Episode 213: The NICU OT: Advocacy, Education & An Interdisciplinary Approach with Jacklynn Knotts

Hi and welcome to episode 213 of the Untethered Podcast. Today we have Jacqueline Knotts joining us. Jacqueline is an occupational therapist who specializes in infant development, infant feeding and lactation. She currently works in a Level 4 NICU and sees patients through her solo practice with Nurture Development and Lactation llc. She's a certified Neonatal Therapist, International Board Certified Lactation Consultant, Certified in neonatal Touch and Massage, and is a certified Child Passenger Safety Technician. She is trained in tether oral tissues, the tummy tie method and infant cranial sacral therapy. 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 healthcare provider. Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway tether, dural tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Jackie, welcome to the podcast.

Hi. Thank you. Thank you for having me.

I am excited to talk to you. I've been following you on Instagram for a while and you know, I think that one of the things that comes up so much in like the course that I teach, the question we get all the time, whether it's from SLPs or OTS, is like, how do you get into the NICU?

How do you get into a NICU?

So I know that you, you know, have a lot of experience working in a nicu and I think one of the, you know, I'm going to turn it over to you, but I would just love for you to share with everybody, like, how did you get your start in the nicu?

Okay, well, I was actually lucky enough to have a fieldwork rotation as part of my school in a level four nicu. So that was where I really got a lot of initial experience. So that was really, really great. I wish I would have been able to stay at that nicu. But I actually traveled to go do that interview or to go do that, to do that, that internship. And it was a 13 week internship. It was really great. I learned a lot. And at the end I had to come home and I was really, really sad about it. So from there I actually started in eci because there wasn't any open positions in our community. And that was just something in our area. It was really hard to get into the nicu. It was kind of well known that, you know, PT was kind of in the nicu and that was really it. So I started an ECI and I worked for two years there, just kind of working with a lot of NICU grads and kind of using a little bit of what I got from the NICU experience for my fieldwork rotation. Excuse me, fieldwork rotation, and using that in the, in the, in the sessions that I worked with, with the babies. So. So that was how I got started. But I would say the biggest thing that kind of got me to really try to push to get into the NICU was I ended up having my firstborn who was admitted to the nicu. And so being in that NICU and having that experience and just kind of seeing a lot of the things that, you know, could have been improved upon, especially, you know, with my own son, as far as feeding and positioning and things like that. That was kind of when I started really trying to push to get into the NICU again. So the way that I did it was I actually reached out to the rehab director and I, you know, asked if there was an open position. And I did have a friend who was working at the hospital at the time. I told her about my interest and she ended up putting me in touch with him. And so a position was actually created for me after having kind of like a conversation that turned into an interview, that turned into a peer interview, and being able to start in the NICU that way. So there wasn't any place for OTs in the NICU at the time. So it was myself and another colleague who worked together to try and build that caseload. And we started really just with educating about what our services could do, how we differed from the other services that were in there, which was primarily physical therapy and what our strengths were. I think we really focused on how we were both certified in neonatal touch and massage and how we can educate parents and parent bonding and sensory and stuff like that. And so that was able to get our foot in the door. From there, we were able to just kind of expand and move into Working on feeding and stuff like that. And now we're at the point in our NICU where there's all three disciplines, which is really great, and we all work together, and it's really good. So that was how I got my start. But I would say the biggest thing that I feel like made the biggest push for me was having my son who was in the NICU and having a lot of the struggles that we did.

Yeah, I mean, it's both a blessing and a curse, all at the same time. Like, having to live through that experience, I'm sure. I mean, I'm not a NICU mama, so I can't speak to that. And I will never say I understand by any stretch of the imagination. But what I do know is that anytime any parent or, you know, therapy parent, Right. A therapist basically has her own child and experiences something firsthand. It's like everyone says, mama bear comes out. Right? So, like, obviously, like, you want to be the best advocate. Advocate, educator for your own child, but then to be able to take that and, like, go back and deliver that passion and through education, advocacy for other people's, you know, other babies, it's just. It's incredible. I get goosebumps talking about it, because, like, for me, like, that's part of the reason why I do what I do is, like, having experience some of the things I do with my kids. You know, I want to make that pathway easier in a not so easy situation. Can we make it easier? Can we help be that advocacy and the educator? Because parents don't know. I didn't know. And I was the therapist, you know, I'm sure you probably had some new experiences, too, you know, in the NICU as a mom.

Yeah, for sure. I mean, I think even just thinking about my experience versus my husband. So, you know, I had been in the NICU primarily as a student, and so when my son was born, I mean, I walked into that unit and, you know, I opened up the isolate, put my hands on my baby, and I did all the things that I knew that I should have done. But I know that's not an experience a lot of. A lot of parents have. Specifically my husband. I remember there's actually a video that he has that I. Even now, like, my son just turned 8. But even now, like, I look back and I'm like, it breaks my heart because he's recording my son, like, through the isolate. My son is, like, screaming. And of course, like, the therapist part.

Of me is like, oh, my God.

This dress is crazy. Like, he needs Containment. He needs help. But my husband's just sitting there, you know, recording him through the isolate, and just, you know, his thought is just, baby's crying and he's not allowed to touch our baby yet. And so I think a lot of parents have that experience of not understanding and knowing that they can touch their baby or, you know, they're afraid to touch their baby, or there's just, you know, the idea of, like, we need to let them rest and don't put your hands on them. But that I think for me is probably even now. Like, I hate walking through the unit and seeing that there's a parent sitting at the bedside. And I'm like, help that baby go skin to skin. Like, that baby should be on mom and dad. That baby should be touched by their parents. Like, someone should be helping them. So a lot of the times I do go, and I'm like, hey, would you want to touch your baby? Like, let's put your hands on them. And I'm always like, to the nurse, like, I'm going to. I'm going to help them touch their baby. Is that okay? Like, but I agree. I think having that experience there is. Is one of the biggest things that helps me to, I think, empathize with the families that are there and then just also kind of show them that I know that, how it feels and how it's how, you know, I've been there. Um, and so I think that really helps us to kind of let that family let their guard down and then we can kind of work together, and it's really good. I think that, for me, is one of the. One of my favorite things is being able to really help with that, because that was.

Yeah, that connection that's lacking because you don't get to take that baby home and, you know, basically have the baby on you all day, every day. It's, you know, that's. The. The work that you're doing is just absolutely incredible. I mean, absolutely incredible. And the other thing I heard you say, too, which I kind of alluded to already, but, like, the whole advocacy of, like, getting in there and helping to educate even just other professionals and having them, like, create a position for you, because like you said, traditionally in NICU is like, we'll see. Sometimes they're very pt heavy, sometimes it's very ot heavy. Even just getting SLPs in the NICU sometimes, you know, for feeding whatever their credentials may be, whatever the need may be, you know, it's. It's not well understood. And I think it's like, sort of like. Well, we've always done it this way, and this is kind of how our NICU runs. But it, like, you know, having the slp, OT and PT in there, depending on their various, you know, skill sets and expertise, I think is such a beautiful marriage of that interdisciplinary care that that NICU baby really needs, you know, and, you know, it may not always require SLP and OT, but, you know, having at least an OT and or SLP, I think, in there along with PT. Yeah, 100% is like, I'm so excited to hear that you guys have all three, because that's so unusual these days.

I love it. I mean, I think we're in a really great spot. So it definitely took a long time. I've been in there. This is going on my seventh year in the nicu, and so we. We've gone through a lot of changes, and I think we've gone through a lot of, kind of like, the territorial idea of, like, specifically around city feeding, but of who's going to do what, who's going to, you know, who's going to do feeding, who's going to take the lead, you know, how are we delegating services? And it's been difficult because we've kind of had some people come in, and it's been difficult to work with each other because we had different ideas. But we're in a really good place now, and I really enjoy having all of us there. I think for me, when I. When I first started, that's one thing I really wanted us to work towards, was having all of us in there, because we all bring different viewpoints. And sure, an OT and speech therapist can both do feeding, but being able to have the viewpoints of both and being able to work together is amazing. And I love the speech therapist I work with now. She's great. Like, I think we work so well together, and just because of that territorial kind of idea that we've all had that's kind of come and gone, we've actually just moved into the. We've moved into all of us kind of doing the same thing across the board.

So, like, we.

We talk about each other. We're all neonata. We are. We are all neonatal therapists, and we all are doing feeding, and we all kind of focus on development. And so we each, I think, are really good at respecting all of our professional boundaries of what we can and can't do within our scope, but being able to level the playing field. And all of us work together, and all of us are Doing feeding and all of us are doing development in some capacity, I think has really helped our team because where we work really well together, and it's just to have other people in the. In the NICU as well know, like, they can just. They can ask any one of us, and we're going to communicate really well together to get that answer that they need. So it works really well for us. And I really think that's really how it should be across the board, because I do think it's beneficial to have all three of us there. And I think just having a team without that. Without that territory, it's. It's been the best that I think it's been in the seven years that I've been there. That's.

That's amazing. And I hope that that's where every NICU is headed in the future, because like you said, it's even. You know, I always like to say, like, when I'm sitting around a table with various disciplines, whether it be slp, ot, pt, and whoever else might be at the table, you know, even though we may have similar trainings, you know, on the back end of our education, you know, like, more recently, that's kind of helped us specialize where we are. We all have different backgrounds leading up to that and our perspective of, like, where we're coming at to even address the same issue. I think holistically, like, we all bring something to the table that is going to be beneficial. And that, really, honestly, in my experience, really helps move the needle forward faster for a lot of patients, because, you know, it's like, OT is thinking about something that I'm not thinking about it as slp. PT is bringing something else to the table, and we're. No, we're all having the same conversation, but with all very different backgrounds and lenses. And I think, you know, it's just so cool. It is really cool to see, like, the marriage of those interdisciplinary approaches really helping patients. So I just. It makes me so excited. I love it. And I'm like, can we clone this? How do we make this happen across the nation?

No, it is. I really. I really enjoy it. I think it's. It's been great. Yeah.

When you mentioned feeding. Right. So feeding challenges, you know, if you're willing to share your experience as a mom with, you know, with your little one, and also just speaking to, like, what that looks like, you know, in the nicu, with this interdisciplinary approach, that'd be really cool to hear about.

So my son, we didn't spend a lot of time in the nicu, we spent a little under two weeks and in the nicu, and I think we see this a lot with our patients, but as they start off, he did really well with feeding. He never had to have an NG tube or anything. He did okay. But it was towards the end of our journey and as the volume started increasing, that's when we started to see, see that he kind of didn't have the activity tolerance kind of started to shut down. And so for us, that was where our feeding journey, I think the difficulties that we had kind of started. So I remember like the last couple of days he started kind of shutting down. He would just barely finish. And at the time it was very volume driven feeding. And so I'd come in and they'd be like, oh, well, you know, he fell asleep. But we got him to take, you know, whatever. And sometimes I'm coming. I'd come in and he'd have like this crazy amount. Like I think his minimum was like 40 in it. They were like, oh, well, he took like 70 last night. And I'm like, who was feeding him?

Yeah.

And of course we had a lot of like the nipple changes. So that was super frustrating. Like, I remember I was trying to breastfeed and I didn't know a lot about feeding at the time, but I think the lactation consultant had told me, you know, use a slow flow nipple, that'll help. So that's what I was like, all right, we're going to do that. And I did see it, you know, if he ever got changed to the standard faster flow nipple, like, it definitely made a difference for how he was breastfeeding with me. So I remember coming in every day and being like, you know, what nipple did he feed on and who changed the nipple? And I'm pretty sure I yelled at a nurse one time like, like, where is this written down that he has to be on a teal nipple? Like, where is it? And they're like, it's not written down. And I'm like, you write it down in his chart. Like, I want to see you write it down. So I remember that was like really frustrating. But I remember we were supposed to go home and we show up and we're super excited. And the nurse who's taking care of him, who is like a really great friend now, but she tells me like, well, I don't know if he's going to go home today. He just doesn't have a positive weight trend. And I'm like, oh, God, of course that time. And I Feel like I see this in a lot of parents that I work with, but the idea of like, what do we need to do to get him out of here? Because we just want to go home. And I think that is kind of like it's a double edged sword now that I look back at that, because everyone wants to get their baby home. But then if my son is having difficulties towards the end and we send him home, like he's going to have difficulties when we get home. And that's what ended up happening. But I remember that night like thinking like, okay, he's got to finish. And there's one bottle he's not finishing. And the nurse is sitting with me, who's a really great friend right now, but she's sitting with me. And I can picture like exactly where we are. Um, but she's sitting and she takes him from me and she puts him on his back and changes the nipple from a teal to standard. And she's like pumping that milk in his mouth. And as a therapist, I know and I'm watching and I'm like, it's, it's terrible. I'm like, she's forcing my son right now. And my thought is like, I just, I have to let her do this so that we can go, so that we can get out of baby jail. Because that's how it feels. It feels like baby jail. And so sure enough, he gains, you know, a few grams, I guess, and we went home the next day. But we went home, you know, always in the nicu, we were always feeding on those disposable nipples. And so of course going home and trying to transition to that. And I didn't have any of the knowledge at that time. And I knew Dr. Browns was great, but I wasn't aware of all the other flows at the time. And so we go home and you know, my baby's like 30, I think he's like 36 weeks at this, or 37 weeks. And we're feeding on a level one and he's spilling and he's coughing and now my milk's coming in and it's like I've got an over active letdown and we're just, we have tons of problems like going on. He also started projectile vomiting after every single feed. And that actually continued until we were five, which kind of.

Yeah.

Which we can keep. We can go into to what I think it was.

Yeah.

But it was, it was crazy. So I remember thinking like, at the time all I knew was like, maybe I'll put him on his side and I'll pace him. So I was doing that and it was actually a therapist from who I worked with in UCI was like, maybe you should come to the office and I'll give you some preemie nipples. And I was like, okay. Like so she did and that helped.

But.

But we went through a lot of different bottles. Like, like a lot of parents too. I mean I think. And of course we did like the breastfeeding bottles, right. We tried Tommy Tippy which now is like I don't. I hardly ever recommend like.

But things we learn, right?

Exactly. No, but we use that one. And so I think we ended up, we tried the Avent Natural which I think we used for a while, but it was just really difficult to figure something else for him. And he actually never stopped projectile vomiting regardless. So we did get breastfeeding on track, but of course that took a lot of time as well and a lot of like me googling and you know, learning like that my lipstick nipple shaped when it came out of his mouth like wasn't supposed to be what it should look like. And having to navigate figuring out latching and all that, like it was just, it was a lot when we got home. And so, so being in the NICU now, just having that journey like that was kind of one of the biggest things that I wanted to try and change, which we luckily have, was making sure parents are not going home on disposable nipples. But we are getting parents on home bottles. So we do now have Dr. Brown's in our units which a lot of babies end up using. But even then, like if parents aren't wanting to use that, we do use the research that's out there now to help them determine which bottle may be a good fit for their baby. And all of our babies are going home on home bottles to help reduce that feeding difficulty when they get home. And I think in our high risk clinic we've seen that it's made a huge difference. We're seeing a lot of our babies come back and they're doing a lot better. They still follow up with like if they go home on an ultra preemie or preemie, they'll come into the high risk clinic and be assessed to see like where they're at, do they need to stay there, do they need to go up to a. So I think we have a pretty good system.

Yeah, I mean that sounds the amount of support that you're providing free, you know, before them going home. And then also making sure that there, that there are Check in points after. I think is incredible because I hear so often that, you know, these babies leave the NICU and there's no follow up. There's, you know, they're going home and they're, they're having exactly what you experience. They're having a lot of struggles feeding and you know, it's like, okay, we just, we just left the nicu, but how close are we to going back in? You know, And I think that there's a lot of fear and a lot.

Of parents, you know, just, they want.

To just feed their baby, right? It's like you have a baby and your main goal in life at that point is keeping your baby alive and loving on that baby. And when you can't feed the baby and you can't hold your baby, I mean, that's, it's so hard. I mean, I can't even begin to imagine. But it's that alone, I would think, you know, contributes to, just to then the continued struggles at home, which I.

Know you guys, and it's scary too. I think it gets very scary when you get home. Like, I know for me it was really scary. And just, even the idea of like being in the NICU and having those minimum volumes and then just not really primarily breastfeeding in the nicu, but doing a lot of bottles and trying to get onto breastfeeding. But then that, I like to call it the fear of the feed of like that, that idea of like, you have to have that minimum volume in and you're not sure, you're not sure how much you're supposed to be breastfeeding. And so that was another struggle for us. Like, how do I know that my baby's actually transferring? Like, I had no idea about breastfeeding at that time. And so, you know, I would often breastfeed and they tell you like, okay, you have to supplement after. But now my milk's, you know, in and he's getting more efficient. So now I'm breastfeeding, but then also supplementing after. And then there's other issues going on, which now I, I know he totally has a tongue tie that was undiagnosed at the time. And that probably contributed to a lot of his like, reflux. And we were on reflux meds and he was vomiting all the time and he had, he's snoring. So it's actually something now. Like, I'm like, we need to go get him an air. We need to get him into his sleep study and he needs to be seen by an entity because I'm pretty sure he has some pretty bad sleep apnea that we need to. To. To, you know, figure out. But, yeah, there was. It was very scary to be able to transition from the NICU to the home and to be able to figure out what was going on and. And had, you know, we kind of somewhat figured it out. Like, it was failure to thrive until he was 2. And so, you know, even. Even with all that, like, it was just. Which was kind of crazy, though, to think about it now. Like, he was failure to thrive, but then also projectile vomiting and also had the reflux. But there was never, like, like, a real concern to, like, figure out what was going on. I think we were seen by a gi. But even that, it was like we were trying different things. And I think at the time, like, my husband was, like, between jobs or something, so then we were also on, like, Obamacare and, like, a really high deductible, so we spent, like, thousands of dollars trying to, like, figure out what was going on, and nothing was coming back. I even, like, pushed for, like, an mri because I'm like, is there something going on in his brain that, like, we aren't aware of? And luckily, that was okay. But thinking back now, I'm like, it probably was that really severe tongue tie.

That he had because he had probably part of the problem. Yeah.

Yeah.

And so now he's. He's had a frenectomy at this point, or he hasn't.

He has not. No, I do. So I've been, like, for years, and I'm like, I need to get it done. I actually had mine done, like, two years ago, which is amazing as an adult. Like, just the tension that was relieved in, like, my shoulders and my neck. And learning, once you start learning about tongues, and I'm sure, like, you've done this, like, it's a really dark, deep, and far hole.

Oh, it is. Oh, it is.

Yeah. So, like, I have totally. Like, I'm doing, like, I have Invisalign right now. Like, I had my frenectomy. I'm, like, looking into getting my deviated septum fixed. Like, it's.

I just did that a year ago, so I can. I can say it's. That's totally worth it. I didn't realize how bad mine was until the ENT was like, hey, yeah. You know, like, because in the front of my nose, like, it was not super, super bad, but the back part of my nose, like, the left part was completely crooked. And she's like, you can't breathe out of the left side of your nose. I was like, what? Because here I am going, like, I just really didn't. I mean, hi. I teach this stuff, right? So I had some like air coming through. But it's really hard, like as a human to really understand how much air you're getting through both sides, your nostrils, when you are able to at least breathe somewhat through both sides. And I mean, it wasn't just that for me. I had like enlarged turbinates and nasal spa and I was a whole mess. But I am telling you, like, my sleep, everything has improved. Like my life has improved after having that, that procedure. And I'm like, I wish I had done this 10 years ago.

Yeah. No, so I've actually been to an ent.

Yeah.

And I'm like, the same way, like he said that I would like on this side I'm like 80 obstructed. And like on this side I'm like 75%. So we've done the whole. For insurance, the nasal spray to see if that helps. Of course it doesn't. Yeah, I just haven't gone back to do it yet. But that's. I'm looking for someone who's good. He was going to refer me somewhere else, but that's where I am in the process of myself. But for my son, it's a lot. Yeah, my God, a lot.

Especially when it's like you and then you have at least one or two kids that you're also kind of focused on with this. It's just you kind of have to pick and choose. I hate to say it, but you have to pick and choose, like, who goes next for what, because otherwise there's no way. There's no time to work. I mean, it's like driving my kids to their appointments for their expansion and having to deal with my nose surgery last year. I was like, I just need to hit pause on things so, like, I can focus on like working for a little while and then like, we'll get back into it.

It's just, it's.

It's a lot.

Yeah, that's totally where we are. Like.

Yes.

But I do, I am trying to prepare him because, like, my son knows, like, I showed him my tongue tie and I actually had my daughter's done right after she was born. But I'm pretty sure there's a little bit of attachment, like reattachment. So I know we'll eventually need to get hers redone. But my son, I tell him, I'm like, we're going to get. We're Going to get your string cut. Okay. Like we're going to have to do it. Like you're get. It's getting to that point.

Yeah.

Actually there's a. I just found an airway center dentist here in our area that I need to make an appointment with. So I'll probably make an appointment for all of us to kind of go and get us started over there. But yeah, we're, we're, we're getting it slowly.

So you had mentioned the projectile like vomiting, like and so that doesn't happen anymore. Does he still have issues with.

No. So my. He is diagnosed with asthma, which I think is part of it. I'm pretty sure I've been wanting him to get seen by an ENT because I can like see just how enlarged his tonsils are. They like nearly touch. Like it's crazy. He snores like crazy. He doesn't projectile vomit. But I kind of wonder if that was what it was related to. So I think just a lot of the air that he was possibly swallowing just the way that he was eating. But it stopped about five, I would say. So I don't know if part of it was also. We did extended breastfeeding up until about 4. A lot of mom guilt involved in that or breastfeeding until 4. Yes. So, but that's normal.

Like no, no, no world.

No, no, no. My, I'm still extended breastfeeding. My, my three year old right now. The mom guilt in the sense of like. So my second son was born at 2 and I was like trying to wean at that time, but then he was born and I was like, well, how can I let this newborn baby feed? And like I have to tell my son that he can't. So that's why I got.

No.

But yeah, so no, I'm all about extended breastfeeding. I think I saw recently on Instagram someone posted like Michael Jordan breastfed until he was 3. So I'm like, that's my go to thing now.

Like, you know what, it's, it's so interesting. Yeah. Cause I mean look, I don't have lactation credentials, but as I started to work with patients, like Even in the D.C. metro areas, it's so transient. There's so many people from all over the world that come in through D.C. and we'd have different families in early intervention. And so when I was like working in EI for a couple of years way back at the beginning of my career and I actually it was a year and EI, I was in the preschool stuff before then. But anywho, this one mom just, like, really. She was French Canadian and just really opened up my eyes to the fact that, like, the United States of America is really not, like, you know, functioning from a healthy standpoint when it comes to breastfeeding. Because, like, we are forcing parents back to work. You know, that whole conversation of, like, how do you even breastfeed a baby when you have to go back to work at three months? And even if you want to pump and feed when you can, you know, there's. It's almost like you're taught that, like, we wean it at 12 months because then we give our kids, like, cow milk, which they don't need. But that's a whole different conversation for different day. Like, there's other ways to child nutrition outside of cow milk, you know? And so. But then I started to, like, like, learn from more. Families are like, oh, in my culture, we breastfeed till five. Oh, in my culture, till seven. I was like, what is happening? Bed share till nine. I was like, oh, my gosh, this is amazing. Like, why does nobody know about this? Why are we not talking about this? Like, I'm like, it's so fascinating when you start to dive into, like, the other cultures of the world to find out, like, what they've done, either from a survival standpoint or because that's what they had to do, or because it was cultural and. Or it's some combination of the two. And I'm like, and here we are in the US like, basically shaming moms and forcing moms to make a choice against their free will, you know, in certain situations. And it was like, it just broke my heart because. And that's why when you said you felt guilty, I was like, please don't tell me you felt guilty because you breastfed for so long. I was like, that's why I wanted you to clarify. Cause I was like, I don't think that's, like, what you're saying. But, yeah, so I love. I love hearing about extended breastfeeding, because I also think that, you know, with everything else that maybe was going on, like, that also probably super benefited him, like, in so many other ways, I think.

So I think that was what helped kind of keep his weight up and. Because we did so. Yeah, just a lot of feeding stuff. So he was premier. So we started, I think, doing, like, solids at about eight months or seven months. But even then, like, he just had a lot of difficulty with that. Like, he just wasn't eating. And then I think he was on iron because he had an iron deficiency. So then I think that really suppressed his appetite. And so just a lot of things contributed. I remember. And, like, as a feeding therapist, like, I know, but as a mom, I'm like, I'm gonna do what I can to get my kid to eat. And this is so gross. But I remember, like, I remember being like, do you want, like, you want some chocolate syrup on your eggs?

Like, yeah. Yeah, Right?

If this got him to eat something, like, it was okay. Like, he would eat because it was just. It was really difficult. And, like, he's like this. Looking back, he was like this skinny little thing. But, you know, just. It was kind of like that tug of war of, like, being a therapist and, like, knowing. But then as a mom, being like, got to eat. Like, just eat something.

Well, and I think that that's also, like, I love this kind of real talk because I think that we have a lot of parents of all the podcasts, of a lot of, like, professionals who are in the feeding space and who are not in the feeding space. And then we also have those feeding therapists who then become parents, right? And it's like, I tell everyone. I'm like, the second that. First of all, when I had my first child, I was not working with infants. I was working more with, like, toddlers. So, like, from a feeding standpoint. So when, like, I had her, I really had no idea what I was doing. Like, zero idea completely. And even transitioning to. I was like, I feel like I should know this stuff. But, like, my. My brain was just like a blank slate. Because when it comes to your own kid, it's like everything you know goes by the wayside. You challenge everything you thought you knew. And, you know, I think it's a very humbling experience, too, because then you start to go like, you know, And I always was like, I'm so glad I never made parents feel bad or was, like, never, like, super strict about this, that or the other. And that I was never like, oh, you have to do it this one way. And I always gave options because I'm like, as a parent, you need that. You need somebody who understands, like, okay, this is great in theory. And this is like, what we should, quote, unquote, should do per whatever, you know, research and resources are out there. But then there's reality, there's real life, and there is, you know, functioning and getting through the day. And I think there has to be a healthy balance of those two things. And I know, you know, just like, as that. That feeding Therapist mom. It's like, holy cow.

Like, no.

Yeah, yeah. It's a very humbling experience.

Well, with my third. So with my daughter. Yeah, it is. Like, it just happens, like, everything. You know, as a therapist, like, you don't do, like, so my. So I'm just gonna kind of give you a stories. Like, even with development, like, with my firstborn, I was like, all about it. I was like, all right, we're gonna. We're gonna do all the things right. Like, we're gonna do the tummy time. We're gonna do it. And we did right, because I was like, I was a therapist, but then by the time my second came around, I'm like, he'll get it. Like, he's fine. And I was like, way the opposite end. And so by like 7 months, my kid, like, has a flat head. Like, and I'm like, flatheads is one of the things. Like, I can look at you from the front and I'm like, I know, like, what you were sleeping, like, as a baby. I know what's going on. You know, I can see a baby in a car seat. And I'm like, I know. Like, I want to help you. Like, but so with my second, I was like, man, like, I should really start working with him, like, because I didn't. Like, he was in the containers. Like, he had a flat head. Like, he didn't walk until he was like, 18 months. And I remember at his 15 month checkup that the doctor was like, you know, we should. We should probably refer him. And I was like, I got it. Like, I'll do it. Like, I'll work with him. It's fine. And I'm like, so I'm like, doing all these, like, things with him. Like, come on, we got to get you walking by the time, like, the next appointment because she's watching you. So, like, with him, like, you know, the second one. And then with Rosalie, like, she was. She was pretty cool. Like, she was like my happy medium. Like, I wasn't overly, like, like, ah, they're fine. And I wasn't overly, like, trying to do all the things. But when it came to feeding with her, like, she had a tongue tie, I immediately went and got it. I think it was like day five. We got it and, you know, worked with that. But of course, I didn't introduce bottles prior to going to work. So here we are at 12 weeks, and my daughter doesn't want to take a bottle. And I'm like, I know we should have done this, but her too, because of like, even just the difficulty with her tongue tie, she still had a little bit of difficulty with the bottle, even following that. So trying to find a bottle that worked for her, even, like, I just. Yeah, parents need to know. Like, I know all the flows, and I know these things. My daughter used this, like, weird, fast flow, like, on a mason jar. It was like, the mason bottle, super fast. Wouldn't recommend it, but for her, it was like, this is what we're using, because this works for her. And I ended up giving her to the nanny, and I was like, you just need to feed her because she's not going to feed with me. You just need to fix her. And I walked away, like, please.

Thanks. I mean, it's. We always joke and say, like, you know, doctors make the worst patients. It's sort of like, therapists make the worst therapy moms. Like, I can't. I ended up, like, hiring somebody on my team, like, paying someone on my team to treat both my kids for mayo, because I was like. Like, first I was like, I'll do it. And then it just wasn't happening. And I was like, by nature of, like, scheduling, I'm like, it has to be on the calendar with somebody else, or it is just. It's not going to happen. Or it's going to be so inconsistent, it's not going to be worth it. And then I'm going to be, like, that patient in my practice. Like, the family where you're like, hey, so you guys only, you know, you're canceling a lot, and the consistency is the problem. Like, we're not going to make progress therapy with practice in between. And I'm like, sitting here going, like, how you were now that that family, like, you become an old family and you own the practice. So, like, you know, so I was like, all right, we're going to have somebody else work with them. Which I did. It was super helpful. But, yeah, it's. You know, I have a lot of therapists that, like, come and take. Feed the peds, and they're, like, getting into it because of their own kids. They're like, I'm taking this course, like, help my own child. And, like, halfway through, they're like, oh, my gosh, now I'm helping everybody else's kids, and I don't even know what to do with mine. And, like, I'm gonna have somebody else help my kid. And I'm like, that.

That's you.

That's how it works. It does come through. And they do work with their kid. And, you know, the purpose is exactly what they intended it to be, but it's like, more often than not, they're like, okay, this has been helpful, but also like, I'm. Thank you. I've now transitioned to becoming a pediatrician. That was my goal. I don't know about you, but I'm excited.

Yeah, that's definitely how it works. Oh, man.

But I love that message, though, that, you know, there is sort of like, what is thought to be the best for certain needs. And, you know, we'll make recommendations as the specialists are, you know, in the space, but also figuring out and, like, trialing what is out there and figuring out, like, what works for you and your kid is important. And, you know, and like, I have an Instagram account where obviously I will make blanket statements or I'll say certain things. And it's never, you know, I always try to, like, disclaim. Like, this is never to shame anybody. It's never to make someone feel badly. It's more so just to educate. So you know where to start. And, like, start with these things, and if those things don't work, it's, you know, try something else. Right. And I think that's. That's one of the biggest messages that, like, if we can share with other therapists and families, people get so caught up on, like, well, what does the research say about this? I'm like, there. Nobody's researching this cup. Nobody's researching, like, you know, yes, there's some research surrounding, like, bottle flow, you know, nipple flow and certain bottles. But, like, as far as, like, transitioning to a cup goes or beyond that, like, okay, yes, we have very little information, but what we do see on a daily basis is just helps to form, you know, our opinions as therapists. And, you know, but even with that, I still tell people, I'm like, you get to choose. I will tell you what I've seen, what I know, what has worked for hundreds of patients in my practice, you know, which is going to be various different things. But beyond that, I'm like, at the end of the day, the parent gets to choose. And, yeah, we all have free choice, you know, and so that I always kind of like to put that out there. I'm like, I do my job to educate you do your job to basically parent and make those tough decisions. And, you know, I've been there as a parent, too, so.

Yeah, yeah. No, and I think it's the same thing. Like, of course we have, like, I think that's how it is in the NICU as well. Like, Parents get to choose. And of course, and I think that's part of why, you know, parents, like, they'll bring things in and of course we're trying to guide them. But at the end of the day, like, if a parent wants to use something that, you know, may not be like, what we recommend or what is the best, at the same time, like, their goals are my goals. And so I'm going to try to do the best that I can to help what they want work by helping them adapt that or helping them figure out a different way so that it works or just, you know, letting them come to the idea themselves that, you know, maybe, maybe they do want to try something different. And so I think really involving the parents is a huge part of that because they're the ones who are taking their babies home. And, you know, we have had some parents, you know, who, who just being in the NICU and being in that environment, like, they're just going to. Sometimes they're just going to do what people are telling them to do because they feel like they have to. And I don't think that's, that's not, that's not therapeutic.

And that's uniform consent. Right? It's not like, yeah, you're not getting all the options.

Yeah, yeah, because they're going to go home and they're going to do what they want. And of course, for like, the benefit of the baby and the safety of the baby, like, we have to be sure that, that we're meeting them where they want, where they're at and that we're helping them so that, you know, they're not going home and making these crazy different changes because, you know, they don't trust us. Like, they, we should have them trust us. And they, the trust starts by us listening to them and letting them know that, like, I get no benefit over what bottle their baby go home, goes home on. Like, I don't care. You know, I don't care if they use a Dr. Brown's bottle or whatever. Like, what I care most about is that their baby is fed well and that at the end of the day they're not going to have the same experience that I had as a mom, like, because it's terrible. They're a huge part of their baby's care. And so I think that's one thing that I really wish and hope that a lot of people who work in the NICU kind of just remember as, like, parents are their baby's parents. They're the biggest part of the team and we shouldn't be gatekeepers and we should, we should really be involving them in their care and just letting them help dictate and then just also being empathetic and understanding like, you know, what else is going on in their life and you know, giving them those opportunities like, you know, specifically like even like to breastfeed or whatever. Really helping to reinforce their goals and not pushing, you know, our, our agenda because of course the baby needs to get out, but just also within that, helping them to achieve the goals that they want for their, for their baby and for themselves. I think it's really important.

Yeah, no, I think that's true. It's like this, you know, in the medical system, right, Insurance driven medical system, there's that whole, you know, productivity and just you probably, you know it much better than I do working in there, I'm sure. But it's, you know, it's one of those things where it, I think has for a very long time impacted care because we're so driven on the end goal instead of that patient and that feeding dyad, the family, you know, support unit and everything sitting right there in front of us. And it's like to go back and you know, what you're, what I'm hearing is like in the NICU that you're in, it's like people first. Like, yes, we have productivity goals. I mean, yes, we've got, you know, whatever. Basically, yes, our goal is dismissal. Like let's, let's, you know, send you home. Like let's, you know, make sure baby is ready to go, but also you're going, okay. But this family has to function after they leave and after the baby's discharged from, you know, the nicu. We need to make sure that this family is supported and that they are really feeling good about this very scary situation. Like, how can you feel good about something so scary, right? Like, you know, and that was one of the things that you had mentioned was how scary it was and to have, I think, for people to hear from you, you know, with the experience and knowledge that you have, the fear that you still had leaving the NICU after your baby was discharged and you know, heading home to feed and you're like, oh my gosh, now I'm on my own. Especially because your feeding challenges really started towards the end of your NICU stay. I think that's a lot. I think that's going to be very eye opening for people to understand that like, just because someone has the credentials or even some experience doesn't make it any less scary. Because really, at the end of the day, you know, everyone says, oh, it takes a village, but where is the village? Right? The village is just not there. And so, you know, you guys, I think, are actually starting to make some change in that. Like, you're actually creating a village where you're like, hey, we're gonna support you now. We're gonna make sure that you're good before discharge. Like, we know we're headed there, so let's make sure, like, you're set. Even if it's not with our bottle. Like, I love that you guys are like, what do you want to use? Are you gonna use this home? Because if they can trust you and they feel supported, they're gonna be more vulnerable. They're going to tell you if they don't understand something, they're going to, you know, have their breakdown and kind of go, like, I just, I can't do this. And you're gonna be able to help them through that. So that when they do leave and they go home, they feel at least empowered to try. And maybe a little bit less, it's a little less scary, even though it's still pretty scary, I'm sure. And I just, I think that's a beautiful thing because that is the beginning of them, I think, one that that community. Right. Feeling supported. But also, this is their baby needs to feed and they need to have that relationship with their baby. And we, we all know as parents who have had any struggles feeding our babies, how much that bond is impacted.

Yeah.

And then add in the NICU where you're talking about these parents. You know, you can't hold your baby or you think it's normal to not be able to touch the baby and the baby just screaming and, you know, all of these like almost stories that become committed to our brains that we think are, quote, unquote, the norm, I think also then changes our relationship with our child. And so, you know, I think everything that you guys are doing is, it's, I'm like, I love this. Like, it's just, it's such a beautiful thing because you're really helping to shift that. Like, you're, you're like, hey, let's get skin to skin. Like, we need to start building that bond. Like, you know, let's make sure they can feed the baby when they go home. Even if that's on a bottle that maybe we don't typically recommend in this nicu. And then you guys have that follow up afterwards. It sounds like where, you know, they can come back to the high Risk of clinic if needed. But also maybe, you know, some, some of them are doing so much better. You admit you had like alluded to like maybe improvements in eating and, and how much better some of the families may be doing based on this approach. And it really, I mean, I know like, I'm sure it took like years and a lot of advocacy to get this put in place. It sounds so simple on like an outsider perspective, which I know it was not, but simple in the sense that like, well, this is what we should be doing. This is what care should look like, you know, this is. How are we not doing this right? How do we get so far away from this, especially with babies who are in, you know, the nicu. Like, it just, it doesn't make sense on paper, but we know that that's unfortunately the reality.

Yeah. And I think part of it is like, I think just part of it is a lot of like the rotation of people that come within the nicu. So it's constant re education. I mean, I think just especially in the hospitals with how many nurses have been leaving or you know, changing, I mean that's definitely impacted us as well. And so getting a lot of newer nurses and having to re educate. And of course all of those old practices come back, you know, like all the volume driven strategies and just things that, or things that we just naturally like do because that's what we've seen, you know, because that's how they feed babies on TV or whatever or that. Or on Grey's Anatomy, which don't get me started on developmental care of Grey's Anatomy. But, but yeah, so a lot of those old practices come back and so it is very hard to kind of do re education. And then even then I think just sometimes, sometimes in the nicu, like justice therapy, like we're often, sometimes we're very dismissed, which can be very difficult, specifically when it comes to feeding. But trying to be loud but not being aggressive like which with my face sometimes is very difficult. The mask really helped. It's just my face. But yeah, having a lot of that education and that re education and that re education is, is really what kind of helps keep us going. I will say a big part of helping to make a little bit more of that change in the NICU is the fact that we're able to work with the nurse practitioners or the pediatric nurse practitioners in the high risk clinic. I no longer work in the high risk clinic, but my colleagues do. But I think that's where we've had a lot of buy in because they have seen some of these babies that come back who are having that difficulty feeding. And my friend's able to sit down with the family and observe a feed and make the changes that need to be made, whether it's teaching them how to pace or putting them on a slower flow. Because at our high risk clinic, we're also getting babies from other hospitals as well, so hospitals that aren't doing what we're doing. So of course we're seeing those discrepancies in what is happening somewhere else and how that's impacting them. That's been really good for us in our unit to be able to work with them, and they can see those, those immediate changes in that baby and then continue to see that follow up with those babies. And so from there, that has really transitioned into, you know, working really great with each other in the nicu. And now, I would say with most of our practitioners, there's a really good, like, dynamic of where, you know, they'll ask us, like, hey, do you think that this baby's ready for, like, this flow? Or can, you know, you trial this? And, you know, the way that we work in the NICU is even though we know baby may not be ready, I think it's always really important to, to work with the, to work with your, with your, with your team. And so not just flat out being like, no, I'm not going to try it, but also going to be like, yeah, I'll try it. Even if it's for like a few secs or like, you know, 30 seconds, just enough to be like, okay, so we tried it and didn't look good. You know, I think just having that, that back and forth of they know that they can trust us, that we're going to listen to them and try what they're recommending. But then they also trust that we looked at it and this is why it's not working yet. So this is why they're not ready. But I would say it's gotten a lot better. I think in any nicu, especially ours, we still have a long way to go. But to be able to see the NICU from when I started to how we are now, and then just my experience as a mom in the NICU to where we are now, like, it's really awesome. And I would say our relationship with nursing is really great. We have a lot of really great nurses. But sometimes I walk through the NICU and I'm like, I just, I love it. Like, I was just telling a nurse the other day, like, Just how quickly they respond to alarms and monitors. It's just those are the. Those are the small things that we should be paying attention to in the nicu and to see how quickly they do it, like, there's never alarm fatigue in our. Our unit. It's. It's really awesome. And I feel like a lot of that comes with just working together, because we all have a different lens and a different, you know, we all bring different things to the table.

Yeah, well, and it goes back to respecting each other's professions and respecting each other as humans and respecting each other as, you know, professionals who are all working ultimately towards the same goal. And, you know, you see so much of, like, on social media these days. There's just so much of, like, you know, people not staying in their lane and then people getting mad, and everybody's like, you know, and it's like, you know, at the end of the day, if we all could kind of, like, take a step back and be like, okay, what is my role here? And then how, like, who do I need to collaborate if I don't have this skill set? And, like, who to collaborate with? And I think when people start to look at it through that lens, they can also appreciate the fact that, like, we are better together. And, you know, I don't think there will ever be a day where I would feel comfortable with, like, somebody having a ptot, slp, nursing license, like, all, like, ibclc, like, if they had all those credentials as a one person. I'm like, at what point do you. I just don't. I don't think it's possible, like, for someone to actually function at the top of their game just because they've taken all that coursework. Like, I really think that when you become, like, niche down and you become, like, very specialized, like, let's say you have, like, you know, as an OT or an SLP or pt, you go and you get your IBCLC or your CLC or whatever. And then also you've been specialized and trained in other things related to, like, feeding or, you know, like, that. I'm not talking about that. I'm talking about, like, the fact that, like, we've all had so many different experiences in the past that we can all bring to the table. And then also there's so many other things that we're doing that other professions, I think half the time don't even realize that's the nurses, whether that's the ot, whether that's the pt, whether it's the slp, you know, whoever else may be in there. And it's like, for what? Like, why are we always at each other's throats? Like, it can be such a beautiful marriage of all of our professions and expertise and specialties coming together really for the benefit of helping our patients, which is again, it sounds like what you're doing in nicu. And I'm like, this is amazing. And yes, I'm sure there's room for improvement everywhere. Anywhere but the program you guys have in place. Just, you know, I'm like, how do we clone this? How do we. You guys got to go out and like, educate the rest of, like, the NICU world.

I really wish. I know we might. My coworker, who's also like my really great friend, my best friend. We talk about it all the time. And we're like, like, there's a lot of education specific for, like, therapists and there's like, education for nurses, but there's not a lot of places or there's not really any education for, like, where therapists, like, educates like physicians and like, the people who are like, making and calling the shots, who have a big impact on. And who are often a lot of the ones who are like, you know, why is this baby on a slow flow nipple? And I'm like, for the millionth time, I know it sounds counterproductive. Like, I promise it's not like. But yeah. So we're like, how. How do we go and like, like make a course so that we can, like, go and educate these people? Because all the therapists, like, most of us, like, we're all kind of. We're all, A lot of us are learning. We're already kind of going in. We're all advocating, but we need to, like, move.

Yes.

Beyond therapy into, like, nursing in physicians and nurse practitioners. Because, like, that wallet.

Yeah. Even so they know, like, where to refer, with whom to refer, for what to refer, like, what to be looking for, what may actually be concerning versus what, you know, something we could kind of like, wait and monitor. Yeah, it's. There's so much of that. And I, I've had pediatric, I've had pediatricians come to me and ask if they can take my course. And I'm like, they're like, I'm not going to use it. I just want it for educational purposes. And I'm like, by all means. Like, yes. Like, please. Because I'm like, where are the rest of you? Because exactly what. But I, you know, it's not really geared towards them. So people, they probably most don't see it because we just, we market SLPs and OTs, you know, but that's exactly it. It really needs that whole educational. And, you know, you guys have figured that out, so you guys go create that thing and get it. I'll. I'll promote it. I mean, it's one of those things where I think that, like, it sometimes starts and ends with these other pediatric providers and not necessarily, like, NICU related. I'm sure that there's that big piece there too. But, you know, once they're out of the nicu, like once you're going into your pediatrician and they're like, oh, you don't need that. Oh, you're fine. Oh, let's wait for and see. And half the time, like, oh, my gosh, like, if only you'd come three months ago, like, we would be in a very different place. And, you know, it's. I can't blame them because they don't know. Right? They need that education. But, yeah, that's one of the trickiest things in my practice is sometimes what we hear from families and we're like, oh, okay. Conversation.

And going back to like, yeah, like, as being a parent, as a mother, like, oh, yeah. Going through this, these situations, like that is. Yeah, it's really difficult, like, thinking back now, like, for my son, like, it just revolved around tongue ties. Because I know, like, that's its own thing. But I mean, if anyone at that point had even thought to consider, like, his oral cavity, like, we may have had a very different journey. But I mean, and too, like, in the area that I'm at, I'm at, I feel like we're really behind. We always kind of are a few years behind. I feel like everyone else, just because we're so far removed. I'm. I'm located in El Paso, so border city in the far west Texas. But I think that in itself, like, we're real behind the curtain, real behind in just a lot of different areas. And so the fact that, like, with my son, like, even me, I didn't know at that point, but no one thought to look, like, what is. What's going on with his mouth? Like, why is he having so much reflux? Like, why is he projectile vomiting? Like, why does he snore? Like, why is all these things happening? It may have been very different. Like, had our journey just been like, going to an ENT or going to a dentist at that time, or even if there was a dentist at that time, I'm not sure if there was. But our journey may have been very different. It may have been maybe not as expensive still. Probably expensive, but, yeah. And I mean, even now, I think, like, with my. With my daughter, when I was like, we're gonna go get a tongue tie release, like, I love my doctor. I don't think he. He's very knowledgeable in that area, but I think he also knows me. And he's like, all right, like, do what you want. So. Yeah, yeah, pretty much like, he's like, all right, like, that's fine.

Whatever you think you need to do. Yeah, no, it's.

Well, and it's.

You know, it is very interesting, the whole evolution, too, because you hear a lot of times that, like, you know, and this is my experience that tongue ties are just not a thing. There's, like, gag orders in a lot of hospitals. And, you know, with my first one, nobody looked. I didn't know till she was 24 months old when I, like, finally went down that rabbit hole and, like, for my own coursework and everything. And, you know, with my second, like, in the hospital, I was like, I'm not going to look. I'm not going to say anything. I latched. And I was like, oh, man. Like, this feels like there's some dysfunction in here. All right, what's going on? And sure enough, you know, there's a tie. But it was a very. Like. I also texted the oral surgeon. I'm like, hey. And he's like, okay, let's, you know. So day five, she had her upper lip and her tongue tie released, but also just very different experience compared to my first and feeding and everything. And, you know, long story short, it's just we were in the hospital with my second. They were like, nobody said anything. And then finally, the pediatrician's office comes by. I say something to the pediatrician. It wasn't like our main one. It was just the one on call who was, like, on the rotation that day from our pediatrician's office. And so she agreed with me. And then all of a sudden, because she agreed, and I was like, you know, I actually had not really said anything to, like, the nurses or the ibc, ibclc, but because she then said it, they were like, oh, do you want us to have the hospital surgeon release it? And I was like, what just happened? I was like. I was like, don't touch my baby. They wanted to, like, take her to, like, out of the room to do, like, a hearing, you know, their hearing that, you know, you weren't hearing tests. And I was like, no, that Baby's not leaving my side. I don't. You can do it right here. Like, I don't know, unless there's a problem, you have to take her to lab. Like, no, she's. No. I was like, now, tongue tied. You've offered the service. Like, you do not have my consent. But it was just very interesting to have them not say a thing until an outside provider diagnosed it. And then all of a sudden, now they want to bill my insurance and have the hospital surgeon release it. But that wasn't an option before. And I was like, this is not okay. Like, this, this is not a good look. I was like, this is not good for anybody. But anyhow, I was like, I don't know that surgeon. They could have been awesome. But also I was like, I got my guy and you wouldn't even diagnose her look. So. No, it's just a no for me. Yeah, that's. So do you guys. Have you run into that, like, in your setting or are you guys able to do, like, oral examinations? Like, what does that look like in the nicu?

So, no, it's been good. So, of course, when, when it comes to babies in the nicu, of course there's like a lot of different things, right? Like, the, the first thing we don't look for is like, the tongue tie. Of course, like, the first thing, it's like breathing and getting in there. But of course, we have had some infants where they're on a good flow, their breathing's okay, we're doing everything we have, and they're still not progressing. So then it's usually at that point that we're like, okay, like, what's going on? Because of course I don't want to look in their oral cavity, like, of a 33 weeker. Like, there's just no reason to that point. Like, it's more stressful. So we, we usually start looking if. And I mean, of course we can see, like, if they're crying or like, if we're doing like, oral stimulation or anything. We kind of, you know, we make it a point to each other. And we do put in our documentation, like, you know, patient has lingual frenulum, like that may be demonstrating function consistent with a tongue tie, you know, so of course we don't document or diagnose, but we say it might be one, but we definitely start paying attention to it. We have had a few where. We've had a few where there have been providers who come in and they're like, yeah, that's going to affect Them and they, like, do a scissors. And I'm like, oh, my God. But we actually, we've had some changes. So we do have a pediatric dentist who also does, like, the NAMS for with infants who have cleft palate. And so she is the dentist usually here in our area who. Who does a lot of the releases. And so she's really knowledgeable in that area. But we have had a few actually where we've actually been able to have her do that release and then we manage that care in the nicu. It's been great. We've had a few changes, but I will say it hasn't been a lot. It's been very few, of course, because they need a reason as to why I think that we have to be a major function, take them to her office and then they'll bring them back. So, you know, a reason to transport. But we often, like, start talking about this, you know, maybe it's a baby that they're possibly talking G tube or things like that. And we're like, you know, but this baby also has this issue, like, maybe this is an avenue we need to try to see, you know, before we start, like, doing that more invasive thing. So we have had some success with that, which has been good. But we also have had some where they've done like, an anterior release, and it's kind of been enough to get them out. Don't recommend. But of course, it's also been something that, like, that's done. And we're like, you. You still need to go follow up with someone.

So at least a conversation is being had. And, you know, I know also in the nicu, like, there's a. A lot of other stuff going on with these babies too. And so, like, it's. Yes, but I love that to hear that it's at least part of, like, the consideration is part of the puzzle because of the other 1000 things you guys have to assess and monitor and, you know, possibly treat for, you know, it still is great to at least be educating on it. And then also in situations where you feel like, hey, okay, we're actually at that point, like, it's. It's also neat to hear that you guys were able to help the families. So that's, again, I think, unusual and really just nice to hear the education starting there.

And we do still have some of those barriers because, of course, like, we do have a dentist who can come, but then of course, we also have some ents who are like, not a tongue tie, like, baby can stick out their Tongue. And we're like.

Okay, all right. We're going to create a course for you. You're going to take it. Okay, all right, great.

So, you know, we've got all different kind of providers, but it is neat. We definitely can have those conversations. And that's. It's something that we every so often are able to do like a, like a short educational presentation for our NICU, for our NEOs or the NNPS. And I wish we did them more often. I wish we did them like quarterly at least, but we've done them a few times and that's something that I want us to like to educate on, on Tongue Ties about how when you have a baby who's unlike vapotherm, like, that impacts their feeding, even though their term, they should still be probably seen. But yeah, that's definitely an area we want to do a little bit more education in. But that is, I think, another area where in the high risk clinic with the nurse practitioners or the pediatric nurse practitioners who are there, we've been able to have more of those conversations and they've been able to see that as well. So it's been good. I think that usually is kind of like our bridge to kind of come back around.

You guys are, I mean, you're doing incredible work. I absolutely love it and this has been amazing. I think it's going to be very cool for others to hear, you know, both your experience and kind of what you've actually taken from that and what you've been able to go out and advocate and do and just the incredible impact that you and your team are having on all these families that, you know, have to come through your nicu. So thank you for your work that you're doing and all the advocacy. And I hope it's a model that others, like, hear and strive to emulate and try to, like, put into place in their, you know, either clinics or NICUs or high risk. You know, it's just, it's a beautiful model. So thank you for that. Where can everybody find you? Will you share with us your. Your website?

My Instagram handle is the nicu. And then I have a website, Nurture mom and Me. So I do provide services for the community. I know we didn't discuss this, but the reason was just to kind of be able to help moms after the, after the NICU with breastfeeding, because that's kind of another area where people have a lot of difficulty, not just with bottle feeding. So that's primarily the service that I provide. So they can find me through my website.

That's amazing. So nurture mom&b.com and the nicuot on Instagram and just, you know, Jackie, thank you so so much for your time today and sharing this incredible, you know, journey experience and all the amazing outcomes you're having, you know, with with us.

Thank you. Thank you so much for having me. It was really great.

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