Episode 101: Keeping Cultural Differences in Mind with Sabrina Rebollar M.S., CCC-SLP, CIMI-II

Hi and welcome to episode 101 of the Untethered Podcast. Today we have Sabrina Robillar joining us. Sabrina is a bilingual speech language pathologist and orofacial myologist. She provides orofacial myofunctional therapy, feeding and swallowing therapy and speech language therapy for children and adults in the Rio Grande Valley, Texas area. Through her private practice, Mighty Bites, Sabrina recognizes the importance of a client centered therapeutic experience which inspires her to create strong and long lasting bonds with each of her patients. Today you'll hear her talk about her feeding and tots journey with her very own daughter. I was inspired when I heard her story and I knew she had to come on this podcast as soon as I met her. So I know whether you're a parent listening or a professional listening, you're going to get a lot out of this episode. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified health care provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses.

Let's get started. Well Sabrina, thank you so much so much for joining me today and being willing to share your story with us.

Yes, thank you so much for having me today. Super excited.

I'm excited too. I'm excited. I know that you're one of our community members and so that even makes me more excited because I love that the online things that we all do have brought some of us together that maybe we wouldn't have been connected otherwise. But I feel like you've got a really great story and message to share and so I'm excited to jump into that.

Yes, definitely in about 2018. I gave birth to my daughter in April. Right away in the hospital setting, lactation department personnel came in and I'm saying that choosing my words wisely because now we know there's IBCLCs and this individual unfortunately did not have those credentials. She came in, just asked how I was doing. I was a first time mom, I didn't know what to expect. She goes oh it looks good okay, bye. Bye. And she left. And that's the only time I had lactation support in the hospital setting. We came home. My daughter was born on a Thursday in the evening. So Friday evening, we were released. We didn't go to the pediatrician until Monday, but right away on Saturday and Sunday, that's when I say, and it's really sad to look back, that my nightmare began. It was just so painful and excruciating. And every time we had a feeding, I was dreading it. And it felt like my baby was dreading it, too. So I have a crying baby, and at the same time, I'm crying also. And I knew, because I already had worked with feeding before, that feeding should not feel that way. It should be a delightful time for mom and baby. And it was far from that. So what we had was coughing, choking. I know some anterior spillage is normal right away after birth, but the baby was literally dropping milk from her mouth. And it was just very scary and frightening. And that's when it clicked on me. I was like, oh, my gosh, this is a form of dysphagia. Like, this is not normal. Because I had worked in the geriatric population, I was like, something's going on in her mouth. It's not working, and I need help, and I don't know what to do. And I told my partner, call the hospital. That's all I could think of because I didn't know there was any resources. Call the hospital. Take me to the hospital. I need that lady to come see me. We were actually seen by another lactation personnel. She propped me up on, like, six pillows and then handed me off the baby and a nipple shield. And she said, oh, how do you feel now? And of course, at the time, I was like, I feel great. And I was like, this was a successful event. She didn't look in my baby's mouth. She didn't assess our latch. She didn't look at my nipple before or after. And all that extra good stuff. At that point, I had cracked nipples, and I was bleeding. I hope that's allowed.

Of course.

Yes, it was bleeding, and I was so concerned. And she didn't even address that. It was just with a nipple shield. So I came home, and the first time we tried to do it, I'm like, oh, my gosh, I'm alone because my partner was working. Who's going to hand me off the baby on my pillows? So I was like, okay, that's not ideal. The next appointment, Monday. We come to Monday. She dropped some weight which the doctor didn't really seem concerned. And they have you fill out like that postpartum depression. And I'm like, well, I'm a medical provider. I'm not depressed, but I'm really sad that I'm not having an enjoyable experience breastfeeding. And I didn't know how to relay that to my pediatrician, but all I could think of is, it's hard. I kept telling him, it's very hard. He gave us formula, formula, and sent us home. He never really addressed the feeding portion of it. So that left me really, really sad.

I can only imagine. I mean, it really.

Everything you're saying speaks to me because I was also this mom who went through a similar experience. And, you know, it's like, what, you don't know, you don't know, right? So I didn't know. Even though I was a pediatric feeding therapist, I was working. I was not working with breastfeeding babies at the time. I was working with 12 months plus, you know, so I could recognize that something was wrong. I didn't know what was wrong. I didn't know how to assess it myself with my first child. I knew with my second because I went down that rabbit hole, like, deep after experiencing this.

But, yeah, the same thing. The lactation personnel came in at the hospital and asked if things were okay. And I was like, I don't know if things are okay. You're supposed to tell me if things are okay. How do I know? Like, I'm this mom who just had this, like, I had other birth, like, other complications during my delivery, and we were both fine and everything, but I feel like I was exhausted. I had a lot of loss of blood. You know, it was just, how are you asking me if I'm like, if things are going okay? Please assess. Come on over, take a look. And so with my second daughter, I feel like I latched onto them because I was like, no, no, no, come over here. You're not leaving yet until we figure this out together. And at that point, I hadn't told him what I did or anything with my second child. But I also was like, I'm not looking in her mouth for the first 24 hours. And then the second she latched the first time, I was like, oh, there it is. Don't need to look in the mouth. I already know. Totally different experience, but it also gave me and empowered me to handle it differently. But also I had know with my second one that I didn't have with my first. And I relied on and trusted all of My providers. And I feel like I was failed. And I know that this is still happening on a daily basis to a lot of mamas and babies out there. And the biggest thing that you said was you felt like this should be an enjoyable experience. And when you flagged it as hard, it was like you were dismissed and handed formula. And that same thing happened to me. Like, I didn't flag it as anything. Nobody, really. I did fill out those same, like, postpartum questionnaires, and they were like, nope, you're not depressed. And I'm like, no, but I can't feed my kids, so this is a little stressful. Like, I'm crying baby shrieking at the top of her lungs. We did give her some formula because she had dropped so much weight already, and that was like, a day after coming home from the hospital. And I'm like, well, she clearly can't digest this formula. Like, it's not. She's shrieking like she's having a reaction. I'm having a reaction because she's shrieking. So now I'm crying, and this is just a whole big freaking mess. Like, something has got to give.

Right?

And that was the same thing. I went into lactation. They positioned her differently, told me I was holding her all wrong. And I have said this now three times in, like, the past week. I'm like. It was like when you take your car to the shop, right? And the noise stops when you get in there. And it's like, oh, we just have to position differently. Look, she's feeding beautifully. And then we go home and it doesn't work. And it's like, oh, there's the squeaky noise again. As soon as you drive off the lot.

Right.

Exactly. That's exactly what we went through. And the other thing I want to go back is to the pediatrician, is my baby was born full term. We didn't have any complications.

Yeah.

But she wore preemie clothing till about three months.

Mine, too.

It was so small. In about till 24, 25 months, she weighed 15 pounds. I had a tiny kid, and nobody saw this. And that's because we went to multiple pediatricians and nobody saw this concern at all. So.

Well, and the other thing with mine was they were just like, well, she's on. She's first percentile for weight, but she's on her own growth curve. Like, okay, um, I can't keep pants on her, but that's cool. I mean, I really, literally. She could only wear leggings until around four and a half years of Age. And like now we can put other clothes on her, but really the leggings still fit best. So she's got tiny, tiny little waist. And it's basically, that's just how she's been since the beginning, like always really tiny. But yeah, first percentile, her entire first year of life. And the whole message was, but she's on her own growth curve and she hasn't dropped below the first percentile. So she's fine, you know.

Okay, great.

Yeah, definitely. Same same experience we had here. It wasn't until it took me getting mastitis three times, getting sick consecutively, and I was already back at work at that point. But when I went to my ob gyn, they didn't have appointments to see me. And the receptionist was really nice and said, oh, miss, you know, we have a lactation center in the Valley that could help you. And I was like, how come nobody told me? The pediatrician didn't tell me the first time I got mastitis. Nobody told me, like, where are you supposed to find this information when you're brand new? The hospital didn't even tell me either. So I go there and that's the first time I meet an IBCLC who actually looks in my baby's mouth. And this is the ta da moment when she goes, your baby has a high palate and your baby has a tongue tie. But same thing she just said. It just positioned, baby, send me on my way. And I wasn't given much direction there. And it took me having to dive into research and start looking for articles. And then all I could remember in grad school was tongue ties could potentially be led to lead to a list for some sort of arctic impediment. So I was like, okay, so it's not affecting that. They never taught me this in grad school. So is this in my field? Is this not in my field? What's going on? And then I started looking into other providers by that time, I think Dr. Baxter released his book at the end of the summer. So my baby had just. I was in that phase. And I was like, there's a dentist who's doing this in Alabama and he's talking about therapy and he's talking about these therapists and oh my gosh, I'm going to go to Alabama. I love it. We are so far away from Alabama. So that was not possible. So then I started looking for providers in my region that were potential release providers, and that was really hard for me to find. And one day online when we were breastfeeding, I Found a dentist here who on his website said he did releases. I called, made an appointment. We went in, he laid the baby back, just looked at her mouth and goes, there's no tongue tie. Oh, gosh. Sometimes breastfeeding is just really hard for moms. And I was like, I already had researched more than how to do an assessment. I already had looked up the, like, the Hazel Baker, and I was already trying them on her. So I already had figured out that we were having issues at that point. But once again, I didn't say anything, because if he is a provider performing this, he should be competent to know what kind of assessment to perform. And he didn't do it. So when we walked out of the door, I was like, okay, it's just a sign. Maybe we're just going to have to tackle this on our own with, I guess, me doing manual therapy. I had Beckman training, so I was doing a lot of stretching. We kind of had a good experience. Could it have been better in our breastfeeding journey? I'm sure, But I didn't have the help. All I had was me and just continuing to learn on how I could make this as successful as possible.

Yeah, well, and that's. I mean, that's kudos on you, though, because to have that many providers.

Right.

And I went through it, too. I had an ENT tell me, well, she's not breast. I see it. It's there, but she's not breastfeeding, so we're not going to release it. And I was like, huh? Like, she's having trouble eating right now. I'm telling you, as a pediatric feeding therapist who does specialize in this age, because at that point, she was 24 months old, I was like, this is my specialty. She can't drink from an open cup. She takes really large bites. She can't manage the food. She can't lateralize her tongue. She can't suction her tongue or palate very well.

I was going through a whole laundry list of things.

I'm like, she has an oral. She has a. She's got dysphagia, oral phase, feeding issue. And she was like, oh, she's not breastfeeding, so. Nope. And I was like, all right, well, now we gotta go find somebody else. So. And that was supposed to be one of, like, the top people you go to in this area for these releases.

Yeah.

And so I was like, okay. So then I found the oral surgeon, who I refer to a lot now. And there have been a lot. I'm very fortunate because there are a number of skilled release providers in like the D.C. maryland, Virginia, Northern Virginia area. So, like, we have options here now, but there's also people who have gotten into it who are not so skilled and who probably shouldn't be doing it or who should really focus on like a certain age group versus, like lifespan, you know.

But I will say that there is.

An oral surgeon that we referred to all the time who released me and released my two daughters. One at 24 months that when I was just talking about Lily and then the other one at five days of life and me was like, I was.

Like, well, I put both of them.

Through it and I have a tongue tie, so here goes nothing. So he did mine as well.

But it's been, you know, it's been.

Really incredible to be the patient, the mom, the therapist, the researcher, the, you know, in all things. Because now. And you get it, like, you understand. Well, one, we don't want anybody else to go through what we went through. I won't speak for you, but I know we were talking about this before. But two, there are options out there and a lot of parents don't realize that they don't have. There's no handbook that's handed to a parent that says, if your child has trouble with X, Y or Z, see this specialist in your area. Right. And so then it becomes like, okay, well, how do we get our voice out there so that these parents do know that there's help and they do know there are options. And even if they're not, maybe in their backyard, but they're close enough, they can go drive a couple hours for this one time appointment or whatever the case might be. So, you know, I'm happy that I feel like especially pediatric dentists are really on the up and up in this space. I keep joking that they'll be our next pediatrician because like, everything starts in the mouth. And I just get so excited to see competent, like pediatric dentist stepping into this and recognizing the full body impact that this little restriction in the mouth causes. So, yeah, I know you get it now, you've lived it. But I mean, it also just makes it that much easier to relate to our patients and to other moms in our space because we've lived it, this is our truth. And it's not a question of whether or not research supports it or not. I can tell you firsthand what I.

Experienced and what I've gone through now.

With a lot of my patients. So, yeah, so it's an exciting time and an exciting space and everything. But how is your area doing like, in terms of like providers? Has it improved at all or is it still.

I think we're, I'm really trying to advocate for that here in our Rio Grande Valley region. I know we have a provider that recently went to training, but he has identified that he likes the adult population and maybe some teenagers. Anything younger than that, he's like, I'm not ready.

So.

So I appreciate him. We've collaborated on that for him. My daughter, we did travel to Houston and there's a pediatric dentist there. And I already had started dabbling once my daughter had her release already working with previous kiddos who were getting releases and pre and post op. But it was never my daughter's time because her dad works so much and then I work so much. And when I talk to my families, I tell them this is a commitment. When you're in that early, like zero to five and you're going to do a tongue tie release, you really have to be committed for a good, a good while. Because we don't know how they're going to react even if they're acting amazing and behaving appropriately in therapy before, after you have that little guy removed, oh my gosh, you have to be ready for a lovely journey. Because I've had kids that are like, this is wonderful. And I've had my own child who was like, I don't like it, I don't want to do this anymore, like not letting me in her mouth. And I'm like, I'm the therapist, everybody lets me do this and you're not letting me do it. So you have to have time and sometimes you need somebody else in the therapy with you to really make that environment friendly for the kiddo when you're doing these types of post wound care. So we waited till she was about two and a half and we drove all the way to league city with Dr. Garrett to do her release because I had to find a provider that also would fit my kiddo. And I think sometimes parents just rush to a provider that they think can do the release and they don't really check them out. They don't speak to the provider, they don't speak to the receptionist. I like to talk to everybody. If the receptionist is not going to be well versed in this area, I don't feel very comfortable sending a patient there just because it's an a whole body setting and that's everybody included. And this pediatric dentist, I found her with another client. She actually called me and said, hey, you live in this Area, I'm going to send you a kiddo, because mom wants to have a release. And I was like, oh, my gosh. This is a provider who called me. She called me after her long day. That says so much about her. And ever since then, we've been collaborating with patients. And then I told her, well, you know what? I have? I have a baby that's tongue tied. I still call her baby. I go, she's tongue tied. But at that point, I already had tried taking her to a lot of providers, even as she aged, and they couldn't see this tongue tied. And I knew it was there. And they were like, no, because she would stick out her tongue, and because of the therapy, she was moving it side to side. And because. And I'm like, but I've worked so hard. You don't understand how much work has got into where has gotten her to where we are now. They weren't seeing that, and they weren't listening. So she said, well, if you want to make the drive, let's do it. And she did the release. We did have to choose to do anesthesia. I know some people worry about that, but baby's dad is an anesthesiologist, so.

You know all about it.

All about it. We looked at the pros and the cons, and we wanted a good procedure, and we wanted the provider to have a good procedure as well. So we did the anesthesia. And I think that was the hardest part, seeing her come out of the anesthesia, not so much the release, because I know I broke down in her office. They have a special room for you after. And when I saw her lip, because she also had the maxillary frenum as well, her lip was always tight and very thin. She always had this callus in the middle of her lip all of her life, which everybody said was, oh, that's just how her lip is. And I was like, no, it's not. It's her restriction. As soon as she came out, her beautiful lip was just relaxed. You could see the muscular tension just release there. And I started crying, and she's like, it's okay. And I go, I don't think you under. I go, I know you understand, but I always see this for everybody else's kids, but for the first time, it got to be my child. Like, it was like, always the bridesmaid, never the bride.

I'm getting chills. I love it.

I love it.

I just. I've seen so many kids, and I saw how they were changing, but we just never had our Schedules never met, meshed. And that's why I tell families it's okay if you're not ready for a release right now. It has to be a whole family decision because if dad's not on board or mom's not on board or you know, you're going to be working a lot. We need to do what we can right now and then revisit it later. But because I know and I went through that experience that we couldn't do it right away. And then I knew we had to do the bodywork in therapy because she had aged and we had so many compensation little strategies that were occurring with her. But yeah, pediatric dentist, she got it, she saw it. I didn't tell her anything because I wanted her to finally feel me and see it. And she perfect, amazing procedure.

I love it. Well, and I think that that's really cool, right, that you were able to finally have it done for your child. But I mean, it just goes to show that when you're working with a provider who gets it, it's not just about how it looks. And that's how so many dismiss this. They don't listen to the parent like you're saying, hey, here's this list of symptoms and my child is functioning right? They're functioning, but they're not thriving. They are surviving. They are compensating in order to survive. And do we want a child to.

Survive or do we want them to thrive?

And so if there is this procedure that we can do that can give them full function and make them super functional and, you know, and no longer just survive, but actually get out there and thrive, why wouldn't you want that for your child? I mean, we know all of the side effects of not addressing it. Right. And you know, we always say like, yes, the earlier you can do it, awesome. But you make such great points because, yes, everybody needs to be on board. We really need to take that team approach. We need to make sure that the child is, that everything is optimal and that includes family commitment and involvement. Because it's not going to be helpful if we send a patient for a release, a little baby or a toddler or even an older child or an adult.

They're not prepped.

They haven't done the right pre op work to prep their body and make sure this is as successful as it can be. They don't know whether or not they need to do active wound care. Are they getting sutures? Are they not getting sutures? And then active wound care is different than post op stretches and exercises. But that also can change based on whether or not you've had sutures. And so there's just so many little nuances that go into your individualized, like, therapeutic plan to prep you for this. And this is also, I think, why this discussion comes up so much in our industry where people are like, well, can someone just send me a list of like, pre and post op exercises to do? And we're like, no. Well, like, there might be some overlap and what you give one patient to the next in terms of different exercises. However, like, the one specific to that patient is going to be so dependent on, like, is it passive? Are we doing it to them? If we're talking about like a younger child, is it active? Are they engaging in doing and imitating, copying, you know, doing it on their own between our sessions, you know, and.

What are their needs? Like, you said, you had prepped your.

Daughter so much that she looked like she didn't even have a need for it anymore. But you're like, no, deep down I know she's compensating. And compensating is never what we want for our children. We want them to thrive. We want them to not have to compensate because we know that compensations, even when you compensate, well, it's exhausting. It's super fatiguing. You don't want all your energy to be expended on compensating because that takes away from enjoying other things in life. And so as adults, I think more.

People getting into this space to recognize.

That they now realize, wow, I compensate so much. And now I carry all this tension in my neck, in my shoulders. I have back issues, I have migraines, I have TM issues with my temporomandibular joint. And I was just told that that's because of X, Y. And you know, I snore. You know, all these things that people have no clue can be related. Well, not can be, is related to like, what's going on in your mouth. And so that's where I always look at it. And I'm like, I'd rather have a child do it. I don't care if they're five, I don't care if they're nine. I don't care if they're one, two, two days. Whatever the case may be, when that family is ready and that child is properly prepped, you are going to have a more optimal release than just like doing it immediately to get it done immediately, you know, and that's the other thing too, that I'll point out is some people Go, well, why are you waiting a month? Well, it's not necessarily that you're waiting a month. It's that you're making sure the child is ready. Right. And so arguably my disclaimer on that is, you know, yes, a newborn can go pretty quickly right after birth, or we, I always say, like, within the first four weeks or so, you can get away with, like, not having to do a ton of prep. However, bodywork usually is still very helpful in a lot of these kiddos. But you, you don't need as much work. Right. But then after that point, that's where all those compensation starts setting in. And so we really need to, like, undo what's been done before we send them for the procedure or we're not going to get the most optimal result. So, anywho, that's my long soapbox on that topic. But you know what, Like, I'm curious to know, like, because you mentioned she had compensatory strategies. Are there some that you can share with us that you feel, like, really stood out to you in terms of her feeding, like, what you knew was just not what she should be doing. And you were like, that's compensatory.

And I think I do have a lot and I think my background with the geriatric population, because there was a time when we were doing dysphagia therapy in geriatric that it was all about compensatory strategies like chin tuck. Let's do a head tilt and see if they can pass on an MBSS that way. And then I remember I had one patient who had a stroke and we were doing a head tilt and then he was like, man, Sabrina, my neck hurts so much. Like, I enjoy this water, but my neck is hurting. And then that's when that clicked that the misalignment in your head and neck posture when you're swallowing or eating, the repercussions, like, automatically are in effect. So I was, I knew these adults that I had worked with, and at that point, so I would ask them, like, hey, you're okay like this? And, yeah, I just want to drink my coffee. I just want to eat a donut. Yeah, I'm fine. They will hustle through it. And I had one lady tell me, I lived my life, just let me enjoy this piece of cake and I'll get through it. But for a young child, I think it's important that we notice this. It's not normal for a child to be ducking their head or doing a chin tuck and already cueing themselves on a Hard swallow. A lot of these kids are very smart because they don't have anything else going on. And they know how to adapt. And they, like you said, they want to survive and their body's going to survive. And they developed this strategy. So for her, everybody thought it was so cute because she would dance. So she would do like a turtleneck. And I was like, that's not cute. She's not dancing when she's eating. What I always claimed was that she was ducking forward, so her head was coming like away from the pharyngeal wall. So we were creating more space from that tongue to where we go up and then back. It was making it more difficult for her. And we already had this restriction. So the tongue wasn't even moving. Because I'd be like, open your mouth after. And you would just see like the bolus spread out. And I'd be like, why are you taking forever to eat? But she was just causing a slower transit time to eat anything. And then by that time she's like, I'm not hungry. So I will also mention this child only ate puree food. Like he would not eat anything crunchy. We had these. Yeah, these Mickey waffles. She loves the Mickey waffles that we would buy. And yes, I'm not organic or anything. I just wanted her to eat so I would buy anything. At that point, we bought Mickey waffles and she would butter them up and everything. I'm like, she's going to eat this. She would take one bite and. And I asked her one time, what's wrong? And she told me it hurts. It hurts my mouth. So she's very articulate. She talks so much. And she told me it hurts. And she goes, make me toast. But she likes the toast very white and butter on it. So if you work with textures for a while, you know, that would be like a mech soft compared to a waffle, which would be a regular. And I was like, this kid is making her own diet without anybody else figuring it out. Same thing for pizza. We ordered thin crust pizza one time and she was like, I can't eat it. And that would be more regular because you have to really chew and get some work going. But the hand tossed, which is a little bit fluffier. Oh, that's more of a Mex off. She can tolerate that and somehow pass it. So I was like, that's when it started connecting, like, oh my gosh, she's changed her own diet. She doesn't eat this. Not because she's picky. She told me it hurts that she physically can't. So I remember going to the doctor and at this point we were living for a while in San Antonio and I was like, we're in a university, they're going to listen to me here because it's like a research hospital. They're forward. And I went and I told them and we had a first year resident and it's not to be mean to her, but she was like, okay, ma'.

Am.

And it just left there. So once again, I didn't really. When I was saying, like, there's picky, she's like, well, maybe she has sensory aversions. And I was like, that's not what it is. Like, I know that's not it. Like I've done it all. Like touch it, feel it, smell it. All of the SOS approach I had tried and that wasn't the breakthrough.

You're like, she will put this in her mouth, but then it doesn't feel good to try and break it down at that point. So. And it's not a sensory feeling, it's a motor thing that. I mean, yeah, it's all interconnected, sensory, motor. We can't truly separate it.

Right.

But at the same time, like she's saying it hurts, like that's telling us that something is wrong, something is not working the way it should.

Exactly. And another one, her sternocloid mastoid. I know I'm getting more into body work, but working in the geriatric setting, I have my OT and my PT who have explained so much to me to look out for for my geriatric. So I noticed her sternocloid mast asteroid was so tight. And this had just developed from that six month mark to about her 20 year when she was going to be two. This was like a trapezoid. I tell everybody that's the only way you can describe it. And she's a tiny toddler. Why she's not rest. She doesn't work. She's not a computer.

Yeah. Especially if your jaw is like. Was her jaw sliding at all or was she like having a hard time or was it just inside you? She really just wouldn't chew anything she couldn't match.

Wouldn't chew. She just wouldn't chew. And I think if she would try because I was. And this is where I felt bad because I was like, come on, just try it. Like we're doing the therapy, you can do this. Like, come on. And she would try and she'd be like, it just looked terrible. It was just not fun. And as you know, when we work with eating and it's such an enjoyable experience at all ages because you eat at birthday parties, you eat when you get a job promotion, it's very social. And that wasn't fun for her, like eating as a family. She really didn't want to engage in that. She would kind of like eat on her own, which we all know is not normal because we want to include the kiddos. So all those little signs I was picking up and like I said, nobody really was catching onto it until I met Dr. Garrett. And I was like, this is what's going on. And she was like, yeah, yeah, it totally.

Yes. Yeah.

And then I did have to go out and find a chiropractor to kind of work on that body work. And I had also done the certified, the See Me training where I could do infant massage. And as an slp, we can't do them on children, but she's my own child, right? Like, oh, my God, this is why I did it. I did it for her so I could feel it. And oh my gosh, her back and neck and head were just so tight and she felt like a 30 year old woman who had a really intense job.

It's so interesting you say that because with Lily I didn't do that, but with Mia, I did. I went and I took my own just like, you know, massage, infant massage class. And it was almost like a fun activity for the two of us. It was my own child so I could do it on her. And I learned so much, just about. And it really made so much sense too, because I was like, yep, okay. Confirming a lot of the things that I believed about how we're so interconnected and like, how what's going up on the, you know, what goes on up on the face inside the mouth is just connected to the neck and the shoulders and the gut. And you know when you could feel the tension on your own baby and feel like, okay, wow. This is because both my kids had tight necks like Mia's. We ended up going through months of PT and I kept feeling like, this is not working. They kept trying to stretch against the tightness instead of bending into it. And then I met a PT who now explained to me, because I've had the work done on me, that, well, this is kind of counterintuitive, but we want to actually help the body move towards the tightness to release it. And I was like, well, that makes sense. And so I started to go down this whole new rabbit hole of bodywork and I'M not getting into it myself, but I just wanted to have that understanding. Like, well, why is it that we need this? Because so many people ask, why do we need the bodywork? And why is it, like, why do you tell everybody to go get this done beforehand? And I'm like, because I've lived it as a mom and a patient and I see the difference between my first child, my second child, and now me to fully understand how much tension our body carried because we were compensating. And that is one way that our body compensates is through carrying tension elsewhere. Certain muscles are overworking to compensate for the ones that can't do their job. And that's why we get this asymmetry. That's why we get tension and nobody's perfectly symmetrical. But when we start to become aware of this, I'm like, this is why both my kids could hold their necks up at birth. That's not normal. Like, babies should not be born and hold their head up two hours after birth. Like, major red flag, you know? And then I learned, oh, well, it's because they have all this tension underneath their tongue and in there, in that connects to what's going on in their neck. Like, okay, why did anybody tell me this? Why is anybody looking for this? Why aren't they screening for these things? Like, they screen their hearing, but they could. They are not screening for things that, like, hearing is important, but so is the tongue. Why are we not screening this at birth? So, yeah, it's, you know, but I think that whole conversation of just compensations, like when you talk to a parent. But we would talk, like, if I were to get on an intake call and talk to a parent and say something like, does your child tend to, like, take really big bites? And it doesn't really make sense because they can't manage the food normally very well. And they're like, yeah. And I'm like, and do they prefer softer foods? And I'll like, start listing foods. I'm like, are the foods usually like these colors? And they'll start going, yeah, how did.

You know all this?

And I'm like, because this is the patient I see all the time. And this is typically what we find. So I'm not pre diagnosing your child. But here's what we need to rule out. Here are some things we want to look for. And like, here's what we're going to do when you come in for an evaluation kind of thing. And, you know, it's. I'm like, why isn't this More information, more readily available, you know, and why have not have other providers not caught on to this? Because that's really the biggest issue at hand is if the pediatricians are not treating this, which they shouldn't be, it's not their specialty. It should be part of that screening. It should be part of the questionnaire that they give out to mom after baby with that first visit and then a couple months later, and then a couple months later, because we know how rapidly feeding changes in the first year. And you go from breast or bottle feeding or a combination of the two to solid. Like that's a huge change at six months. So why are we not asking things other than just like, how's it going? And then dismissing what mom tells us when it's not going so well? So, yeah, I feel your pain, but I mean, how thankful like your community must be for you to know that they have you. But I know it's hard to get the word out to everybody, even if you are in a small community. How has that been for you? Have you. Do you feel like you've been able to connect with other parents or where. Where are you with that?

It's been quite difficult. And even in this whole Covid era, that's even harder because you can't even go into doctor's offices and try to pitch something or leave a brochure on it or. So that's been really difficult. Families have found me. I had one mom find me through you. She was saying, I need this, this, and this. And I looked it up and you came out and I was like, oh, yay. So your podcast has been very helpful.

I'm so happ.

Um, Facebook, Instagram, I've been trying to post. I'm very. I'm a shy person. And then when you have a daughter who went through this, for me, it was kind of almost sad because I could go help a TBI patient or a trach patient swallow. But here I was at home and I had a baby that I was so sad and I couldn't even get her to eat a waffle that she wanted to eat. So it's sad. I balance that I'm trying to still learn as a. As a mom, as a human being and clinician, but so far we've been okay. Like I said, we found that chiropractor. It's a family of chiropractors. And they also have experience with tongue ties, so they understand, they get it. They're so on board. If I send a patient to them, they are able to complete that body work for them with PT and ot. I'm still finding my buddies. So if anybody is listening, reach out, reach out message. I'm here. Lactation. I've met more ibc. I'm so happy for that. That are gaining the momentum and opening their eyes. And we're trying to collaborate a little bit more with that. So it's going. It's a little hard, but it's going.

And I know that you're, you know, your community, so you're in a bilingual community as. As well. Is this something that you know is well received by your community? Do you get a lot of pushback? Like, how is that?

In my own personal experience, when I was having so many issues with the breastfeeding, my family, my maternal family never breastfed, but my boyfriend's family did. And when I was telling them I had so many issues, they were kind of seeing, like, you just want to cut the baby's mouth. Like, why do you want to put the baby in so much pain? And I was like, okay, we can pierce their ears at two months.

But.

You don't want me to help her eat? And so it was very difficult. And when you have families that are so close, knit together, like I said, it has to be a whole family experience. And you kind of have to involve that grandma and grandpa in this as well. Because if you have a negative energy and if you're trying to do this wound care with a baby or you have a therapist coming into your home and grandma's over here saying something not so positive. Babies feel everything. Toddlers feel everything. And it can change the dynamic of your treatment. I've noticed in this region, I've had to be very, okay, Grandma, Grandpa, come see what we're doing. Hey, aunt, come. I had one baby that mom was working so much, and this is when I was in San Antonio for a little bit. I had to train all three aunts that lived in that home, and I had to train grandma and grandpa on what we were doing because mom had to work a lot. But they wanted the help for the baby and they were going to do.

And it's when they want the help that you're like, I am more than happy to teach all of you if that. If you're receptive to this, like, let's go. But I mean, what an important point that you point out, because we don't talk about that enough on the podcast here. There are cultural components that we need to consider, and we really need to be asking our families, because you might be in a Big city, like, where I am in D.C. it's a mixing bowl. Like, we've got everything here. And so we need to be cognizant of, like, who is in that family unit, who is going to be present a large portion of the time that we really need to make sure that we educate them and get them on board and get their, you know, almost like, get their approval, in a sense, so that the family feels supported. Because, like you said, how awful is it for someone to be standing over your shoulder being like, I can't believe you're going to cut this baby. And you're like, okay, not what we're doing here. Like, yes, but no, you know, it's. We're not trying to bring harm. We're trying to. To make things easier and make sure baby can thrive and is fed, which is, you know, and then you're going. And, you know, it's like, we can pierce their ears at, you know, a couple months of age. I can't help her eat. Like, that's. I mean, what. What a good point. And, yeah, and it just kind of brings me back to. We like to ask, like, on our intake, you know, what languages are in the home and who is in the household with the child. And so this kind of. It's our way to, like, tiptoe into this conversation of, like, who do we need to involve in this conversation and who is really present in this child's on a daily basis so that we can start to have those conversations? And so. But again, it's not discussed enough. So thank you for pointing that out because, you know, just culturally, I think we have to be so sensitive and so inclusive of making sure that everybody really is ready to go, not just mom and baby, or mom, you know, and partner and baby. So thank you for that.

No, you're welcome. But it's been a. It's been something to tackle, and that was new to this region because I already had started dabbling in this in San Antonio, and it was kind of fine until I got to the real Grand Valley again, where I was like, oh, my gosh, I have Grandma's taking the baby away midway in session. And I was like, please come back. And then, of course, apologizing. And then like, well, let's try to make this better. I've had families who love essential oils, and I'm like, okay, spray them in the room. Let's do that. If that's what Grandma's going to be happy with, let's do it. I had another moment. Who believed in like crystals. And she wanted the crystals around the baby, but that's what she really believed in. And I was like, okay, let's go for it. Just as long as I can do the treatment. So it is in that intake. It's very important to know what you're walking into and just be open minded. I want, I want all of my families to feel welcome and not feel like they have to hide anything because sometimes they'll be like, are you doing the stretches? And they'll be like, yeah. And then you go see the baby the next day and you're like, oh my gosh, you did not do the stretches. We are friends. I am a clinician, but I am your friend on this journey because I think that's very important also that we're there for the family and we want them to know we care about their child and we care about their well being and that's why we're doing what we're doing. It's not just to bill insurance or anything. It's. We really want this child to be successful because like, you and I, we've walked that path and it's been so hard when you don't have anybody guiding you. And I want to be that guidance for anybody in my community that needs the help.

I completely hear you. And I think that that is so important. And I mean, how amazing that your community has you, you know, leading this path because it's. I tell people, if you want to get into working with infants, like between birth and 12 months of age, like, like it's not just a journey and it's not just a matter of learning the skills, but it's a matter of connecting with these moms and partners and families on a whole different level than you might be used to in the older crowd. And I'm not saying that we don't connect with the older kiddos either, but we have to also keep in mind mom's hormones are all over the place. Like, mom might cry and you got to be okay with that. Mom might whip her boob out and you got to be okay with that too. You know, if you're not lactation, you know, you're talking about feeding a baby. There are certain things that I've had therapists who are like, oh, so this happened today? And I'm like, yeah. And, and what did you expect? Or I guess you didn't expect that. That's why we're talking about it. So like you said, just being open and knowing that any number of things might happen, but you are A sounding board. You are a therapist, but you're also a sounding board. And sometimes we have to get creative and we just need to let mom talk and we need to let them share with us, because that's where you get into them also feeling comfortable enough to share with you what's important to them. And that's why your families can say, you know what? I really believe in crystals, or I believe in essential oils, or I need this in place to do this. They're not going to feel comfortable even telling you those things if they don't feel comfortable with you. And so it's like, that's step one. Right. Building that rapport with mom, obviously, baby too, but definitely with mom and anybody else in the family who is going to be an integral part of this therapy. So I love that. That's, that's. That's such a key point that so many of us forget. And it just seems. It seems so intuitive, but it's not.

Yeah.

And it's the biggest difference, I think, in some infants having success in feeding, like working with a therapist who really connects with the family and who really. Yes, you're skilled. Yes, you can identify the issue baby's having. Yes, you can treat it. Yes, you can dismiss them after a while. Yes, all those things. But we cannot, you know, it's like, you just can't forget, like, they're humans first.

Right.

And we have to connect on a deeper level, especially with mamas who are in that we joke like the fourth trimester, especially those babies, those new babies in the first three months after birth, because they could have just gone through something completely traumatic with that pregnancy or that birth. And now here we are as another reminder that baby, that something's wrong, something's not going as mom expected. Like you said, you were like, this was supposed to be enjoyable.

This is supposed to be easy.

And everyone just writes it off as like, nope, it's hard. And it's not just that. It is way more than just hard.

Yeah.

So on that note, where can they find you? I know that you are part time in a skilled nursing facility, but you're also part time in your own private practice, Mighty Bites. So how do they find you if they want help with these issues?

So right now we actually went through a name change because I was under La Paloma Therapeutics trying to. I was like, La Palma signifies a dove, and dove is hope and faith. And I just felt like that's really something I needed as a mom to have hope that this feeding journey was going to get Better. And I was going to find a way to do something for her and then for other babies, because, like I said, I don't want anybody else to go through this, just like you. So I was like, paloma Therapeutics. And then after six months, I'm like, okay, it's not really rolling off the tip of the tongue. And then I also work in the geriatric home, nursing home. So I was like, okay, I need something like Mighty Bites. The chewing. We're getting there. And that also was seeing Tatiana after her release. Like, the first day of her release, she ate a waffle. She ate three waffles, the Mickey waffles she always wanted to eat. And I cried because I was like, oh, my gosh. She always wanted to eat it, and I would always present it to her. And I felt so bad that she couldn't do it. So it's part of her. Her mighty, her mighty bite, her strength. And that just speaks so much, because I want Mighty Moms, because this is something for moms to really advocate. It takes you being mighty. Oh, my gosh. I might cry because a lot of people don't listen to you, but I'm here, and I'm going to listen to you. And if I'm not the right person for you, I will open a door and I will try to do what I have to do for you and your child. So I want my mighty moms, my mighty babies, my mighty toddlers, my mighty teens, my mighty, mighty adults. It just meant more to me. So we went with Mighty Bites. Yeah. So right now, my Instagram is still La Palama Therapeutics or Pinky Sabrina. And you can message me there. I also have my Facebook, and that one is on Mighty Bites already. It got changed, so it comes out La Paloma Therapeutics or Mighty Bites. But it's just so much more. And I wanted it really to be meaningful because it's a journey, and I want to be there for families. That's really what it is.

I love it.

I mean, and you can hear it. You can hear in your voice. I mean, I know you teared up. And, like, I'm over here getting chills, like, throughout this conversation today, as we're talking, as a mom, as a therapist, as a business owner, like, I get it. And, you know, it's one of those things where you. We name our practices sometimes because we want to attract people to understand what we do, but also when we have, like, our very own meaning and everything, something special behind the meaning, like, it just makes it that much more Authentic and that much more exciting to talk about. And, you know, it totally comes through you. It just shines through you. So I'm excited. I think you're. You're in a small town, but how fortunate they are to have somebody like you in their corner who, you know, you're even able to say, look, if I'm not the right fit for you, I just want to open the door for you. I want to connect you with somebody who might be the right fit. And that speaks volumes. You know, just being that connector, being that person who either can deliver the therapy they need or being the connector is, you know, that whole mindset of, like, there's enough of us to go around. Maybe we're not all quite here yet. Maybe we're not all quite in this space locally, but, you know, but yeah, how. How great that it is that they have you, Seriously. And I mean that, like, wholeheartedly because, you know, you work from a place of being, the mom of the patient, being the practitioner, having worked with all kinds of patients that are struggling with this. And, you know, but you also get it on a holistic level, which is really rare and really cool. And I hoping it's becoming more common than not. But, you know, it's really. That holistic approach is what serves our patients the best through and through every single day. So thank you. Thank you for your work and thank you for sharing Tatiana's story and your story with us, because these stories need to be heard. They really need to be heard. And so I'm glad to have you on share it.

Thank you so much for inviting me.

Of course.

And we will make sure that we put all of your contact information in the show notes and everything. So. So if they are looking for you and they can't find you for some reason, it's in the show notes. You guys can grab those and connect with Sabrina. But thank you again, Sabrina, for being on. This has been amazing.

Thank you so much.

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