779 --> 00:20:28.079
I know.

00:20:29.140 --> 00:20:29.259
Sure.

00:20:29.299 --> 00:20:29.859
It helped out.

00:20:31.200 --> 00:20:32.260
Yeah, she did great.

00:20:32.401 --> 00:20:34.141
But going then on other

00:20:34.181 --> 00:20:35.300
toilets was an issue.

00:20:35.340 --> 00:20:36.201
So trying to figure out

00:20:36.241 --> 00:20:36.942
what's going to work best

00:20:36.961 --> 00:20:38.001
for kiddos in the long run

00:20:38.041 --> 00:20:38.781
is always helpful.

00:20:39.241 --> 00:20:40.343
Yeah.

00:20:40.482 --> 00:20:41.623
You know, you mentioned treatment.

00:20:41.762 --> 00:20:42.962
You mentioned some anatomy.

00:20:42.982 --> 00:20:43.983
Let's go further up.

00:20:45.364 --> 00:20:46.443
Intestines are muscles.

00:20:46.844 --> 00:20:48.545
You've mentioned training, retraining.

00:20:49.085 --> 00:20:49.964
What's your approach for

00:20:50.125 --> 00:20:51.545
treating them in terms of

00:20:51.565 --> 00:20:54.086
the intestines in pediatric cases?

00:20:55.140 --> 00:20:55.440
Yeah,

00:20:55.500 --> 00:20:56.900
so a lot of the kiddos that I see

00:20:56.960 --> 00:20:58.421
have slower bowel motility

00:20:58.641 --> 00:20:59.780
and some providers,

00:20:59.861 --> 00:21:01.840
some MDs or urologists or

00:21:01.980 --> 00:21:04.082
even GIs will tell you the corn test,

00:21:04.122 --> 00:21:04.761
which I love.

00:21:08.001 --> 00:21:09.702
So the corn test, if you've never done it,

00:21:09.742 --> 00:21:10.282
please do it.

00:21:10.803 --> 00:21:11.942
It's where you essentially

00:21:12.022 --> 00:21:13.722
eat corn for one meal and

00:21:13.883 --> 00:21:14.943
see how long it takes for

00:21:14.963 --> 00:21:16.963
you to poop it out because

00:21:17.084 --> 00:21:19.384
corn does not break down in our system.

00:21:19.545 --> 00:21:21.045
So it looks the same as when

00:21:21.065 --> 00:21:21.865
you ingested it.

00:21:22.845 --> 00:21:24.865
So you eat it for one meal, one meal only,

00:21:25.046 --> 00:21:27.205
and then you spot it in your poop.

00:21:27.386 --> 00:21:28.326
It's a really,

00:21:28.807 --> 00:21:30.326
it's a beautifully

00:21:30.386 --> 00:21:31.647
scientific thing to do.

00:21:31.708 --> 00:21:32.407
Kids love it.

00:21:32.867 --> 00:21:33.768
If they have siblings,

00:21:34.028 --> 00:21:35.009
I tell them it's the corn

00:21:35.348 --> 00:21:37.229
race and they all search for it.

00:21:37.288 --> 00:21:38.650
They are just so excited of

00:21:38.769 --> 00:21:41.171
who can poop out corn the first time.

00:21:42.790 --> 00:21:43.570
So you can see,

00:21:43.671 --> 00:21:45.172
so normal bowel motility is

00:21:45.211 --> 00:21:47.031
anywhere from 24 to 72 hours.

00:21:47.071 --> 00:21:47.991
That's one to three days.

00:21:48.053 --> 00:21:49.593
That's a pretty long variation.

00:21:50.387 --> 00:21:52.410
So 24 to 36 hours is usually

00:21:52.470 --> 00:21:53.611
what my kiddos will be at

00:21:53.691 --> 00:21:54.912
when they're having daily

00:21:55.031 --> 00:21:57.192
or frequent enough bowel movements.

00:21:57.693 --> 00:21:58.674
But I've had some kiddos

00:21:58.714 --> 00:21:59.654
that will have corn in

00:21:59.674 --> 00:22:02.336
their poop at two days, at four days,

00:22:02.438 --> 00:22:03.458
and then a week later.

00:22:03.878 --> 00:22:05.019
And so you know that their

00:22:05.059 --> 00:22:06.560
bowel motility is not where

00:22:06.601 --> 00:22:07.260
it needs to be.

00:22:07.441 --> 00:22:09.222
So it's not a precise test, right?

00:22:09.303 --> 00:22:10.202
We can't use it as the

00:22:10.263 --> 00:22:12.704
end-all be-all diagnostic, but it's fun.

00:22:13.145 --> 00:22:13.965
Kids like it.

00:22:14.146 --> 00:22:15.407
It's an easy test to see

00:22:15.567 --> 00:22:16.667
sort of what's going on.

00:22:17.588 --> 00:22:18.690
And then I can address them

00:22:18.730 --> 00:22:20.829
with electrical abdominal stimulation.

00:22:21.411 --> 00:22:22.911
So I use just a regular

00:22:22.971 --> 00:22:24.352
abdominal stimulation unit.

00:22:25.011 --> 00:22:25.991
I put it on their belly.

00:22:26.152 --> 00:22:28.153
I train parents how to do it at home.

00:22:28.173 --> 00:22:29.693
There's actually a lot of

00:22:29.834 --> 00:22:31.513
really good evidence to

00:22:31.574 --> 00:22:33.394
show how well it works in

00:22:33.414 --> 00:22:34.654
the pediatric population,

00:22:34.755 --> 00:22:35.875
which is sort of unheard of

00:22:35.955 --> 00:22:36.955
for something like this.

00:22:37.936 --> 00:22:39.257
So in two to four weeks, a lot of

00:22:43.489 --> 00:22:44.509
reduces or eliminate their

00:22:44.648 --> 00:22:46.789
urinary accidents during the day as well,

00:22:47.349 --> 00:22:48.830
improve their bowel frequency.

00:22:49.711 --> 00:22:50.771
So I normally keep my kiddos

00:22:50.832 --> 00:22:51.672
on it for about three to

00:22:51.711 --> 00:22:53.373
six months for daily use or

00:22:53.432 --> 00:22:54.973
five to seven times a week use.

00:22:55.823 --> 00:22:57.324
depending on what's going on with them.

00:22:57.423 --> 00:22:58.743
And they make exceptional

00:22:58.804 --> 00:23:00.724
progress because it's smooth muscle,

00:23:00.805 --> 00:23:01.025
right?

00:23:01.065 --> 00:23:02.306
Intestines are smooth muscle.

00:23:02.365 --> 00:23:05.207
We can't voluntarily contract them,

00:23:05.747 --> 00:23:08.008
but with electrical stimulation, we can.

00:23:08.028 --> 00:23:10.288
And so we can affect change

00:23:10.489 --> 00:23:11.569
on those smooth muscles

00:23:11.849 --> 00:23:13.490
just as we would on a skeletal muscle.

00:23:14.131 --> 00:23:14.830
I just got really nervous

00:23:14.851 --> 00:23:16.852
because I just shifted weight in my seat.

00:23:16.872 --> 00:23:17.932
And I'm like, is Kylie going to,

00:23:18.053 --> 00:23:19.212
is she going to like read into that?

00:23:19.532 --> 00:23:21.314
Like, she's going to think I've done that.

00:23:21.574 --> 00:23:22.734
No, I was just shifting weight, everybody.

00:23:22.755 --> 00:23:23.414
That's all I was doing.

00:23:24.789 --> 00:23:25.190
It's okay.

00:23:25.230 --> 00:23:26.191
My two and a half year old,

00:23:26.310 --> 00:23:27.431
she will shift weight and

00:23:27.471 --> 00:23:28.491
then she'll let out a toot

00:23:28.551 --> 00:23:29.132
and she's like.

00:23:29.672 --> 00:23:30.031
Well,

00:23:30.752 --> 00:23:31.492
she's going to be the most

00:23:31.512 --> 00:23:32.192
comfortable talking about

00:23:32.252 --> 00:23:32.913
it because I'm guessing

00:23:32.932 --> 00:23:33.394
like you're pretty

00:23:33.433 --> 00:23:34.753
comfortable and that's just how it works,

00:23:34.834 --> 00:23:34.973
right?

00:23:34.993 --> 00:23:35.914
The more comfortable you are,

00:23:35.954 --> 00:23:38.715
the more comfortable kids are around it.

00:23:38.756 --> 00:23:38.715
100%.

00:23:38.935 --> 00:23:40.497
One of the lectures that I did,

00:23:40.517 --> 00:23:42.057
I got invited to present at

00:23:42.116 --> 00:23:44.417
a pediatric like monthly

00:23:45.018 --> 00:23:45.979
meeting essentially.

00:23:46.358 --> 00:23:49.380
It was with like 30

00:23:49.380 --> 00:23:50.941
pediatricians in the area and

00:23:52.074 --> 00:23:53.275
And my first opening line,

00:23:53.295 --> 00:23:55.336
whenever I do any sort of presentation is,

00:23:55.757 --> 00:23:56.477
who pooped today?

00:23:57.798 --> 00:23:58.419
Did you poop today?

00:23:58.598 --> 00:23:59.078
Raise your hand.

00:23:59.159 --> 00:24:01.160
And no one raised their hand.

00:24:01.180 --> 00:24:02.040
They said,

00:24:02.526 --> 00:24:03.807
So you're all constipated.

00:24:03.906 --> 00:24:05.087
This is great, right?

00:24:05.127 --> 00:24:05.989
You'll have a lot to talk

00:24:06.009 --> 00:24:06.888
about with these kiddos.

00:24:06.909 --> 00:24:07.450
I said,

00:24:07.529 --> 00:24:08.589
I'm going to ask you one more time.

00:24:08.891 --> 00:24:09.770
Did you poop today?

00:24:09.891 --> 00:24:11.172
And most of them raised their hand.

00:24:11.231 --> 00:24:11.432
I said,

00:24:11.471 --> 00:24:14.034
if you aren't comfortable talking

00:24:14.094 --> 00:24:15.674
about your own bowel movements,

00:24:16.175 --> 00:24:17.757
how do you expect a child

00:24:17.856 --> 00:24:18.817
to talk about their bowel

00:24:18.837 --> 00:24:20.219
movements with a stranger?

00:24:20.239 --> 00:24:21.579
Right.

00:24:22.059 --> 00:24:22.539
No way.

00:24:23.480 --> 00:24:24.662
No, that's a great point.

00:24:26.083 --> 00:24:27.344
So talking about that in

00:24:27.604 --> 00:24:28.424
terms of like being

00:24:28.484 --> 00:24:29.905
uncomfortable or hiding it,

00:24:30.625 --> 00:24:32.167
I'm sure there are kids who

00:24:32.228 --> 00:24:32.888
might be hiding

00:24:32.929 --> 00:24:34.270
incontinence and the

00:24:34.330 --> 00:24:35.192
challenges that that

00:24:35.231 --> 00:24:36.314
probably brings up as well.

00:24:37.214 --> 00:24:39.176
Yeah, the older they get, right,

00:24:39.377 --> 00:24:40.358
the kids get mean.

00:24:40.799 --> 00:24:42.662
Kids, I will say, oh, you stink.

00:24:42.701 --> 00:24:42.862
Yeah.

00:24:44.662 --> 00:24:45.823
Yeah, kids get super mean.

00:24:45.883 --> 00:24:46.784
Oh, you're smelly.

00:24:46.903 --> 00:24:48.744
Oh, I can see you peed your pants.

00:24:48.924 --> 00:24:50.967
And that sometimes starts around age six,

00:24:51.027 --> 00:24:52.268
which is really unfortunate.

00:24:52.428 --> 00:24:53.288
So the older they get,

00:24:53.348 --> 00:24:54.489
the more they try and hide

00:24:54.548 --> 00:24:55.269
what's going on.

00:24:56.090 --> 00:24:56.990
So parents will find

00:24:57.111 --> 00:24:57.932
underwear stashed

00:24:57.951 --> 00:24:59.432
throughout the house or

00:24:59.553 --> 00:25:00.894
even in the trash can,

00:25:01.153 --> 00:25:02.634
or kiddos will change as

00:25:02.655 --> 00:25:03.536
soon as they get home,

00:25:03.675 --> 00:25:04.497
or they'll keep an extra

00:25:04.517 --> 00:25:05.718
set of clothing in their backpack.

00:25:06.198 --> 00:25:09.138
I treated one gymnast who

00:25:09.740 --> 00:25:11.039
she at practice would

00:25:11.119 --> 00:25:12.480
always wear multiple pairs

00:25:12.540 --> 00:25:14.301
of shorts so no one could

00:25:14.362 --> 00:25:15.682
see that she leaped every

00:25:15.702 --> 00:25:16.643
time she landed.

00:25:17.442 --> 00:25:19.023
So the older they get,

00:25:19.263 --> 00:25:20.964
they're definitely hiding it.

00:25:21.965 --> 00:25:23.246
Any sort of incontinence,

00:25:23.506 --> 00:25:24.227
they're going to try and

00:25:24.247 --> 00:25:25.287
hide because they think, oh,

00:25:25.326 --> 00:25:26.807
no one else is going through this.

00:25:27.248 --> 00:25:28.868
but 30% of kids are

00:25:28.909 --> 00:25:30.329
experiencing constipation.

00:25:30.769 --> 00:25:32.731
That's a huge amount of kiddos.

00:25:33.852 --> 00:25:35.153
It's 5% of pediatrician

00:25:35.192 --> 00:25:36.453
appointments each year,

00:25:36.513 --> 00:25:37.275
which I think that is

00:25:37.394 --> 00:25:39.816
grossly underestimated for constipation.

00:25:39.875 --> 00:25:40.777
Because if you think about

00:25:41.156 --> 00:25:41.938
kiddos coming in with

00:25:41.958 --> 00:25:43.137
delayed potty training or

00:25:43.278 --> 00:25:45.160
urinary accident or fecal accidents,

00:25:45.279 --> 00:25:47.500
those are all related to constipation.

00:25:47.520 --> 00:25:49.623
And so a 16 year old isn't

00:25:49.643 --> 00:25:50.563
going to tell you, yeah,

00:25:50.583 --> 00:25:52.203
I'm peeing my pants every day.

00:25:53.244 --> 00:25:53.924
They're just going to try

00:25:53.964 --> 00:25:54.865
and drink less water or

00:25:55.546 --> 00:25:56.287
hide what's going on.

00:25:57.368 --> 00:25:57.588
Yeah,

00:25:57.648 --> 00:25:58.549
they're going to do it just like the

00:25:58.569 --> 00:25:59.170
pediatricians.

00:25:59.230 --> 00:25:59.690
We're just not,

00:25:59.730 --> 00:26:00.509
we're just going to ignore it.

00:26:00.529 --> 00:26:01.290
We're not going to talk about it.

00:26:01.310 --> 00:26:01.990
They learn from us.

00:26:02.290 --> 00:26:02.471
We're,

00:26:02.510 --> 00:26:03.832
we're the ones that are wrong and we

00:26:03.852 --> 00:26:05.093
just keep repeating that sort of thing.

00:26:05.893 --> 00:26:06.032
Right.

00:26:07.334 --> 00:26:07.473
Um,

00:26:07.614 --> 00:26:09.153
is there anything I didn't ask in terms

00:26:09.193 --> 00:26:11.796
of common misconceptions and this, I want,

00:26:11.816 --> 00:26:12.375
I want you to go for a

00:26:12.415 --> 00:26:13.316
couple of different audiences,

00:26:13.536 --> 00:26:14.156
other providers.

00:26:14.196 --> 00:26:14.817
Cause you said about 30%,

00:26:14.817 --> 00:26:16.018
the people that you treat

00:26:16.077 --> 00:26:19.219
are kids of other providers, um, or the,

00:26:19.499 --> 00:26:21.480
or the other 70%, which is our, you know,

00:26:21.539 --> 00:26:22.240
people who have kids,

00:26:22.259 --> 00:26:23.661
but maybe don't have a health background,

00:26:23.840 --> 00:26:24.781
other misconceptions that

00:26:24.821 --> 00:26:25.701
you get commonly.

00:26:26.791 --> 00:26:27.913
Yeah, there's a lot of them.

00:26:28.032 --> 00:26:28.953
So from parents,

00:26:29.153 --> 00:26:30.634
one huge misconception is

00:26:30.694 --> 00:26:32.435
that my kiddo can't be constipated.

00:26:32.496 --> 00:26:33.497
They're pooping every day.

00:26:38.811 --> 00:26:40.113
and if they're not getting

00:26:40.173 --> 00:26:41.613
everything out then it just

00:26:41.673 --> 00:26:43.013
continues to back up in the

00:26:43.054 --> 00:26:44.974
colon even more so then we

00:26:45.075 --> 00:26:46.675
see this cyclical pattern

00:26:46.935 --> 00:26:48.737
of you know five or six

00:26:48.777 --> 00:26:50.336
days maybe even two weeks

00:26:50.436 --> 00:26:52.157
of medium poops and then

00:26:52.178 --> 00:26:53.798
the accidents start for a

00:26:53.858 --> 00:26:54.818
couple days and then they

00:26:54.838 --> 00:26:56.420
have these colossal poops

00:26:56.819 --> 00:26:58.480
that clog the toilet or

00:26:58.740 --> 00:27:00.102
happen for a couple days or

00:27:00.162 --> 00:27:01.382
kiddos get sick and they

00:27:01.402 --> 00:27:02.603
start vomiting from it

00:27:03.403 --> 00:27:05.105
That is functional constipation.

00:27:05.885 --> 00:27:07.587
So even if they're going every single day,

00:27:07.688 --> 00:27:08.469
it doesn't mean that things

00:27:08.788 --> 00:27:10.191
are going well, right?

00:27:10.230 --> 00:27:11.451
It just means that the body

00:27:11.491 --> 00:27:13.094
is starting to compensate

00:27:13.213 --> 00:27:14.615
and stretch the rectum.

00:27:15.076 --> 00:27:15.856
So what are some of the

00:27:15.876 --> 00:27:16.978
questions you'll ask there

00:27:16.998 --> 00:27:17.798
in terms of like

00:27:18.039 --> 00:27:20.182
consistency and viscosity

00:27:20.221 --> 00:27:20.903
and things like that?

00:27:21.760 --> 00:27:22.020
Yeah.

00:27:22.060 --> 00:27:22.682
Consistency.

00:27:22.701 --> 00:27:23.603
What are the poops look like?

00:27:23.643 --> 00:27:25.223
Are you having mashed potato poops?

00:27:25.324 --> 00:27:27.465
Are you having ripe bananas?

00:27:27.746 --> 00:27:28.426
Are they looking,

00:27:28.527 --> 00:27:30.167
nobody really knows milk does anymore.

00:27:30.268 --> 00:27:31.990
So you have to sort of adjust, like,

00:27:32.029 --> 00:27:33.230
are they tootsie rolls all

00:27:33.290 --> 00:27:34.051
stuck together?

00:27:34.071 --> 00:27:36.513
But if you've ever had a box

00:27:36.574 --> 00:27:37.555
of milk does like sit in

00:27:37.575 --> 00:27:38.315
the heat for a little bit,

00:27:38.335 --> 00:27:39.336
they're all lumped together.

00:27:39.355 --> 00:27:39.717
Right.

00:27:40.037 --> 00:27:41.778
But you can see the little balls of does.

00:27:42.018 --> 00:27:42.499
So that's,

00:27:42.878 --> 00:27:44.059
bad poops essentially,

00:27:44.119 --> 00:27:45.520
or too hard of poops?

00:27:46.162 --> 00:27:47.823
Are they having mixed media?

00:27:47.863 --> 00:27:48.844
I call them mixed media poops.

00:27:49.765 --> 00:27:51.546
Is it, you know, like mashed potatoes,

00:27:51.807 --> 00:27:53.367
but then at the front of it

00:27:53.448 --> 00:27:57.872
is like a big pile of marbles or pebbles,

00:27:57.932 --> 00:27:59.573
you know, is it mixed together?

00:27:59.673 --> 00:28:01.295
That's a sign of functional constipation.

00:28:01.315 --> 00:28:02.536
I always tell them just to

00:28:02.596 --> 00:28:04.217
do the corn test to see what happens,

00:28:04.237 --> 00:28:04.938
see what you find.

00:28:04.978 --> 00:28:05.417
And they go,

00:28:05.857 --> 00:28:07.118
we waited for four or five

00:28:07.138 --> 00:28:08.400
days and we didn't see any corn.

00:28:09.417 --> 00:28:09.718
Well,

00:28:09.738 --> 00:28:11.700
you probably have some slower bowel

00:28:11.720 --> 00:28:12.161
motility,

00:28:12.260 --> 00:28:15.202
or we sell corn for four days in a row.

00:28:15.222 --> 00:28:18.846
So those are the kiddos who

00:28:18.925 --> 00:28:20.167
really need some adjustment.

00:28:20.228 --> 00:28:20.847
Those are the types of

00:28:20.867 --> 00:28:21.808
questions that I ask.

00:28:22.028 --> 00:28:23.790
Another misconception,

00:28:23.830 --> 00:28:25.112
which is huge for kids,

00:28:25.172 --> 00:28:26.873
and they're so smart with it,

00:28:27.733 --> 00:28:29.795
the more accidents,

00:28:29.815 --> 00:28:32.016
the more pee accidents I have, well,

00:28:32.036 --> 00:28:32.976
the less water I'm going to

00:28:33.016 --> 00:28:34.737
drink because then I won't

00:28:34.757 --> 00:28:35.696
have as many accidents.

00:28:36.218 --> 00:28:37.917
And they're so smart to think that way,

00:28:37.978 --> 00:28:38.699
but it's actually the

00:28:38.838 --> 00:28:41.299
opposite because when our

00:28:41.579 --> 00:28:43.881
urine is more concentrated,

00:28:43.901 --> 00:28:46.021
it becomes more irritating

00:28:46.061 --> 00:28:46.622
to the bladder.

00:28:46.642 --> 00:28:47.982
So you're actually more

00:28:48.123 --> 00:28:49.423
likely to have an accident

00:28:49.442 --> 00:28:51.884
the less urine you have in your bladder,

00:28:51.943 --> 00:28:53.605
the more higher concentration there is.

00:28:54.300 --> 00:28:56.222
So you can sort of drown out

00:28:56.282 --> 00:28:58.144
the urine and flush it out,

00:28:58.605 --> 00:29:00.026
and then it will be less irritating.

00:29:00.145 --> 00:29:01.787
We still need to clear up the constipation,

00:29:02.048 --> 00:29:03.167
but the more water you drink,

00:29:03.228 --> 00:29:04.670
the less constipation you'll have,

00:29:04.789 --> 00:29:05.671
and the more our bowels

00:29:06.351 --> 00:29:07.051
will be functioning.

00:29:07.071 --> 00:29:08.913
Talking a lot about food and water,

00:29:09.032 --> 00:29:10.855
I'm guessing another person

00:29:11.055 --> 00:29:13.096
in your referral repertoire

00:29:13.136 --> 00:29:14.718
probably is a nutritionist?

00:29:15.898 --> 00:29:16.480
Sometimes.

00:29:16.720 --> 00:29:18.401
Sometimes families are maxed out, though.

00:29:18.421 --> 00:29:19.902
They say, I can't go to another provider.

00:29:19.922 --> 00:29:20.021
Right.

00:29:20.973 --> 00:29:22.954
Yeah, a dietician or a nutritionist.

00:29:22.994 --> 00:29:24.756
So it depends on their area.

00:29:24.796 --> 00:29:25.695
It also depends on state

00:29:25.736 --> 00:29:27.376
licensure who you would send them to.

00:29:27.396 --> 00:29:29.597
But a lot of times parents will say,

00:29:29.617 --> 00:29:30.917
I'm not going to another provider.

00:29:31.057 --> 00:29:32.618
So we follow just a general

00:29:32.838 --> 00:29:34.759
five servings of fruits and veggie rule.

00:29:35.279 --> 00:29:37.421
Anywhere from about 25 grams

00:29:37.480 --> 00:29:39.122
of fiber is what most

00:29:39.162 --> 00:29:40.261
people should be getting at

00:29:40.962 --> 00:29:42.583
age six or seven.

00:29:42.603 --> 00:29:46.065
There's a good body of

00:29:46.125 --> 00:29:47.105
evidence that will show the

00:29:47.164 --> 00:29:48.125
more fiber you get, the

00:29:49.010 --> 00:29:49.392
better.

00:29:49.531 --> 00:29:51.334
However, it depends on the type of fiber.

00:29:51.354 --> 00:29:53.175
So you have soluble fiber,

00:29:53.276 --> 00:29:54.778
which will turn the poop into,

00:29:54.798 --> 00:29:56.941
I always say like a jet puff marshmallow,

00:29:57.020 --> 00:29:57.240
right?

00:29:57.300 --> 00:29:58.362
It's a little bit sticky.

00:29:58.843 --> 00:29:59.824
It will give it some bulk.

00:29:59.963 --> 00:30:01.105
It will help everything move

00:30:01.125 --> 00:30:02.126
through the intestines.

00:30:02.567 --> 00:30:04.169
And then you have insoluble fiber,

00:30:04.209 --> 00:30:05.510
which doesn't dissolve in water.

00:30:06.330 --> 00:30:07.271
And those are like nuts and

00:30:07.332 --> 00:30:09.594
seeds and they will pull more water in.

00:30:09.634 --> 00:30:11.214
They will help to speed up the poop.

00:30:12.115 --> 00:30:13.936
So we want a good balance of the two.

00:30:13.997 --> 00:30:15.317
So normally we can take care

00:30:15.357 --> 00:30:17.960
of that together through

00:30:18.039 --> 00:30:19.582
just a dietary log,

00:30:19.701 --> 00:30:20.622
seeing what they're eating,

00:30:20.843 --> 00:30:21.962
adding things to it.

00:30:22.023 --> 00:30:22.963
I don't like to take away

00:30:23.023 --> 00:30:25.286
from kids because they have

00:30:25.306 --> 00:30:27.208
a rough enough go right now anyways.

00:30:27.688 --> 00:30:29.469
So if we can add flax seeds

00:30:29.529 --> 00:30:31.050
to their mac and cheese or

00:30:31.738 --> 00:30:31.917
you know,

00:30:31.998 --> 00:30:34.098
whatever else they're eating and

00:30:34.118 --> 00:30:34.939
they're enjoying,

00:30:34.999 --> 00:30:36.720
if we can add some things to it,

00:30:37.259 --> 00:30:39.740
then we're in a better

00:30:39.820 --> 00:30:41.662
model for them to be compliant too,

00:30:41.741 --> 00:30:42.923
because you also walk that

00:30:42.962 --> 00:30:44.563
fine line of them having a

00:30:44.623 --> 00:30:46.003
poor relationship with food.

00:30:46.124 --> 00:30:47.664
And we definitely don't want to do that.

00:30:50.881 --> 00:30:52.702
If a parent's listening or a

00:30:52.803 --> 00:30:54.025
provider who maybe doesn't

00:30:54.065 --> 00:30:56.346
treat kids is listening, what's the line?

00:30:56.647 --> 00:30:57.788
When would you like someone

00:30:57.828 --> 00:30:58.990
to call and come to see you?

00:30:59.030 --> 00:31:00.633
Like you just said,

00:31:00.692 --> 00:31:01.933
some kids are just provided

00:31:01.993 --> 00:31:02.634
out or doctored out.

00:31:02.674 --> 00:31:04.237
And I'm sure parents,

00:31:04.336 --> 00:31:05.818
there's vaccine schedules

00:31:05.858 --> 00:31:06.880
and they're provided out.

00:31:07.300 --> 00:31:08.721
What's the line where it's like, yeah,

00:31:08.741 --> 00:31:09.182
you should go?

00:31:10.777 --> 00:31:12.077
Anytime you have that gut

00:31:12.137 --> 00:31:14.119
feeling that something is going wrong,

00:31:14.539 --> 00:31:15.601
pediatricians oftentimes

00:31:15.621 --> 00:31:16.842
will say they'll grow out of it.

00:31:17.182 --> 00:31:18.222
If you were asking the

00:31:18.262 --> 00:31:20.365
pediatrician about it, go see someone.

00:31:20.684 --> 00:31:22.606
Go see a pediatric PT or a

00:31:22.646 --> 00:31:24.968
pediatric pelvic health PT or OT.

00:31:24.988 --> 00:31:26.009
There's a lot of great OTs

00:31:26.048 --> 00:31:27.509
that treat pediatric pelvic health too.

00:31:28.666 --> 00:31:30.128
go see someone as soon as

00:31:30.148 --> 00:31:30.869
you think it might be an

00:31:30.930 --> 00:31:32.152
issue because it's so much

00:31:32.332 --> 00:31:33.453
faster to resolve.

00:31:33.854 --> 00:31:35.336
So if they end up getting a

00:31:35.636 --> 00:31:36.637
stretched out rectum,

00:31:36.718 --> 00:31:38.000
it can take up to a year

00:31:38.099 --> 00:31:39.521
for it to shrink back down.

00:31:40.002 --> 00:31:42.246
That's a long time for kiddos of,

00:31:42.980 --> 00:31:43.280
you know,

00:31:43.340 --> 00:31:46.041
being on laxatives from GIs or

00:31:46.162 --> 00:31:47.982
doing exercises or having a

00:31:48.042 --> 00:31:48.983
belly stimulator.

00:31:49.124 --> 00:31:51.345
It's really taxing to work

00:31:51.384 --> 00:31:52.664
at this for that long.

00:31:52.805 --> 00:31:54.726
It weighs on everybody in the whole family,

00:31:54.885 --> 00:31:55.066
right?

00:31:55.166 --> 00:31:56.467
I've had parents say,

00:31:56.487 --> 00:31:57.508
we have to create our

00:31:57.548 --> 00:31:59.628
vacation schedule around Johnny's poop.

00:32:00.669 --> 00:32:03.130
So it's, it's so taxing on families,

00:32:03.190 --> 00:32:04.851
the further on down the road you get.

00:32:05.401 --> 00:32:05.560
I mean,

00:32:05.580 --> 00:32:08.664
with a lot of things that we and

00:32:08.684 --> 00:32:10.666
being anybody listening is an expert on,

00:32:10.707 --> 00:32:11.468
it's like, man,

00:32:11.548 --> 00:32:12.970
if you just come to me six months sooner,

00:32:13.009 --> 00:32:13.931
this thing would have been done.

00:32:14.412 --> 00:32:15.333
And I'm sure you might see

00:32:15.353 --> 00:32:17.035
that a lot where a lot of times,

00:32:17.736 --> 00:32:18.457
myself included,

00:32:18.957 --> 00:32:20.077
you might not want to go and...

00:32:21.740 --> 00:32:23.362
Open that can of worms, right?

00:32:23.403 --> 00:32:25.664
Just more food and animal analogies here.

00:32:25.945 --> 00:32:26.346
But you're like, oh,

00:32:26.425 --> 00:32:27.267
it's going to take forever.

00:32:27.287 --> 00:32:29.170
Pediatrician said I'll grow out of it.

00:32:29.190 --> 00:32:30.411
I really don't want to dig into this.

00:32:30.711 --> 00:32:31.092
And meanwhile,

00:32:31.112 --> 00:32:32.353
there's someone like you going, well,

00:32:32.373 --> 00:32:32.794
if you'd come,

00:32:32.834 --> 00:32:33.375
I could have given you

00:32:33.394 --> 00:32:34.015
three things that you could

00:32:34.035 --> 00:32:34.876
do on your own and you

00:32:34.896 --> 00:32:35.356
would have been done.

00:32:35.376 --> 00:32:37.098
You would have been glad you came here.

00:32:37.118 --> 00:32:37.960
You would have been done six

00:32:38.000 --> 00:32:38.381
months sooner.

00:32:39.631 --> 00:32:39.951
Yeah.

00:32:39.971 --> 00:32:41.031
And for most families,

00:32:41.211 --> 00:32:42.692
it's often more like four

00:32:42.712 --> 00:32:45.015
or five years by the time they get to me.

00:32:45.615 --> 00:32:47.856
So I have, yeah,

00:32:47.876 --> 00:32:48.798
I have a set of teenagers

00:32:48.817 --> 00:32:49.838
that I'm treating right now

00:32:49.878 --> 00:32:50.459
and they've had these

00:32:50.519 --> 00:32:51.539
issues for eight years.

00:32:52.421 --> 00:32:52.560
Um,

00:32:52.881 --> 00:32:54.301
and they've just been kicked around by

00:32:54.342 --> 00:32:57.064
different providers and people say, Oh,

00:32:57.104 --> 00:32:57.845
we'll try this.

00:32:58.085 --> 00:32:59.085
Oh, just do Kegels.

00:32:59.266 --> 00:33:00.006
Oh, just do this.

00:33:00.145 --> 00:33:01.626
And nobody really addressed

00:33:01.646 --> 00:33:02.748
their root of the issue,

00:33:02.807 --> 00:33:04.108
which was their constipation.

00:33:04.128 --> 00:33:07.612
Um, or I have kiddos who, um,

00:33:08.310 --> 00:33:09.351
have been through the ringer.

00:33:09.431 --> 00:33:10.672
I have one teenager I saw

00:33:10.711 --> 00:33:12.133
that went to a cardiologist

00:33:12.173 --> 00:33:13.212
and a neurologist and a

00:33:13.292 --> 00:33:15.153
urologist and a gastroenterologist.

00:33:15.173 --> 00:33:16.673
They went to everyone.

00:33:16.795 --> 00:33:18.015
And then finally someone

00:33:18.174 --> 00:33:21.155
gave them to me and you've

00:33:21.175 --> 00:33:22.497
got dyssynergic defecation.

00:33:22.517 --> 00:33:23.557
Your pelvic floor muscles

00:33:23.596 --> 00:33:25.518
are contracting when you

00:33:25.577 --> 00:33:27.038
are trying to let the poop out.

00:33:27.558 --> 00:33:29.079
And so your body isn't able

00:33:29.579 --> 00:33:30.819
to let it out effectively.

00:33:31.300 --> 00:33:32.760
And so I was able to then

00:33:32.840 --> 00:33:35.162
get him to a GI who could

00:33:35.182 --> 00:33:35.922
help address that.

00:33:35.942 --> 00:33:37.002
He ended up needing Botox.

00:33:38.182 --> 00:33:39.884
or not necessarily needing Botox,

00:33:39.923 --> 00:33:42.285
but he went the Botox route.

00:33:42.825 --> 00:33:44.405
So it's just,

00:33:44.526 --> 00:33:45.967
it's a long road for a lot of families.

00:33:46.346 --> 00:33:46.626
Wow.

00:33:46.826 --> 00:33:47.667
I'm learning so much.

00:33:48.367 --> 00:33:48.968
And now I don't know how

00:33:49.008 --> 00:33:50.509
long it'll be before I eat pudding again,

00:33:50.709 --> 00:33:52.769
but now I understand some things.

00:33:53.569 --> 00:33:54.211
Probably never.

00:33:55.931 --> 00:33:56.631
All right.

00:33:57.011 --> 00:33:57.912
Let me see.

00:33:57.932 --> 00:33:58.751
We're going to do a game

00:33:58.791 --> 00:34:00.053
called Overrated Underrated.

00:34:00.073 --> 00:34:00.752
Are you ready for this?

00:34:01.534 --> 00:34:01.753
Sure.

00:34:02.193 --> 00:34:02.453
All right.

00:34:03.474 --> 00:34:05.174
This is the PT Pinecast.

00:34:05.194 --> 00:34:05.516
All right.

00:34:05.615 --> 00:34:06.435
I'm going to give you a

00:34:06.536 --> 00:34:07.497
topic and you're going to

00:34:07.537 --> 00:34:09.117
tell me if it's overrated

00:34:09.356 --> 00:34:11.378
or underrated and why.

00:34:11.557 --> 00:34:12.798
So we're going to do five of these.

00:34:12.898 --> 00:34:13.219
First,

00:34:13.860 --> 00:34:16.121
public awareness of pediatric

00:34:16.360 --> 00:34:17.001
incontinence.

00:34:17.021 --> 00:34:18.981
Is that overrated or underrated?

00:34:19.713 --> 00:34:20.934
Oh, it's completely underrated.

00:34:20.994 --> 00:34:23.695
People don't even know what is going on.

00:34:23.775 --> 00:34:25.735
They just think that, oh, five,

00:34:25.755 --> 00:34:26.675
six-year-olds, yeah,

00:34:26.916 --> 00:34:27.896
it's totally normal that

00:34:27.916 --> 00:34:29.117
they pee themselves sometimes.

00:34:30.018 --> 00:34:32.699
Yeah, the whole normal, oh, it's, you know,

00:34:32.918 --> 00:34:33.820
I've heard this before

00:34:33.900 --> 00:34:35.320
thing winds up making a lot

00:34:35.340 --> 00:34:36.320
of things pretty miserable.

00:34:36.340 --> 00:34:36.420
Yeah.

00:34:37.360 --> 00:34:38.302
All right.

00:34:38.442 --> 00:34:39.541
Overrated, underrated,

00:34:39.782 --> 00:34:41.422
standard potty training

00:34:41.583 --> 00:34:42.963
methods are the things that

00:34:43.103 --> 00:34:44.304
mostly everybody does.

00:34:44.844 --> 00:34:45.485
Are they okay?

00:34:45.545 --> 00:34:46.565
Or should we be doing something different?

00:34:46.646 --> 00:34:47.326
Overrated, underrated.

00:34:48.800 --> 00:34:50.342
I think they're overrated.

00:34:50.601 --> 00:34:51.942
I think listening to your

00:34:52.001 --> 00:34:53.543
kiddo and following their

00:34:53.623 --> 00:34:55.143
cues says a lot.

00:34:55.224 --> 00:34:56.264
I think making sure that

00:34:56.304 --> 00:34:57.364
your kiddo is pooping

00:34:57.423 --> 00:34:58.905
regularly before you start

00:34:58.945 --> 00:35:00.766
potty training is such a

00:35:00.806 --> 00:35:02.666
huge key to success.

00:35:02.947 --> 00:35:04.206
Most urologists recommend

00:35:04.226 --> 00:35:05.728
waiting until age three for

00:35:05.768 --> 00:35:07.407
potty training because the

00:35:07.447 --> 00:35:08.489
body is ready by then.

00:35:08.989 --> 00:35:10.510
There's a lot of people that say, oh no,

00:35:10.570 --> 00:35:11.489
start at 18 months.

00:35:12.628 --> 00:35:13.789
I don't recommend that at all,

00:35:14.489 --> 00:35:15.911
but definitely overrated

00:35:15.990 --> 00:35:17.192
for a lot of the potty training.

00:35:17.331 --> 00:35:18.393
It will come.

00:35:18.413 --> 00:35:19.594
All right.

00:35:19.634 --> 00:35:20.153
Number three,

00:35:20.193 --> 00:35:21.594
importance of diet in

00:35:21.655 --> 00:35:23.617
pediatric pelvic health, overrated,

00:35:23.817 --> 00:35:24.237
underrated.

00:35:24.998 --> 00:35:25.597
Underrated.

00:35:25.677 --> 00:35:27.440
Diet plays a huge component.

00:35:27.739 --> 00:35:28.820
Your poop is what you eat.

00:35:29.802 --> 00:35:31.023
A lot of it is bacteria,

00:35:31.182 --> 00:35:32.103
but your poop is

00:35:32.143 --> 00:35:33.224
essentially what you eat.

00:35:33.364 --> 00:35:34.666
What you eat fuels the good

00:35:34.706 --> 00:35:36.507
bacteria in your gut or

00:35:36.646 --> 00:35:38.268
allows bad bacteria to thrive.

00:35:38.389 --> 00:35:40.150
So diet is the basis of

00:35:40.922 --> 00:35:41.621
all of our health.

00:35:41.802 --> 00:35:43.163
I'm a firm believer in that.

00:35:43.222 --> 00:35:44.324
And you can really affect a

00:35:44.543 --> 00:35:46.224
lot of change just by what

00:35:46.244 --> 00:35:47.224
you're putting into your body.

00:35:48.646 --> 00:35:49.806
Use of technology in

00:35:49.865 --> 00:35:51.547
treating pediatric incontinence,

00:35:51.706 --> 00:35:53.027
overrated, underrated.

00:35:53.951 --> 00:35:54.431
Oh, both.

00:35:54.570 --> 00:35:55.152
Can I say both?

00:35:55.552 --> 00:35:56.253
Sure.

00:35:56.532 --> 00:35:57.413
So biofeedback,

00:35:57.994 --> 00:35:59.173
biofeedback I think is

00:35:59.255 --> 00:36:00.574
overrated for kiddos.

00:36:02.016 --> 00:36:03.077
I've had a lot of kiddos

00:36:03.177 --> 00:36:04.697
that are great at

00:36:04.737 --> 00:36:07.000
biofeedback and can really

00:36:07.219 --> 00:36:08.099
coordinate the muscles.

00:36:08.239 --> 00:36:09.960
It's a useful tool for some kids.

00:36:10.081 --> 00:36:11.543
I've also had a lot of kids that are like,

00:36:11.663 --> 00:36:11.963
oh yeah,

00:36:11.983 --> 00:36:13.623
I can just sort of contract my

00:36:13.664 --> 00:36:15.664
glutes and do what I need

00:36:15.684 --> 00:36:16.766
to do to make that little

00:36:17.250 --> 00:36:20.110
like flower bloom or spaceship move,

00:36:20.331 --> 00:36:21.652
and it's totally fine.

00:36:22.692 --> 00:36:24.333
But most providers also

00:36:24.373 --> 00:36:25.353
don't use electrical

00:36:25.393 --> 00:36:26.914
stimulation in their treatment,

00:36:27.014 --> 00:36:28.135
and they should because it

00:36:28.195 --> 00:36:29.956
is extremely effective.

00:36:30.416 --> 00:36:31.376
It is super easy.

00:36:31.536 --> 00:36:32.817
We call it belly tickles.

00:36:33.177 --> 00:36:36.458
Kids love it, and it works beautifully.

00:36:36.478 --> 00:36:37.898
All right, final one.

00:36:38.018 --> 00:36:39.500
Role of body mechanics

00:36:39.840 --> 00:36:41.920
education in pediatric therapy,

00:36:42.081 --> 00:36:43.822
overrated or underrated?

00:36:44.713 --> 00:36:45.233
underrated.

00:36:45.494 --> 00:36:46.675
We definitely have to have

00:36:46.715 --> 00:36:48.077
that proper potty posture

00:36:48.097 --> 00:36:49.717
for kiddos to be more

00:36:49.757 --> 00:36:51.380
successful in getting everything out.

00:36:52.280 --> 00:36:53.262
I think some of the extra

00:36:53.322 --> 00:36:55.204
exercises that we do or we

00:36:55.244 --> 00:36:56.465
want to do as PTs are

00:36:56.565 --> 00:36:57.826
overrated and most parents

00:36:57.867 --> 00:36:59.027
are compliant with them.

00:36:59.527 --> 00:37:00.849
And so it just becomes extra

00:37:00.949 --> 00:37:02.610
stuff for the parents to do

00:37:02.731 --> 00:37:03.913
or for them to facilitate.

00:37:04.432 --> 00:37:05.373
I love a couple of good,

00:37:05.434 --> 00:37:07.016
really core exercises.

00:37:07.760 --> 00:37:09.659
really good core exercises, I should say.

00:37:10.201 --> 00:37:11.981
You can pull squigs off of a

00:37:12.061 --> 00:37:13.601
window and that engages

00:37:13.641 --> 00:37:14.840
your transverse abdominus.

00:37:15.101 --> 00:37:16.702
I see you might not know what squigs are.

00:37:17.101 --> 00:37:18.521
They're little suction cup toys.

00:37:18.621 --> 00:37:19.541
They're super fun.

00:37:20.503 --> 00:37:20.702
Yeah.

00:37:21.063 --> 00:37:22.043
But if you pull them,

00:37:22.202 --> 00:37:23.902
you will feel the TA contract.

00:37:23.983 --> 00:37:25.204
And that's a huge,

00:37:25.264 --> 00:37:27.224
huge way to retrain kiddos

00:37:27.264 --> 00:37:29.083
how to gently help to push

00:37:29.143 --> 00:37:30.525
out their poop without

00:37:30.585 --> 00:37:32.284
bearing down and closing the glottis.

00:37:32.876 --> 00:37:33.056
All right,

00:37:33.115 --> 00:37:35.038
you're off the hot seat for overrated,

00:37:35.077 --> 00:37:35.438
underrated.

00:37:35.458 --> 00:37:36.679
That's brought to you by ATI,

00:37:36.719 --> 00:37:37.699
leading the charge in PT

00:37:37.739 --> 00:37:38.840
clinical research with more

00:37:38.860 --> 00:37:39.922
than 900 clinics,

00:37:40.422 --> 00:37:41.483
achieving top marks in

00:37:41.523 --> 00:37:43.326
CMS's merit-based incentive program.

00:37:43.706 --> 00:37:44.706
They're the team to join for

00:37:44.746 --> 00:37:45.387
career growth.

00:37:45.467 --> 00:37:48.789
Explore opportunities at atipt.com.

00:37:49.331 --> 00:37:50.411
Last thing we do on the show

00:37:50.652 --> 00:37:51.632
is the parting shot.

00:37:51.873 --> 00:37:53.594
On the hot seat with three questions.

00:37:53.934 --> 00:37:55.916
This is the parting shot.

00:37:55.936 --> 00:37:56.697
Hit the wrong button.

00:37:56.717 --> 00:37:57.898
That happens sometimes, Kylie.

00:37:58.579 --> 00:37:59.679
A parting shot is your last

00:37:59.719 --> 00:38:01.001
chance for like a mic drop

00:38:01.041 --> 00:38:02.222
moment or a soapbox

00:38:02.242 --> 00:38:03.083
statement or something.

00:38:03.123 --> 00:38:03.744
You got the floor.

00:38:03.764 --> 00:38:04.625
What's your parting shot?

00:38:05.545 --> 00:38:06.286
Yeah.

00:38:06.306 --> 00:38:07.628
So there's a study out of 2015.

00:38:07.668 --> 00:38:08.688
It's pretty long ago that

00:38:08.708 --> 00:38:09.831
said $3.9 billion was spent

00:38:09.851 --> 00:38:11.391
every year on GI related questions.

00:38:18.235 --> 00:38:20.056
So costs related to constipation,

00:38:20.076 --> 00:38:23.599
any sort of testing, ER visits,

00:38:24.119 --> 00:38:25.679
healthcare visits, whatever,

00:38:26.460 --> 00:38:27.420
any sort of laxative to

00:38:27.440 --> 00:38:28.362
address constipation.

00:38:28.961 --> 00:38:30.083
If you adjust for inflation,

00:38:30.123 --> 00:38:32.023
that's almost $7 billion now.

00:38:32.565 --> 00:38:33.704
And they average it out to

00:38:33.744 --> 00:38:36.527
about $6,000 in our money

00:38:36.606 --> 00:38:39.588
now per child per year in

00:38:39.668 --> 00:38:41.630
constipation related healthcare costs.

00:38:42.210 --> 00:38:43.731
So if you put that into perspective,

00:38:43.771 --> 00:38:44.952
which I always try and do,

00:38:44.972 --> 00:38:46.373
because it sounds like a lot of money,

00:38:46.514 --> 00:38:46.713
but you

00:38:47.199 --> 00:38:48.179
You don't really know

00:38:48.259 --> 00:38:49.119
exactly how much money.

00:38:49.940 --> 00:38:51.780
Taylor Swift's Era Tour will

00:38:51.800 --> 00:38:53.362
pull in about $6 billion.

00:38:54.202 --> 00:38:55.742
So if you can imagine

00:38:55.963 --> 00:38:58.003
stadiums full of

00:38:58.083 --> 00:38:59.943
constipated kiddos and

00:38:59.983 --> 00:39:02.324
their parents just throwing out cash,

00:39:02.505 --> 00:39:03.945
and if you put it in those terms,

00:39:04.005 --> 00:39:06.507
people will go, oh my gosh, that is huge,

00:39:07.086 --> 00:39:08.447
huge amount of money and

00:39:08.527 --> 00:39:10.809
resources all for constipation.

00:39:11.909 --> 00:39:13.791
And it's miserable.

00:39:13.931 --> 00:39:15.393
Like you mentioned, like, you know,

00:39:15.432 --> 00:39:16.534
ruining vacation plans or

00:39:16.574 --> 00:39:17.514
planning your day around

00:39:17.554 --> 00:39:18.235
this or like the

00:39:18.295 --> 00:39:19.476
psychological stuff it's

00:39:19.516 --> 00:39:20.737
doing to kids or adults

00:39:20.777 --> 00:39:22.199
like doesn't sound good.

00:39:22.699 --> 00:39:23.300
So this is why everybody

00:39:23.320 --> 00:39:24.702
should see Kylie early and often.

00:39:24.882 --> 00:39:25.483
You're remote.

00:39:26.083 --> 00:39:26.945
So they should.

00:39:27.985 --> 00:39:29.126
Where can people connect?

00:39:29.166 --> 00:39:29.927
What's the easiest way for

00:39:29.947 --> 00:39:30.909
people to find you and connect with you?

00:39:32.222 --> 00:39:35.505
My website is kcgpediatricpt.com.

00:39:35.525 --> 00:39:37.708
I did just start The

00:39:37.748 --> 00:39:39.128
Incontinent Child as my

00:39:39.190 --> 00:39:40.931
Instagram handle a year ago.

00:39:40.951 --> 00:39:44.253
I'm not great on social media.

00:39:44.393 --> 00:39:46.036
I don't have a big presence on there.

00:39:46.056 --> 00:39:47.737
I'm trying because I know

00:39:47.817 --> 00:39:49.699
how valuable it is to get

00:39:49.739 --> 00:39:50.699
this information out,

00:39:51.139 --> 00:39:52.221
which is why I started it

00:39:52.320 --> 00:39:53.121
only a year ago.

00:39:53.940 --> 00:39:56.762
Um, so patients and their friends always,

00:39:57.182 --> 00:39:58.344
always request me.

00:39:58.804 --> 00:40:01.266
This is the great thing about social media,

00:40:01.286 --> 00:40:02.307
or I would say media that

00:40:02.367 --> 00:40:03.548
social is like you put out

00:40:03.568 --> 00:40:04.750
a video on YouTube and

00:40:04.809 --> 00:40:05.751
someone you're like,

00:40:05.851 --> 00:40:07.853
who on their right mind is, you know,

00:40:07.913 --> 00:40:09.793
searching like kid won't poop.

00:40:09.934 --> 00:40:10.815
And then when they see your

00:40:10.894 --> 00:40:12.737
face and they're like 90 seconds,

00:40:12.757 --> 00:40:13.737
you like explained it,

00:40:14.217 --> 00:40:15.018
they're calling you.

00:40:16.021 --> 00:40:17.221
Yeah, my first two videos,

00:40:17.300 --> 00:40:19.422
I was so shocked, had 100,000 views,

00:40:19.541 --> 00:40:22.262
which was pretty cool to

00:40:22.362 --> 00:40:24.184
see how many people that

00:40:24.563 --> 00:40:25.563
the pelvic floor and

00:40:25.583 --> 00:40:26.643
pediatric pelvic health

00:40:26.804 --> 00:40:28.105
really sat with them.

00:40:28.664 --> 00:40:29.764
And they said, oh my gosh,

00:40:29.804 --> 00:40:31.085
I got so many parents that

00:40:31.126 --> 00:40:31.885
messaged me and said,

00:40:31.965 --> 00:40:33.246
this sounds like my kid.

00:40:33.266 --> 00:40:34.347
I need some help.

00:40:34.467 --> 00:40:36.507
I had no idea that this was

00:40:36.547 --> 00:40:37.568
an issue that could be

00:40:37.708 --> 00:40:38.927
addressed or could be fixed.

00:40:39.088 --> 00:40:40.889
I was just told that they were a bad kid,

00:40:40.909 --> 00:40:42.309
that they were doing it on

00:40:42.349 --> 00:40:43.949
purpose or that they would

00:40:43.969 --> 00:40:44.570
grow out of it.

00:40:45.150 --> 00:40:45.411
I mean,

00:40:45.650 --> 00:40:48.512
that's the definition of innovation

00:40:48.572 --> 00:40:50.195
is you find a problem that

00:40:50.375 --> 00:40:51.856
everybody looks at it and says,

00:40:51.896 --> 00:40:54.197
not my problem, or they'll grow out of it,

00:40:54.356 --> 00:40:55.297
or don't worry about it.

00:40:55.838 --> 00:40:58.119
That's the intersection you want to be at,

00:40:58.159 --> 00:40:59.041
where it's an actual

00:40:59.101 --> 00:41:00.221
problem and you have an

00:41:00.382 --> 00:41:01.481
actionable solution.

00:41:01.963 --> 00:41:03.903
It's a disservice not to make more videos,

00:41:03.963 --> 00:41:04.423
Kylie.

00:41:04.503 --> 00:41:06.545
Take the phone out, push record.

00:41:07.246 --> 00:41:08.206
I mean,

00:41:08.706 --> 00:41:09.947
now I'll act like your social media

00:41:09.967 --> 00:41:11.188
advisor for a hot second.

00:41:11.248 --> 00:41:12.108
If you have to answer a

00:41:12.208 --> 00:41:13.509
question in an email or a

00:41:13.568 --> 00:41:15.489
text or a phone call more than two times,

00:41:15.769 --> 00:41:17.170
it deserves a video.

00:41:17.329 --> 00:41:19.291
Now, let's be strategic about it.

00:41:19.490 --> 00:41:20.331
Now we'll go back to what

00:41:20.371 --> 00:41:21.072
the kids were doing.

00:41:22.052 --> 00:41:23.313
Put it on your schedule though.

00:41:23.353 --> 00:41:24.233
I don't expect you to make

00:41:24.253 --> 00:41:25.032
that video that day,

00:41:25.072 --> 00:41:27.373
but say one half day a month,

00:41:27.934 --> 00:41:29.135
I'm going to now just turn

00:41:29.155 --> 00:41:30.675
to my list and clear it and

00:41:30.695 --> 00:41:31.456
do those five.

00:41:31.956 --> 00:41:32.996
And the funny part is the

00:41:33.036 --> 00:41:33.717
more videos you make,

00:41:33.737 --> 00:41:34.556
the more questions you'll get,

00:41:34.577 --> 00:41:35.458
the more questions you get,

00:41:35.478 --> 00:41:36.478
the more videos you'll make.

00:41:37.557 --> 00:41:40.019
One of those things is like a seed.

00:41:40.039 --> 00:41:41.300
You're just flinging out

00:41:41.320 --> 00:41:42.282
there on the Instagram or

00:41:42.302 --> 00:41:43.623
the TikTok and that stuff works.

00:41:44.563 --> 00:41:45.045
It works.

00:41:45.105 --> 00:41:45.784
It works a lot.

00:41:45.844 --> 00:41:46.885
And I've even had parents

00:41:46.925 --> 00:41:48.447
message me on Instagram saying,

00:41:48.467 --> 00:41:49.447
I saw your tips.

00:41:49.628 --> 00:41:50.568
I tried them.

00:41:50.989 --> 00:41:53.010
You know, I adjusted our potty posture.

00:41:53.150 --> 00:41:54.592
We drink more water and now

00:41:54.632 --> 00:41:55.914
the incontinence is gone.

00:41:55.934 --> 00:41:57.574
And now we're pooping more regularly.

00:41:57.594 --> 00:41:59.135
Like I didn't even need to see anybody,

00:41:59.155 --> 00:42:00.237
which is huge.

00:42:00.257 --> 00:42:00.478
You know,

00:42:01.177 --> 00:42:03.360
yeah, this knowledge is out there.

00:42:03.380 --> 00:42:05.143
It's just finding the

00:42:05.403 --> 00:42:06.724
providers that are willing

00:42:06.824 --> 00:42:08.487
to share it for one or

00:42:08.507 --> 00:42:09.509
willing to learn it.

00:42:09.909 --> 00:42:12.413
Well, there's a lot of bad poop out there.

00:42:12.432 --> 00:42:12.932
So you got to look,

00:42:12.972 --> 00:42:14.034
you got to dig and find the corn.

00:42:15.947 --> 00:42:16.726
It's full circle.

00:42:16.806 --> 00:42:18.068
It comes full circle.

00:42:18.088 --> 00:42:18.347
Kylie,

00:42:18.367 --> 00:42:20.387
we'll put your contact information

00:42:20.869 --> 00:42:21.608
in the show notes.

00:42:21.748 --> 00:42:22.929
I appreciate you doing this,

00:42:23.088 --> 00:42:24.909
being there for those people who need it,

00:42:25.409 --> 00:42:26.489
because it's going to resonate.

00:42:26.510 --> 00:42:27.510
The kids aren't going to

00:42:27.530 --> 00:42:28.811
want to talk about it forever,

00:42:28.851 --> 00:42:29.650
but they'll be thinking of

00:42:29.690 --> 00:42:30.431
you forever when they're

00:42:30.452 --> 00:42:31.952
not thinking about going to the bathroom.

00:42:32.652 --> 00:42:32.952
Perfect.

00:42:33.373 --> 00:42:33.693
Thank you.

00:42:33.713 --> 00:42:34.273
All right.

00:42:34.293 --> 00:42:34.733
We say the best

00:42:34.773 --> 00:42:36.193
conversations happen at happy hour.

00:42:36.293 --> 00:42:37.034
Thanks for coming to ours.