Episode 229: Comprehensive & Collaborative Feeding Therapy

Hi and welcome to episode 229 of the Untethered Podcast. Today we have Karen Johnson Fernandez joining us and Dr. Hope Reyes as well. Karen is the owner of Food Is Fun, let's Eat. She's been a pediatric occupational therapist since 2010, working with many families. Over the years, she's realized two things. One eating and family meal time are a huge part of our daily lives which creates connection to those around us. And two, as a mom of a picky eater, her love for exploring, enjoying and sharing a balance of tasty and nutritious food and meal times continues to grow. These two areas combined led her to specialize in feeding therapy in order to help families feel more comfortable, connected and successful with mealtime in their home and the community. She's taken a lot of courses to further educate herself in learning about sensory and oral motor difficulties, tethered oral tissues, breast and bottle feeding in infants as a certified Breastfeeding specialist, food progression and overall pediatric feeding difficulties. She also enjoys values and finds it helpful to collaborate with other like minded healthcare professionals to ensure she's working with all disciplines of a child's team in order to provide the best quality, quality care. In her spare time, she enjoys spending time with her family, trying new foods, cooking and traveling to new places to make adventurous memories. Dr. Hope Reyes is a licensed Doctor of Physical Therapy and founder of Moving Munchkins. She's a pediatric physical therapist and certified Breastfeeding specialist as well. She services patients birth to 12 years of age. Dr. Hope completed her undergraduate studies at the University of Arizona with a major in Physiology and minor in Chemistry. She then went to obtain her doctorate in Physical Therapy at the University of St. Augustine for Health Sciences in San Diego, California, graduating with high honors. It's her extensive background in dance and love for Everything Disney that gives her the ability to make movement fun for all her patients and families that she services. Dr. Hope is most passionate about educating parents so they feel confident to promote their child's physical strength and independence and movement. This passion to start her own practice, moving munchkins, Dr. Hope provides physical therapy services with developmental delay, torticollis, plagiocephaly complex medical diagnoses and feeding difficulties. She believes that infant feeding is a whole body function and collaborative care is essential for safe and effective feeding. When Dr. Hope is not working, she enjoys staying active and spending time with her husband Aaron Furchild, Lily and daughter Brielle.

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, podcast business owner and mentor.

This podcast is all about getting your questions answered and collaborating with colleagues to.

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Information in the orofacial myofunctional therapy, airway.

Tethered oral 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.

Foreign. And hope.

I am so excited to have you guys here on the podcast today. Welcome.

Thank you.

Thanks for having us.

We're having us.

We're definitely excited to chat with you and together and share what we've been doing.

Yeah, well, I feel like I've had a little bit of like insight into what you guys do because you were so gracious and recorded, you know, some therapy for us to share with our feed the Pete's alumni. And I mean I can speak to what I saw. Basically. You guys work so beautifully together as an OT and a PT in a very specialized space. So I would love if we can like jump into that and you can share with us a little bit about how this like beautiful relationship and co treatment model came together.

Yeah, so I'll kind of start. So I've been a pediatric physical therapist for 10 years, worked in various clinics in San Diego and Karen and I worked at the same clinic. And so we met back in 2015 and there was a lot of really great collaboration at that place. And so there was a lot of CO treats. And so between me and like a few of the feeding therapists, including Karen there, we started doing a lot of CO treats and I got really like interested in how postural control can help with feeding and obviously fine motor and all that, the other things that, you know, the OTs were working on. But specifically we had a really strong feeding team there and these were like more medically complex kids at the time and toddlers and older, so they weren't infants yet. But then as the years were going on, I kept asking my infants coming in with torticollis, they all had feeding issues, all of them. And Then on the intake form, I would see tongue tie release. And I'm like, what is happening with my torticollis babies? Like, why are they all breastfeeding? Didn't work out or, oh, we struggled a lot with breastfeeding and, you know, all these things. And so I started asking the feeding therapist, can you guys start being infants? Like, can you help these infants? Because why are they all struggling? And so that's where it all began, I think, for us to really realize, like, oh, like the PT part of it and then the oral motor part of it have to go together. And so then we kind of started sharing infants then. And then Covid hit, and then I left the clinic, and then I opened my own practice, and then I'll let Karen take over because then she opened up her own practice. And then we kind of, like, got back together and started collaborating more, but, like, more specifically on, like, 0 to 3 age and population and a little bit more on, like, the wellness side, if you will. Like, not always medically complex kiddos.

So.

Yeah, you want to talk about that?

Yeah. So we've known each other for years, and I do love Hope. She's so fun to work with.

Sometimes I call Karen my mom. She, like, always feeds me. She's like, I'm a feeding therapist.

I do love to eat, which is why I think I found my passion with feeding therapy, because I want everyone to eat and be happy and enjoy and be able to be with their family at meal times or, you know, social situations. But, yeah, so we did start back in the clinic years ago treating, co treating. And that's kind of where I started to zero in on wanting to just work with mainly feeding the feeding population. So I saw, you know, the infants all the way up through middle school and quickly learned that I like the little ones better. So, yeah, so like Hope said, she left when Covid hit. I stayed on a year longer. And then I decided, you know, I think I just can't give as much of myself as I want to in the clinic. My hands were kind of tied. My sessions were, you know, an hour long. But I always felt rushed to tell the parents about homework and home program at the end. And I felt like it just. There was something missing. And at that point, I had my swallow certificate, and I felt like I was at a point in my career where I was comfortable enough to say, okay, I think I can do this on my own. There are therapists out there that I can touch base with if I have questions, but I feel like I've had enough guidance and support here at the clinic that I'm ready to leave and do this on my own. So with that being said, I was nervous as all heck and I thought to myself, well, I'm going to send some blind emails out to pediatricians, local pediatric dentist and just say, my name is Karen. This is what I do. I'm a pediatric occupational therapist, I'd love to meet up with you, blah, blah, blah. And some wrote back, some did not. And so to this day now I'm still collaborating with a handful of them, which is great. And yes, once I did go out on my own and did start collaborating with those local providers, I was like, okay, I need Hope back in the picture. In my hour session of feeding takes, you know, depending on the age of the child, doesn't matter. Infant all the way to three. It's a lot the intake, you know, on an eval, if the baby's not ready to feed right away, then we do something else first. Or if it's a toddler and they're running from me, you know, it just takes a while to build rapport. So I feel like I was able to give more of myself and you know, have Hope come into the picture and do the body work piece as she mentioned, because it is all tied together and feeding is a whole body activity.

That's, that's kind of our, our motto is feeding is a whole body activity. And that's why the body work piece.

Plus the oral motor piece like work so well together.

Yeah, yeah.

So that's how we came up with our collaborative sessions here. We do a lot of co evals, co treats, overlapping treats, which is also super helpful for famil to minimize appointments and you know, length of sessions back to back.

Yeah, you get that newly postpartum mom and it's like they're running around town to, you know, the release provider and then they're seeing ibclc, you know, lactation and then they're seeing us and it's like, you know, having them come to one place. We also have a fabulous IBCLC here who's also a nurse practitioner. So she is like awesome. And you know, the family can go from her room and just walk right over to our door and get all their questions answered and get some good homework and things like that. So it's really kind of a one stop shop here at Love Strong, which is awesome that we found like our people. We always talk about how like we didn't feel like we fit in until we kind of entered the Space. And I feel like I hear that a lot from, you know, different providers that treat tether neural tissues and are in the airway space. We didn't. I always felt like I treated different. You know, I was doing manual skills on a five year old and some of my pediatric, you know, colleagues PTs were like, what are you doing? Like why? I'm like, but my hands, like they tell me what's happening. You know, it's not always just watching the movement patterns. So anyway, once I kind of got into the space, I'm like, oh, these people get me so important.

I mean I feel like that's, you know, we talk so much about how like this is not taught in graduate school programs or doctorate programs. This is not something that is like spoon fed to us. We are literally doing hours of, you know, investing time, energy, money into learning this specialty. And then as you work, you know, with all the patients over the years, you start to kind of go like, oh, okay, like this makes sense. Why did anybody teach me this? You know, and. But then it's like on the flip side, finding the providers, like you said, who get it, who don't look at you like you have five heads.

Yes.

Actually will like listen to the patients and go like, huh, I don't know how to help you, but go see these people. You know, it's just, just having those referral sources. And then also like you guys have this amazing setup with someone down, you know, right down. I don't know if it's a hallway or what. It is a couple doors down from you that also supports the patients and comes from that same educational background and understanding of the full body involvement. I mean it's so hard to find even still today, but it's so critical. And that's one of the reasons why like we've tried, we, we've stayed a home based service because of exactly what you said. Like we want to make the weekly appointments since we're an ongoing therapy. Like for you guys, everything's in one place, so it's so much easier. The families, for us, we were like, well, we'll just travel to them and go to their homes, which has worked for us. And you know, I think when we really put the family at the forefront, I think that also just, it changes the entire experience with the care that you give. And I think families are, you know, their nervous systems are a little bit more at ease. Well, they're not so at ease when they walk in the door.

Right.

You know, it's like it just, there's Little things that we can do to make it easier for them, for them to then I think have higher levels of success with the work that you're doing. So I love that again, you guys got like OT and PT and you've covered the feeding realm. You've got the breastfeeding side of things, you know. You know, I think, Karen, you have, you're also a cvs, right? You have the breastfeeding credentials too. Okay.

You both do.

Yeah.

So I mean, it's really nice that you guys also have that understanding but still collaborate with an ibc.

We never tend to treat the whole diet to treat it. That, that goes real deep real quick, right? IBCLC to like support that because we could give little tips and tricks, but it's really just to understand where the IBCLC is coming from too. So just that little bit of knowledge was pretty helpful.

But. And have families know that we do have some training and background in that, but that we also do. Yes, collaborate with ibclc. We are fortunate enough here at Love Strong Wellness to have that IBCLC amongst other pre and postpartum providers, chiropractor, acupuncture, biofeedback, pelvic health. So it is wonderful that we can, you know, collaborate here. We hope. And I also do home visits as well. So if that is something that the family is meeting and it's within a certain radius, then we do honor that and we will, we do offer individual and co evals in the home if it's within a certain distance, just to again minimize. And some parents are a little bit more fragile, especially in the infant phase, and need more support. And so we are, we're pretty flexible. Yeah, we're pretty flexible. And I wish I had this support when I was pregnant 11 years ago.

Yeah, me too.

Every time you talk about your daughters, I'm like, me too. Me too.

Yeah.

I didn't know that my daughter, I was told that she has a tongue tie and a lip tie when she was born. She's four now. But then I was told, oh, she's just going to fall and bust it. You know, I was told by lactation every baby has a favorite side. And I'm looking at my baby who was born like this with so, so tight on her right side. I'm like, I know why she has a favorite side, but what's happening here? I don't know this. So anyway, now here we are. An expansion and planning for a release next year, hopefully with Little star breeze with Dr. Hanenbosch. So we're going to get there one day.

It's a journey. And it's, it's like I always say it's like a blessing and a curse all the same time. So it's like when you know what you know, like you know too much, you're just like, oh my gosh. Like, I can't unsee it on my own kid. And also now I can't not do anything about it.

Sure that my daughter's myofunctional therapist is so annoyed with getting pictures and videos of her sleeping with her mouth open. I'm like, help. She's like, we're working on it. I'm like, posture when she's sleeping. And you know, I've even texted, you know, Dr. Hunbosch. I'm like, that release can't come any. Like, please, like, when can we do this? You know, I'm like so anxious to do it because I just see her with her mouth open and I'm like.

So hard to therapy your own child. So both of us and all our kids, I have two girls and Hope has her daughter, but we have all, you know, outsourced other therapists. It's very hard to therapy. Therapy is your own child. So we are, yeah, we're on the journey with our kids too. Yeah, it's been great.

And it definitely gives another perspective, you know, like, like when I, when I connect with families, I'm like, oh, at 34 years old, I got my tongue tie released and their jaws are like, what? This isn't just for bab babies. You know, I'm like, oh, yeah. I was like, but it's a journey. Like, you know, there's a lot of therapy involved and so they're always like shocked to hear that. So it's always kind of like fun.

Fact, you know, or the light bulb goes on. You're treating, you know, a three week old infant and you're listing off some of the things that could present later on in life. And the mom or dad in the session will just their eyes just, they're like, that's me.

Do I have a tongue?

Tongue. You know, and they're showing me their tongue. I'm like, I can't die.

I don't know.

Yeah, we always say, oh, it's, it's a rabbit hole. You're gonna, it's a rabbit hole. You're gonna go down. But it's a good one.

Yeah.

Yeah, it's so it happens so often and especially in evals or like, you know, the parent staying, they're Kind of like, like you said, the light bulbs are going off and they're always like, wait, look under my tongue. I'm like, that's okay, but it's not that easy. Like. But yes, probably based on what you're telling me. But also you need an email. So. Yeah.

Yeah.

So will you tell us a little bit about like your initial evaluation? Understand, like how you work together and you know, what that might look like.

Yeah. So, you know, when we book an initial co evaluation is what we call it with both of us here, it's usually about an hour and a half. So it's kind of a long time. But, you know, it's worth it for the parents because otherwise it would be two separate hours. And as a pt, I love it if the baby's awake for some portion of the evaluation and it's just not possible. Like two hours is like a whole sleep, feeding, wake cycle in an infant. So it is nice to combine it and have it be, you know, just the hour and a half. But basically we kind of go off of what the baby schedule is. So mom comes in and we tell them like, oh, you can hold baby. You know, let us know when they're ready to feed. So we always tell them ahead of time we need to see a feeding if at all possible, whether it's breast, bottle or solids, during our time together so we can finagle that time wise or, you know, so sometimes we'll start with like the body work piece, sometimes we start right away with feeding. And so when we were talking the other day, it's just so nice to have, you know, two brains watching the feed. We both see very different things when the feed is happening. So we're watching, you know, breastfeeding bottle feeding and I'm like, oh, did you see, you know, the posturing? Or did you see the shoulder retraction? Or did you see, you know, and she's like, oh, yeah, and that tongue, you know, so it's like we're both taking in quite a bit when we're observing. So it's a lot of observation. And then we're both watching what's the oral rest posture when they're in tummy time? What's happening with that tongue when they're bringing a toy to their mouth? Can they bring a toy to their mouth? So we're looking at gross motor, fine motor still because of the OTP perspective, but really like how it all incorporates with the oral function. So again, a lot of observation and then eventually we definitely get our hands in there. And I would say most of the time, you can get in there with an invalu infant, get in their mouth because they're little, and if they're regulated, we can do it. But there are times where we've done co evaluations where the baby's really dysregulated. And it's just sometimes I just do. We're both trained in craniosacral fascial therapy, which I know you interviewed Kim and Holly recently. So sometimes we just work on the baby when they're, like, laying on mom, and that's all we can really do. But just observing is enough for us to. Enough for us to go off of. Like, we don't always need our hands in the mouth. We don't always need our hands on the baby's pelvis to initiate something to help the family. So I think that's the nice part, is we're flexible. And I think the families are like, oh. Because I think bringing a baby to a physical therapist or feeding specialist feels a little bit like there's something really wrong, you know, and they get really, you know, families can get a little bit anxious. So we try to, like, squish that anxiety as much as we can initially and say, we're on your baby's timeline, and this is what we're going to do. You know, we can either do this. We have the parents choose. Do you think they're ready to feed or do you think they're ready to, you know, hang out on the mat table? And, you know, we can watch their movement. And so having the parents choose is really helpful for them because they feel like, oh, like this isn't going to be something that is, like, you know, incriminating.

We're doing together. We're a team. Yeah. I feel like having that hour and a half time really gives us time to let the mom, usually new mom, because we see mostly infants come in, settle, set her bags down, get comfortable.

We go to the bathroom without holding their baby.

Yeah.

We offer them to go to the bathroom. We have tea and coffee in the waiting room. And sometimes their face is just like, I can do that. Like, you can watch my baby for a minute. Or, you know, they feel safe and. And. And will speak freely to the way they're feeling sometimes. We have recently we had a mom who was dealing with extreme postpartum, and the whole session was a lot of being there for her, just having.

Being like a good listening ear.

Yeah. Being a listener. And I think when they come to us, you know. Yes. Like, hope Said they're anxious, nervous, what's it going to be like, what's wrong with my baby? And when they're new parents of infants, they're sleep deprived, they are like, wow, this pediatrician told me this and this chiropractor told me this. And now you're, you know, now someone said I should go to the dentist. So we are a huge listening ear and I think that giving time and just being flexible with the co evaluation is huge. Back in the clinic days, I felt like I had to bam, bam, bam, bang it all out or I'm not going to get this in and I'm not going to get all the information I need to write up this eval. If we don't get all the information we need in our eval these days, not a big deal. We'll get it the next time. We'll, you know, we will get it at some point. We don't have a checklist out when we do our eval. It's very free flowing. We might ask the parents, you know, okay, we got your intake form. Tell me a little bit more about this. It says coughing. Tell me a little bit more about the snoring. Does that happen during the day? Does it happen during the night? Is the mouth open? Is the mouth closed? So it kind of gives us, you know, a little bit of a template to ask more questions. But it's again, it's not like we're checking boxes and going off of something that we need to fill out to turn in. We read the parents and read the baby or the toddler or whatever and kind of just ask questions depending on what we're seeing at the time too. Sometimes parents don't report everything in the intake form. And when we come in, when they come in to see us, we're like, we should really ask about this.

Or you know, and they're like, oh, I didn't think to tell you that or I didn't think that was important.

Right. So yeah, one other thing I was.

Going to say too, with, with them coming in and, and telling us kind of like their story is like sometimes there's a lot of venting that goes on and a lot of confusion. And I think sometimes even if they've already had the release done or if they're thinking about it and they're not sure and they're doing some pre, you know, like therapy before release. It's just like, you know, hearing like for like the third time. The same thing of what a provider has already said. Because at this point sometimes They've had lactations say, yes, you need a release. They've had the dentist say, yes, you need a release. And then there's that third party. So sometimes that really solidifies it for them. And I do think that we're a big part because we do have an hour and a half versus sometimes, like a chiropractic appointment is like 15 minutes. It's not wrong or right. It's just. They just don't have the capacity to say, sit with them. So I do think our session is a big, like, fear squisher. And that's kind of our hope. When parents come in and we do get that perspective, you know, we'll get the response of, oh, this was so helpful, like, like, like the parent, literally, like, audibly. That was so helpful. You know, like, they sigh at the end. I'm like, oh, that's what we want to hear. But another question that we like to ask is, like, what does a 24 hour, like, day look like for you guys? Like, because you get some parents that are doers. And I will say, I think a lot of our parents that are doers happen to be SLPs.

I don't know. That doesn't surprise me.

Sometimes we're like, okay, this is. This mom is an slp. So, like, we should probably like, tone down the home program because she'll do it a lot. Like, she's gonna. She's gonna have her hands in that baby's mouth all day if we, like, don't tell her not to. And so that's just kind of a funny thing. But we like to give homework also based off of reading the parent and reading the family of, like, this mom probably can't handle more than the oral stretches from the release. So we're just really going to tone it down. Or this mom is a doer and she wants all the information, so we're going to give it to her, but we're going to tell her, yeah, let's reel it in a little. Let's not have your hands in your baby's mouth all day.

Yeah, I love that. I love that. I think, like, you said so many good things and there's, you know, like one of the things you said earlier too, just around parents and working with this population of, you know, having an infant kind of being in that, especially when they're still in that, you know, fourth trimester, is that parent guilt? Because so many of the parents will say to us, like, did I do something wrong? Like, moms especially, like, did I do something wrong? Did I do this to my baby? Is it something that I did wrong in pregnancy? And it's. And you know, I'm always like, you didn't do anything wrong. You did the best that you could do with the information you had. There is no way that you were changing this in your part, you know, like, no, like, yes, your body created this child, but also you're sitting here looking to get your child help. You're doing all the right things. And I think that, you know, speaking. I love how you really spoke to some parents just really need that ear during the eval. And the eval might look very different. There have been times where we barely touch the baby, we barely get. And not because the baby's not ready, but it's because the parent really needs that ear of a provider who is understanding, who is going to listen, who's not going to gaslight or dismiss or tell you, oh, it's fine. It'll, you know, like, you'll, your baby will fall on their face and they're gaining weight, right? They're okay. They can stick their tongue out. I mean, we could list like 75 different things that people say I called.

All those things with my daughter. So.

Right, right. Me too. I mean, me too. It's like we didn't even get the diagnosis, so. And then once we had it, trying to find someone who actually would do something and work with me was like, like another whole story. But, you know, I think it's so critical to understand that we have to look at the patient in front of us. And I did this training, it was more myo based, but I did a training called Airway first back in December. And it was just like a two hour training. And it was a lot of it was like half of it was surrounding my experience as an adult going through all of this myself as a patient, but the other half of it was like, everyone's like, what's your secret sauce to working with patients? Why are your patients so responsive? Why do they. How do you get them to do their homework and, you know, how do you know what to do first, recommend first or who they should see first? And I said a lot of it's been a learning experience. One is myself as a patient, being the mom of a patient, but also working with patients. And, you know, it's. Not everybody's going to go down the same trajectory. Not everyone's going to get the same referral first. Not everyone's going to get the same exercises. Not everybody needs the same thing. Like, we need to Know, it's not just about. And it's not even just about the muscles. It's like you guys said, if that parent is not ready today to do anything more than active wound care, then that is what we're doing today. And that's probably what they're doing for the next week or until we see them at their next appointment, you know, with check ins in between.

Right.

And I think that's so critical because I also get the question from SLPs, especially in my Feed the Peace course. Like, I actually just recorded an episode on this recently that I don't know if it came out already or if it's the one coming out like next.

But the less is more.

1.

Yes.

Less is more.

Less is more. I was.

Yes, I know that this week.

Okay, so that must have been. That came. That came out this week. Week. So, you know, I. People who are like, well, how many exercises and like how many repetitions of exercises? And I'm like, whoa, pump the brakes. I'm like, first of all, what does that child need today? Because what they need today and what the parents can handle are two very different things. And maybe what happens in the next session or happened last session or happens with this other child who presents similarly. And you know, and that's why I love, you know, what you're speaking to is really keying into like that dyad, right. And the dynamic of caregiver and child. And, you know, whether I'm working with an adult in Mayo or a pediatric feeding patient, what can they handle today? Like, what are they receptive to? Like, just tapping into the human sitting in front of you and kind of being like, what do you need today? Right, yeah, I help you today. How can we work together today to like move the needle forward and you know, and I know we were chatting a little bit before we recorded and you know, I think, I think, Karen, you said this, that sometimes we don't make progress in a session or two sessions or three sessions. Right. And I'm going to turn that over to you and let you speak to that. But yeah, I mean, I totally based my worth as a clinician or in my early days on like making progress every single session. And then later on in my career I kind of was like, yeah, that's not possible. And also, it doesn't define me as a human or a clinician, but I'd love for you to speak to that.

Yeah. So I think that as a new grad years ago, I was always under the impression and I'm type A personality so I'm a planner. I like to, you know, have a list of things and I'm gonna cross it off and get through those and then I know I did my job. So I was under the impression that when I had a client, I needed to see something in the session, I needed the parents to see something. Oh, look, he crossed the shoelace over this time. But last time he didn't. Or you know, he picked up the spoon this time. But now I'm to a point in my career where I will front load the parents, especially if they're anywhere in the age range from eight to ten months, all the way to three, three and a half. I will front load them and just say, I might not get my hands on your child during this eval. I might not get my hands in their mouth for the first two, three sessions and that's okay. There's a lot you can do in a session without putting your hands on the child. My biggest thing is building rapport with the family. First and foremost the family and, you know, the team, the caregivers, whoever is bringing them to the session. But with the child, especially a toddler, if I'm going to force myself upon them just to prove that we are going to get something done and they're going to walk away with something, guess what, the next session they're going to come back and little Johnny is not going to want to get near me.

Trust forever.

Yeah. So I am super comfortable now saying, you know, hey, I, I like to front load my parents of toddlers and say, this is a journey, you know, we can't expect your child. There's no crystal ball that says he's going to react or she's going to react this way. Just as with an infant with tethered oral tissues, some babies progress, you know, and in two weeks we see major changes.

We call them those light switch babies where it's like a light switch turns on after the release and we're always like surprised. We're like, whoa, what just happened? I, I guess you're doing what you, you met your goals, like, you know, and then there's those that take, yeah.

Then there's those that take six months, eight, ten weeks. I once got an email from a mom that I was working with. I started working with her baby at 6, no, probably 4 weeks old. And at, and we had had some sessions and then at about 10 or 12 weeks I get an email, follow up email from her. Hey, I just wanted to let you know we're finally exclusively breastfeeding. But this was weeks of her putting in homework. You know, we saw each other every other week for all these weeks. And so that baby took a lot longer and it was a lot more effort and time on the mom's purpose. She was really invested in breastfeeding and whatnot. And. But so we. I like to tell parents, too, that, yes, there's no crystal ball. I don't know if your baby's going to show progress in two weeks. I don't know if it's going to be 10 weeks later. And I think when they hear that, especially before pre release or pre doing any of this stuff, it also helps to ease because many times there's providers that will say, oh, yeah, let's just do this. It's going to fix everything. We're going to do all the ties and you'll be good to go.

Ah, no, there's no mention of the collaborative care.

Right. Or any other care at all.

Yes, it hurts my soul a little bit.

Yeah.

And then we call those the cleanup cases. I know that's a little bit of a harsh term, but, you know, sometimes I'll text Karn, I'll be like, cleanup case today. You know, where it's months post release. And they're just now, oh, wait, I, I didn't know I needed bodywork. I didn't know this was. I didn't even know this was a component until I saw it on a Facebook group and I saw your name and I thought I'd just call you and see, like, what do you do? I don't understand. And I'm like, like. Or the provider been doing that before and during. And all the things, the release or.

The provider, you know, this family like you're mentioning has gone back to the provider multiple times, still having difficulty post release, and it might be six, eight weeks later. Yeah. And that's when they refer, well, maybe you should try feeding therapy or, and, and, you know, then here we are back in the state of anxiousness, nervousness. Wait, what? Now you're telling me you need another thing? And then when they come to find out that, oh, maybe we should have been doing this all along, there's that guilt. It's another. Yeah, it's another step in their journey. The guilt sets in. And so again, we are the listening ear for many of those cases. But, you know, we're flexible and we try to be as comforting as we can and, and advocate and say, you know, you're here now and we're going to move forward and we're going to get you the help that you need. And. Yeah. So I don't know if I answered all the questions, but.

No, no, no, no, you did, you did.

Sorry. I think it's a little bit less with, like, the bodywork piece. Putting your hands on a baby's pelvis is, you know, or a toddler's pelvis is not as incriminating as going in the mouth.

Mouth.

But having said that, I will say some toddlers just swap me away the second I touch their head. They're like, nope, no, thank you. You know, so then I'm just like, okay, Mom, I'm gonna do it.

We have our little baby doll back there.

Her name is Franny. I have Franny. And I'm just gonna take Franny through some movements, and I want you to do it with your child sitting in your lap, and you tell me what you're feeling. So I kind of empower the parent. And they're like, what do you mean? I don't know what. I'm like, no, we're just gonna go slow. You know, we're going to do some side bending. We're going to do some rotation. Tell me, do they have a favorite side? Do they have a side that's easier? So then the first couple sessions is just mom doing it. Then the child's familiar with me by the next two to three sessions, then I can get my hands on the child. So it does happen for me, probably a lot less. But I think we both, you know, kind of function in that way, which is why I feel like I can look at Karen during an evaluation, and we just like, no know what's. We're like, yep, we're not going there.

We have the Mr.

Mouth.

Oh, yeah.

I always say, I. I can do it here. I can do it on you. I volunteer, you know, myself to do it at the. On the parents. And some are more open and, sure, yeah. And others are like, I don't know. So that's when Mr. Mouth comes into play.

So we have our props to help us with, like, those kids that need more time to develop rapport, which is, you know.

Yeah, yeah.

No, and I love that because that's also, like, one of the questions. And I just came up again yesterday. Or as we're wrapping up one of our courses, but someone at the very end of the course was just like, okay, but, like. But, like, what if I can't get in the mouth? Like, do you refer to somebody else? Do you do this, do that? And I was like, okay, deep breath. I was like, let's take a deep breath. Okay? I was like, yes, one. You can refer to somebody else, because if they're going to go to another provider who's going to diagnose that anyways, and you're confident they're not going to try and release the kids same day or next week and, you know, before the kid is actually ready, then by all means, like. Like, go for it. Make the referral if it's important, especially if it's important to the parent. Right. Sometimes the parents just, like, they want that tissue exposed. They want someone to give the diagnosis. I'm like, don't let that pressure from the parent destroy your relationship with the child. As you guys were speaking to, like, you can so quickly, you know, avoid. Avoid losing the kids.

Try.

You can lose the trust very quickly, and you can also very quickly gain trust by, like, just tapping into who's sitting in front of you and what they need and what they're ready for. And, you know, it's like, I even talk to, like, little babies when I'm like, okay, are you ready? Like, you know, it's like I'm asking permission with, like, knowing that, like, they're not gonna actually talk back to me at these younger ages. But at the same time, like, if you kind of see them kind of look at you and they smile a little, or they're kind of just, like, you know, they're not crying or looking, like, really distressed. You're kind of like, okay, they're responsive to my voice, where everybody's calm. Let's see what they allow. And, you know, sometimes we get in there and we do something, and then it's like, they're like, okay, that was fine, but that's not fine or, okay, I was okay for 10 seconds, but 15 seconds is too much, you know, and. And that's the other piece to it, too, where I think, like, just. I think if we could all kind of just take 10 steps back and not worry so much about what we're getting done in this session. But worrying about connecting, it's. It's almost like. I don't know how to describe it. Always. See, there's like a perfect, like. Like, you know, dance between art and science, because there is no perfect dance there. It's just a dance, right? And it's imperfect, and it's messy, and, you know, and again, it looks so different, one patient to the next. But it's like, when you start to work with these patients, you kind of connect with them in a way where you're like, Okay, I hear you. Like, you liked that. Let's do that again. You didn't like that. Let's not do that. And sometimes that's how I pick the exercises that I send home because I'm like, what went well in the session? Because I want the parent or the caregiver to have success. I don't want to send them home. And, you know, I've had people say, well, no, when they do really well with something, I might give that, like, as a homework, you know, let's work on that muscle or let's do that exercise. But then I'll also give them something that the kid really struggled with. And I'm like, I think that's okay if the kid is receptive to it. If the child's going into, like, shutdown meltdown mode. Absolutely. Never do that ever. You know, because the parent is going to go into shutdown mode.

Yes.

Be anxious, which the kid's going to automatically be anxious. And there's that whole, like, interconnection of like, everybody's nervous system is now in fight or flight when we need you and rest and digest. And it's like, okay, this is a mess. And we're. This is not going anywhere. So I think it's so. I love this conversation and I know, like, we've come back to it a couple of times, but it doesn't matter how many times I tell someone, I still keep getting that same question, which is why I was like, we need an episode on this. Because, yeah, you can. It's like just deep breath and try to connect with the human in front of you.

Yeah. I used to work in academia and I taught first year DBT students and I would tell them, sometimes you have to take off your PT hat and put on your human hat because, like, we're all still humans. And I think too, it's easy to dismiss the baby as weird as it sounds as a human, but babies have preferences and they have tolerance levels and they have nervous systems just like toddlers and they communicate. And so, you know, when you think about like a torticollis case and, you know, oh, we're going to stretch a neck, which, by the way, I don't, I don't do any stretching of the neck. It's just, I treat tortoise calls a little different. But stretching of the neck and the baby screaming or tummy time, and it's like, you know, these parents are told, I have to do this many minutes and the baby's screaming. I'm like, they're not Learning they're not releasing tension if they're screaming like. So we have to respect that. That's what your baby has a preference and your baby's telling us, and that's their way of communicating. So we have to find another way. We have to find another position, another time in the day where they're more regulated and they're happy. So we kind of give parents the grace of, like, not pushing it. When we have those type A moms that are like, but I have to do this five times. It's like, well, in a perfect world, yes, but that's not human. So, like, we always tell parents before any oral stretches, anything where you get in the mouth, you're going to tell the baby, you're going to get in their mouth. And they kind of giggle. Like, the parents are like, what? You know, like, are you serious? But I'm telling you, like you said, when the baby locks eyes with you and they're cooing at you and you're like, touching their lips, you're like, here I go. Can I come in? And I literally show them. Do you see how your baby just opened their mouth to invite me in? They literally do it. They're like, oh. And they open their mouth. And then I'm like, now you can get in there. And I think a thing to add.

To that too is that now that we're both out on our own, one thing that we offer for parents is to text us to send us videos. So that if you have questions, if we send you home with one or two pieces of homework, we do it here in the session. They do it here in the session. But maybe when they get home, it looks different or maybe they're wondering if they're doing it right and they don't want to wait. We don't want them to wait until the next time they see us. Because usually it's not weekly appointments, so it's bi weekly, usually. So we have this open communication system with our families and we do. I get texts almost daily, if not every other day, or videos, you know, hey, here's the sleeping tongue pose. Hey, this is what the snoring sounds like. Am I doing this exercise right? I don't know if I'm getting, you know, under the tongue. Right. Or whatever. But I think that having us so close, and we do say that we'll respond within 24 hours because we both have families and they're very understanding. And I feel like it's just. Just another level of. We're just bringing another level of Comfort human. Another. Yeah, humans, we're listening ear, and they feel so validated and really buy in and, you know, they're compliant with what we're giving them because we are flexible. And I will say yes. Try for a series of three. If you get one out of three and that's all you can do, that is awesome. Life happens. You're tired. You are a new mom, and that is huge. So if there's three days that go by and you're like, shoot, I didn't do anything Ms. Karn told me to do, that's okay. Yeah, we will move on. We will move forward. Life happens because it does well.

And it's also weird for these parents to get in their baby's mouth. When have you ever gotten in anybody's mouth? Like, it is definitely, you know, a tactile skill, a coordination skill to be doing, like, these lip, you know, stretches and like, oh, do you feel that band in there? Like, some people don't have great tactile sense to feel the really, really thick masseter, you know, that's in there that you can, like, release or, you know, oh, do you feel like. Like I was saying earlier, it's easier to one side or the other. Sometimes the parents are, like, panicking. Like, I don't feel anything. And I'm like, that's okay. They're not. They don't work with their hands in this way. So that's why it's like, oh, if you do a series of three, maybe by the third repetition, you're feeling what we're talking about. So I think there's definitely, like, a physical kinesthetic learning curve for some of these families, for sure. And I always kind of joke with them. I'm like, oh, by the end of the time that you're doing the oral stretches, most of our providers say for four weeks to do them. And so, oh, by the end of the four weeks, you'll have mastered it, and then you'll be done.

But it's so true because, you know, even me as, like, a new clinician, right? Like, I hadn't been in people's mouths, and so kind of just going back to, like, where I was way back when, you know, now having a parent with an infant, obviously, I was also that parent with the infant. My second one was released at five days. We did, you know, body work with her, and I worked in her mouth and everything, but even with her, it was like. And I was. I was working with toddlers prior to my first one, and then kind of integrated the infants in later. But yeah, even with her it was like, does this feel right? I mean it's really hard like we've said to like therapy as your own child. I can do it much better with anybody else's kid. But these parents don't know like what something feels like or what it, you know, what should it feel like, what shouldn't it feel like? You know, and I, I love that you spend time with them because we do that too is, you know, we want them to feel comfortable when they leave. If you just show a parent a video and give them a piece of paper, they don't get their hands on doing it, practicing it. There is very minimal chance they're going to do the homework because one, they're afraid they're going to hurt their child. Two, they have, it's, there's a lot of fear and then that ranks up the anxiety and then the child is not going to be as receptive like we've talked about, you know, it's that nervous system is so important. So I love that you guys are spending this time educating and also making sure they feel good about, you know. Oh yeah, okay, now I feel it. Okay, now I think I know what you're talking about. Okay, now we're one step closer to like, like feeling successful with this because it's, it's the same thing. You know, I've been also the patient I've had but when I lived in Maryland I went to this PT who was trained and what he called, or I guess what he did was manual counter strain, like not your traditional counter strain. And so and he was like pri trained and you know, worked with like mute expansion and all that. And he would say like can you feel this? Can you feel that? And for me I could like, I could feel things pulsing, I could feel things, you know, with very gentle touch. I would feel like things like, like flowing in my body again. And he said to me, he was like, I'm pretty sure that like only 33% of adults can actually feel this in themselves. I think that's what he said. And I was like, huh? And I remember that clicking like this must have been five years ago. But that clicked and I went oh, okay. So if these parents can't even feel it on themselves, these adults, like I wonder how many of them actually can't feel it. Even like when I'm sitting there training them, their hands are in their kids mouth. Like are they not in like you said different, like tasks, tactile input, you know, for different hands and so when you said that, I was like, yeah, that's a really, really, really good point. Because even as much as we train them, it's like parents are like, am I giving enough pressure? Do I do it harder? Is it too light? And, you know, they don't have a good feel for, like, what to do? And again, that fear of, like, I don't want to hurt my child. We're like, well, nobody wants to hurt your child. And so it was going to hurt your child, but it's okay. Like, we're going to work through this together. But I think that level of support is amazing and it's critical, especially with infants.

Yeah.

Yes.

I think with that being said too, and the whole tethered old tissue post release, the provider that we work most closely with, Dr. Hanenbosch at Littlestar, breathe, we try to see the patients within a day or two or three days. We both work out of the office there one day a week now as well, doing wound care follow up. But I think that trying to see a family within that first one to two to three days for the very reason you were just speaking about is huge. Because when they're in the console and they take the video of how to do the stretches or they're given the handout or whatnot, it's a lot. You know, it's an hour consult and what, whatever, what have you, it's a great consult. But most of the time on the first follow up, we get parents that come in and say, I hope I was doing it okay. I don't know if I'm doing it hard enough. I feel like I can't get under the tongue. They're clamping down. So being that listening ear and that reassurance, whether it's at the dental office when we're there for follow up days, or it's here or it's in home and really reiterating what is to be done and showing them, you know, no, you're not, you're doing a great job, or, yeah, we do need to apply a little bit more pressure. Really, Again, validates like, oh, okay. I. I'm so glad I. And we usually hear, oh, I'm so glad that I came today, or I'm so glad I was able to see you today because I was so worried that it was reattached or, you know.

Like the biggest fear, it's like, oh, is my baby's reattached because their jaw's not opening or they're doing this and yeah, you know, so I always say we can course correct. Like, we. You only got this procedure done two days ago. So we can really make sure that we're gonna make everybody feel comfortable and competent, that that tongue is going to heal the way we want it to. And so they're like, oh, okay. You know, they're like, oh, thank goodness. I mean, it is a lot of appointments because they just had the release, like, two or three days ago, and then they're coming in again, but usually.

They'Re so ecstatic and be like, oh, okay, thank you for validating me. It's never an appointment where they're like, oh, we're here again. They're like, okay, I just want to make sure I'm doing everything right, you know, and, like, what else do we need to be doing? So, you know, we do that.

We do that, too. And, like, I think that that 24 to 48 hour, like, after the release happens window, if you can get to a patient and make sure that, you know, the caregivers feel really confident about, like, what needs to happen now, I think that's huge. And, you know, we also work with some older kiddos and, you know, elementary and through high school, and even adults with the myo side of things. And for them, too, I mean, half the time they're not confident, or the kids, like, not loving how it feels while it's healing. If they maybe had sutures place, you know, and they're not wanting to eat or they're not wanting. They're afraid to speak. And we're just, like, literally sitting with them. They're trying to get them, you know, And I've done this with toddlers, too. Just sticking their tongue out a little bit, a little bit at a time, just like, okay, how did that feel? Okay, great. Can we go a little bit more? Okay, how did that feel? And it'll be like, that was ouchy or something, you know, like, okay, that's where we stop. We don't want it to be ouchy. Like, let's. We'll work on that more later today or tomorrow, you know? And so I think, like, you know, it's. I always loved those sessions because I felt like they were so. So for the parent who's, like, so nervous to go through with the procedure, to then see this on the flip side, like, even within, like, hours or a day or two, like, in this, even with the babies who are still struggling, the parents always will say something along the lines of, like, oh, they don't feel as tight or, okay, now, because we've worked on this so much leading up to it. Now they, they feel the difference. And I think that is so critical. I've always had like photos and videos are great and I think definitely show change. So absolutely love them. However, feeling it and experiencing what it feels like before and after, especially for the caregiver, I mean, I think those light bulbs go off in their head and they're like, okay, now it all makes sense. Like it's clicking. Okay, I see what's going on and, and I think that's especially helpful too, especially with our infants who are really still struggling to feed. And we're going to take, you know, a while to really get on track post release, you know, even though we've done all this work leading up to it. Because it's like all those little like glimmer of hope where like the parent, something connects in the parent and the parents, like, okay, I'm with you, I get this now. Okay, why are we still struggling? And then that's like the next conversation. It's like, okay, we know how we did this to get here. Now we have to do this to get there. And we don't know how long that'll take. Like you were saying, like some kids are, I think you call them the light switch. Like light switch, they get the release and boom, it's like everything's functioning and you're like, whoa, how did that happen? But unfortunately that's less common than it is, you know, than it is like the norm. So most of our kiddos definitely, you know, we see several weeks to several months and then if there's other more involved kiddos, like from a motor standpoint that can be plus of you know, follow up therapy depending on what's going on. But, but yeah, I think I love how you guys take this, this approach that's very supportive, I think, and very, you know, family forward. Because that's, I think that's how it needs to be.

There's way too many and I think the providers we, the providers we work with, like, you know, specifically Dr. Hanenbosch, like, she emphasizes what we need to get done too. So it's like if we're all saying the same thing to the family and they're getting that repetition of like, yeah, it's gonna, you know, she never promises the light switch situation. In fact, she probably more often says it's gonna take some time. It's get, you know, she. And I think like, I can always tell, like, I don't even need to see on paper if the, like where the family got their procedure done for their child. Because if the family is more open to the therapies and they're more like their expectations are set better, you know, by certain providers who do that education and take that five minutes to say, hey, listen, this is a journey. This is, you know, even with those infants, like, the mom is in pain, breastfeeding and all that, like you, I want that light switch to happen. But, like, realistically, realistically, those families are so much, like, better supported and better, you know, their expectations are just set. And I can always tell if they've heard this from their IBCLC or the release provider before they come to us.

Well, many of the families, too, I will come to the first session and they'll say, oh, yeah, Dr. Hanenbosch said her part takes care of the anatomical structure, but we need to work on function and we need to work on. And I'm like, like, oh, I didn't have to.

She started so beautiful.

Yeah, I will reiterate that and I will say, I'm sure Dr. Hanenbosch said in your consultation that her part, you know, strictly takes care of the anatomical portion of what's going on. Myself and Dr. Hope are going to look at function. And how is this impacting feeding function, you know, motor movement patterns, tension patterns. The dentist doesn't do that part, you know, so that's why we are a team. That's why we collaborate, you know, and when they go back for their third follow up, which is their last follow up four or five months post, we hear from Dr. Hanebos all the time is like, wow, like, what a huge.

Like, different baby, different mom. You know, the mom's not coming in, holding their baby with their shoulders up. Like, you can just tell the parents look different too.

Yeah, yeah, that's.

That's the fun part, you know, to see, like, that end journey, like, success cases and, you know, parents that have reached their goals and, you know, it's just fun.

One thing I just want to add too quickly is when we. When I, like, first came into the space and went out on my own, I was so used to having kids in the clinic on my caseload for months at a time, years at a time. And so when I was in this space and on my own and working with these more typical kids, I felt like I was doing something wrong at first because I would have maybe three sessions, five sessions, six sessions, and then I was like, I don't think this kid needs me anymore. Like, what is going on? Am I, am I not seeing something.

And I would see something, Am I missing something?

I would, you know, call Hope and be like, hey, you know, and she would say the same thing. And I, yeah, I feel like the time, the energy, the collaboration, the collaboration is like so huge. And so it took me a few months of this repetition of like, I only saw that kid three times and they're like, are they really ready to be discharged? Are we really ready to be done? For me to realize, like, yeah, this whole team approach, like, like, I don't need a kid on my caseload for a year. I mean, maybe there's check ins. And so some of the infants that I see, you know, that are done working with me at three months, sometimes parents will call me back at six months when they introduce solids and I will, you know, revisit the family and do a session or two based around that. But.

You know, the same with torticollis too. So like in the clinic we would have to wait for the pediatricians to refer, refer, and they're getting a little better. Apta has spit out a little bit of research saying by eight weeks they need to refer. I'm like, I had a 20 day old in my office the other day and I'm like, yes, yes, yes. And I'm like, guess what? I felt the same way. I'm like, wait, they're getting better faster because they're young and they don't have as many milestones to reverse or enhance or oh, you know, he's sitting but he's like this or he's rolling to one direction. I'm like a 20 day old, doesn't have that many milestones stones to like fix, right? So I was like, they're getting better faster because I'm seeing them earlier and I'm not waiting for somebody to tell the family that they need to come see me. So it's really like this conversation, like on the PT side of things. Is it really torticollis or is it just idiopathic postural asymmetry? We're fixing it before the torticollis comes in, before the neck really looks like it's the biggest issue because from my perspective, it's not the neck. The neck is the symptom of something else going on. And then there's the tethered oil tissues and the mal tension and all that. But you know, the whole body approach is like, there's something else, like pulling on that child, on their hip or their pelvis, their trunk, something else. And the neck is just, you know, so we could stretch the neck all we want, but you're not going to fix the problem, and the tilt's not going to go away until you look at the trunk. So. But I get these babies, like, discharged faster. And when I was in the clinic, I wouldn't get a baby with torticostillo, like, four or five months. And I would always think to myself, where were you three months ago? There's no way that this just happened overnight. And these parents would say, oh, yeah, they really did like looking, you know, to this side. But I didn't think it was a problem because the pediatrician didn't catch it.

Wait, let's wait and see.

Yeah, let's wait and see. Or my favorite one is just, oh, yeah, just dangle a toy to the side that they don't like to look. I'm like, well, babies avoid movement that challenges any tension. So there's no way they're going to look to their nostrils preferred side unless they get that bodywork done. Like, I don't know how you're going to do it unless you just force it. But getting them earlier is like. It's almost like wellness versus reactive care. And I love being on the wellness side. And I think that's my favorite thing about, like, having my own practice is that I feel like I'm. I'm, like, doing things before it's a problem. Obviously they have, you know, feeding issues and all of that, but I'm like, I'm doing it before. It's like a really big, gross motor problem. And then we don't need the cranial remolding helmet because we fix the range of motion. And now their head is growing round, and it's beautiful. But, yeah, they discharged a lot faster. So it is a little bit weird being on, like, more that wellness side, catching it earlier. Families are coming directly to me, not waiting for their pediatrician to agree. So that's, like, my favorite part about it. It's, like, so fun to see them discharge in, like, five sessions. If you would have told me that, like, 10 years ago, I'd be like, no way. It takes way more for a baby with tortoise.

Yeah, well, that's. I think that's the beautiful thing of, like, being in private practice for yourself and being able to, like, you know, call the shots and educate and hopefully get the kiddos in earlier. And, you know, I have parents who always come and they're like, oh, my gosh, is it too late? I'm like, no, it's not too late, but depending on your child's age, we have more, like you said, more to undo, more to catch up on. And certain, you know, it's just. It takes a little bit longer, and that's a bigger investment in many ways. So, you know, but I always tell parents, I'm like, the earlier the better. Like, early intervention is so key. And we've talked about that on the podcast a lot before. But I'm like, if we could just get every pediatrician to sit in a room together and somebody could come and talk to them, and we could have this conversation with them and be like, hey, like, when you see that newborn or that baby at one or two weeks of age and mom's got these concerns, it can't hurt to send to a provider who does what we do, because we may save them months of depression, months of feeding issues, months of motor issues. I mean, everything we.

You just listed, it's money and time.

Yeah.

Yeah. I mean, and I think that's, you know, I appreciated our pediatrician that I had when my girls were young because they had like, the. The questionnaires for mom, and they had the questionnaires for baby so they could flag any issues, you know, with postpartum depression or an anxiety or anything else going on with mom where they felt like it might be helpful to refer mom out, too. And so I really appreciated that because I feel like not. That's not standard, and we need to be supporting the caregiver who's taking care of this child that they're, you know, they're the pediatrician of. But, you know, at the same time, it's like, I feel like there's been so much more conversation around, like, mental health, but I'm not not seeing it translate to everyday practice in our young moms or moms of young and, you know, new infants. And anyhow, that's that mean, like, in a perfect world, if we could just, you know, get all these people in one room, educate them, send them off on their merry way, I think we'd all be a better off.

Now go do disperse.

Hope and I both have made little flyers for people in the community, pediatricians, you know, other providers that we would like to collaborate with. And it's more for that discipline, not for the parents. So it's for the pediatricians, and they can look on the back of it and it says, you know, you put on there if your baby's 0 to 2, or if the baby is 0 to 2 months and the parents are coming in and, you know, they have this complaint or this residual, whatever's going on, send them to me. So it's more. We're trying to educate and, you know, those who. Yeah, we're trying.

Those who.

Some are more accepting than others. Yeah. But I do feel like we are.

Slowly getting more referrals from younger babies. Yeah.

Younger babies and providers are like, oh, I just got another referral from this pediatrician. Or, oh, the. This family came in and said. The pediatrician said that we should probably see feeding therapy before we. Blah, blah, blah, blah, blah. So, you know, it's still rare, but we're seeing it.

Yeah, yeah. Slowly but surely, it's harder to tap into that classic medical model. You know, it's really hard to change their process, to change their perspective and all of that.

Well, it's like the bigger higher ups, too. So we have a lot of moms that come in and say, I had a mom two weeks ago that was like, the nurse in the hospital whispered to me and said, I feel tension under your baby's tongue, but I can't say anything. So when you get discharged, go for a second opinion. The nurses, you know, hands are tight. Yeah. So it's just, you know, we do what we can.

I mean, I had that experience as the mom where I was like, okay, I know too much. I'm not going to go. And my child. Child's mouth, like, silly Hallie. Like, okay, as soon as the baby latches to breath, like, you're not going to know if your child has a tongue tie. Like, really? I mean, the second she. She, like, latched, I was like, oh, this is like Lily all over again. Okay, all right. I don't even need to look in the mouth. I know what's going on in here. There's a lot of tension, and maybe there's a time, maybe there's not, but there is definitely tension, and we've got to do something about it. And so, like, day two, I basically showed the pediatrician when they came to visit from our pediatrician's office, and she was like, yep, you're. You're absolutely correct. Like 100. As soon as she diagnosed it, the outside pediatrician who came to visit inside the hospital, then the nurse was like, oh, do you want our hospital doctor to release that for you? And I was like, don't touch my baby. Like, wait a second. There's gag orders. You can't diagnose it. But as soon as my external pediatrician did, now you want to bill my insurance? No, no. Like, this is not. I was like, and no, you're not releasing it today because she's not ready. Like, they were like, can we, they wanted to take her to like do hearing tests outside of the room. I was like, no, no, you can do that right here. I was like, nobody's taking my child after that experience.

Yeah, don't touch her tongue.

This is a room in hospital. My child is not leaving my side.

Yeah, good for you. And I think reminding parents too that you are your babies or your child's biggest advocate and for them to hear that from us on the outside, like, trust your mom gut. Because just last week I was with this family that I just mentioned. The mom was told that in the hospital and she's seen multiple providers since and got the run around. And so she also is dealing with some postpartum now. But I just really wanted her to feel validated and said, you know, reminded her numerous times in the session to trust your gut. You were her mom, you know her the best. If you don't feel like something's right, ask for a referral for somewhere else or you know, seek. Seek someone else. You really have to have that comfort and that level of understanding with a provider you're going to work with or you're not going to get anywhere if you don't. You know, I just wrote a blog.

Post the other day because I was feeling pretty spicy and it was really meant for like, yeah, it was really meant for like other providers and to understand, like when a parent comes to you for a concern for their child, it's real. Whether or not development, you know, or physiology tells you it's a real concern. You either need to validate their concern, then educate as to why it's typical. Oh no, your baby shouldn't be crawling at six months. I get that question a lot. Like that is way too early. That's crazy. Closer to nine months, you know, nine, ten months, you know. So you either validate and then educate as to why it's not a real medical concern or you refer to the right professional. And if you're not the right professional, you only have two options. Like, it's not that complicated. So. But I think a lot of times, like in that classic medical model, we forget to validate and then we don't educate and we just say, nope, it's not a big deal. But like, they need to know the why. Why isn't this why? Why shouldn't my 6 month old be crawling? Because I had a play date with another kid and that old was like on their tummy and my kid doesn't even do this. And I'm like, you know, like, so, like that, that validate, then educate. Like that doesn't happen a lot of the time. And I think that's really hard for parents because then they leave not feeling heard. Even though, like, yeah, it's not a concern that your baby's not crawling at six months. But nobody told you why. Nobody took the time to say that comes later. It's your baby's doing. They're sitting, they're rolling, they look great in tummy time, like, this is what your baby should be doing. And then they're like, oh, okay, then that concern is gone. And I feel like more often than not, I guess, you know, select sample size because of the babies that come in our office, more often than not, the concerns are real physiological issues.

Yeah. So like, same like I, I've like had my jaw on the floor with some of the things that parents have told me they've said to pediatricians and have been dismissed. And I'm like, hold on, hold on, I gotta write this one down. I'm like, I just gotta write this one down because I need to go have a conversation with somebody. Like, this is not okay. You know, it's like the things that you hear, I mean, and just, it's sad to say it doesn't surprise me anymore, but it nevertheless, it breaks my heart like more and more every single time. And then what really grinds my gears since we've gone here is, you know, the providers, the professionals, especially like in the SLP world or in similar, you know, therapy spaces that have entire social media accounts dedicated to, quote, unquote, educating other providers and parents.

Yeah.

And they're like, oh, no, this is not evidence based practice. And the research doesn't support this. And this is that. And this is, I'm going, okay, there is evidence and there, you know, we don't have to go into this whole conversation, but it's very dangerous because one, it's unethical, two, we're spreading misinformation and that is dangerous. It's actually like you can be sued for that. And you know, and then they put the disclaimer like, this is not medical advice. I'm like, oh, great, so you have just now spread all this misinformation, but you're going to put your little disclaimer so someone can't sue you, you know, and then there's a bunch of providers behind the scenes, like pulling their hair out because it's like, well, this person's account says this Right. Hi, it's me. And then, you know, and then they go and speak for big national organizations and things, and we'll just end there.

But similar things happen in the Pete's PT world where it's like, there's this really big fight, like, of quantity versus quality of movement. So, like, for that kiddo that's delayed and this and that, like, you know, some PTs are like, get them in orthotics, get them in a gait trainer. Like, get them moving. And it's like, yeah, we can appreciate that weight bearing is important after one. We can appreciate that structure is a big deal with orthotics. But I'm like, but wait a minute. Like, quality still matters. Like, it. I'm pretty sure the majority of the colleagues of, like, pediatric pts would think I'm not nuts by, like, what I see, what I treat. Like, it's not an issue because we're all trained other under ama, not down to them. And we're all trained to react and not to be proactive. So there's this battle in the pediatric PT world of quality. Like, it doesn't matter. Just get the kid walking. And it's like, but it does matter. It actually really does. The quality does matter. So, yeah, there's like some kids that.

You see from the clinic who are like, oh, yeah, I started walking and they discharged. And then we get them and we're like, like, what?

They started walking at 24 months. And I'm like, I'm so happy they're walking. That's wonderful.

It's like, okay, hold on.

And then the parents again are educated on like, do you want to take a break? Your child's walking. Here's some home program. No, it's like, you're walking. The parent thinks that they'll just magically be fine or that they're caught up to typical milestones. And then I get them at like 30 milestones, months, and they can't even go up and down stairs. And I'm like, but wait, like, what happened when you got discharged with walking? And they were like, oh, they said he was fine. And I'm like, they're not fine if they're walking a year late. It's not fine.

That's a whole other.

Yeah, that's a whole other problem.

But yeah, so the quantity versus quality is huge. And same thing, the. The quantity people are the loud ones at the conferences. They're the ones that are like, like, this is evidence based. Because there's really only evidence to practicing the task to make sure that, like, the motor milestone is achieved. And I'm like, how can that. It just doesn't.

Like, at what expense to the child? And what else are we not working on? You know, it's like, it just completely dismisses, Dismisses root cause medicine. And I, I do love that, like, there are people in this space, like, especially with tongue tied, you know, infants and everything that are working on, on research and publishing things and, you know, trying to really beef this up a little bit so that we can hopefully silence some of that. But, you know, that's where I think it also makes it so much harder for parents because they're like, I'm seeing this split camp even on social media, which is where everybody hangs out all day. And especially, like when these moms are breastfeeding their babies and they're on Instagram, right? And they got their phone up and they're scrolling like, that was me. I, you know, no shame.

I'm like, what else can I learn?

I know, I'm like, oh, my gosh, it's 1aM I got to go to bed.

You know, that's.

That's life. It's like, we're all doing it, but that's why it's so dangerous and why there is, you know, and then a lot of these organizations and even licensure bodies are like, oh, we don't monitor social media. I'm like, what? Like, somebody's deliberately spreading misinformation and causing harm. That's not an issue, like, surrounding, like, there's no licensure issue here. No.

Okay, cool.

And I think that they are starting to change that a little bit with a cow, like, you know, predominant of a media. Yeah, media, you know, Instagram, like, well, Instagram, all the, all the social media channels are now. But still, it's like, that's where I say to parents, look, like, walk in here, forget everything you think you know. And like, let's just like work with your child and see what happens and see like, what your. What your child tells us. And like, you tell me what you're like. You guys, what you said, what are you feeling okay? Do you feel that, like, how's your child responding? Like, what's going on here? Because, because at the end of the day, I'm like, the best provider, in my opinion, is the one that's going to listen to the family and is not going to go, oh, but this paper said. I'm sorry, I don't care what the paper said.

We had to do it five times and you have to Take this and.

Yeah, right.

Well, and I think that's also part of like, you know, in a lot of therapeutic models, it's like, okay, step one, step two, step three, do this, this. Like you said, it's quantity, you know, quantity too. Like, okay, now in step one, we do this 10 times, and step two, we do this, this 15 times. And step three, this happens. And so when we have students come in and they're like, well, what do we do first? I'm like, well, what does the patient look like? Yeah, I'm like, what do you mean, what do we do first? Like, we have to eval the patient to figure out. Like, let's, let me teach you how to do an eval so we can see what we do first. And you know, and that might even not even be what we do first.

Right.

And so like, of course there's generalities where it's like, okay, we need to have jaw stability. And that's kind of a basis for a lot of everything else going on on the orofacial complex. However, like, like what we do first is not like a step one, step two, step three. And I think that's also what makes it complex for like therapists and well, especially new grads.

It's. I was shocked with within pediatrics how much observation and hands off time there is. Whether it's in an eval or a regular session, you gotta look at that baby's active movement before you get your hands on them. And there's so much more observation than I ever thought I would do. Like, eyes have to be so quick to see it because that baby's probably not going to do it again.

My parents go like, are you gonna go? And like, I've had parents say to me, like, okay, are we gonna go.

In their mouth now?

Because it's like 40 minutes of the eval has passed and like, we've been chatting. But like, I'm also like, like you said earlier, like, let's, let's. I see some things that they probably didn't think to report. Like, let's talk about that or. Yeah, okay. They checked this box. If they wrote this on the, the intake. I want to, I want to like dive in open ended to let them elaborate because I think this has got some really good helpful information right here, you know, and so it's very conversational based. And at the same time, while we're, we're talking, we're doing the same thing. We're observing the baby. Is that is the mind I like to see in the Beginning too. Like, does the parent leave the baby in a carrier wearing them? Like, what does that look? I mean, I'm not a pt, but I feel like this is helpful information, you know, and that positioning that they're in a lot. And parents will say, is it okay if I take the baby out? I don't like to leave them in the carrier. I'm like, yes, please do. Like, please take them out of their car seat. I would love for you to like hold them, wear them down on the floor, whatever you want to do, whatever they're happy with. But yeah, it's, you know, thank you guys so much for sharing this because I think it's just, it's a very fear based approach, I think to feel like, okay, I gotta know, like this hierarchy and I got to get in the mouth and we got to do all these things and I have to make progress every session after that. And, you know, it's like all these things that I think we're conditioned maybe like through our graduate or, you know, doctoral programs, like we're kind of conditioned to approach therapy that way. And it's like we have to break that conditioning in ourselves in order to actually like work with these patients.

Yeah. And it starts in the academia programs. You know, like having been in academia, they teach to the board exams.

Yeah, yeah.

So there's not much space or time to go through that, you know, and unless they have a really good clinical instructor out in the field, really pounding that doing this.

Yeah.

You know, know, it just doesn't get taught to these, these students, these new grads, you know.

So I think to piggyback on that though too, as a new grad and kind of what you were saying, you know, there's these people on social media that are saying, you know, all the, all these things. Now as a therapist in the last, you know, however many years when I've felt like, okay, I got this, I can do this. How? You know, I know a lot of things, taken a lot of courses, but I still have aha moments where it's nothing I learned in a course. I just trial and errored something by myself. And guess what? It works.

Yeah.

Clinical experience. Yeah, that's. So I wanted to say, you know, that yes, clinical. That it's huge clinical experience is a huge piece of it.

And that is part of evidence based practice for those who are not familiar with like, what it is. Evidence based practice is more than just just research. It's also that clinical experience and it's also the patient like that, that especially in this case, the caregiver and the infant, like, their goals and what they want to work on is just. That's also part of that whole.

Right.

Approach. Yeah.

Yeah. So I just wanted to speak to that. That, you know, sometimes there's these aha moments where you're like, I put this and this together, and, oh, my gosh, look what this kid just did. Like, I haven't done that before. And I'm learning every day. I, you know, I'm. I make mistakes, you know, and I learned from my mistakes still. Always will.

That's the great thing about our professions, that we're learning every day, you know, or, like, I'll learn at the same time as the parent, what kind of look each other.

What.

Like, one day I was doing some, you know, body work, and I was like, this is how your baby was inside of you, you know, and, like, all twisted up and like that. And she's like, well, it's funny you say that, because when he nurses, he really tries to get into the. This position. I'm like, that's his position of ease. It doesn't surprise me that your baby's really smart and getting into the position that makes him feel nice and homey and gooey, when he tries to feed so that everything else is relaxed and he can just work on his mouth. And she's like, oh. And I was like, oh.

I love it. I mean, and that's again, like, I also talk about, like, we are lifelong learners. Like, none of us know everything. Like, my. I've said since in the beginning, like, I want anybody who comes through, like, therapy with us or, you know, one of my programs online, you know, one of my courses, certifications, whatever. I'm like, I want you to know more than me when you leave. I want you to feel like you have, like, surpassed me. Like. Like, I'm not doing my job. If I haven't elevated you, if I haven't helped, like, you kind of get to the next level for yourself to then continue on your journey. And, like, whether that's with me or somebody else, like, that's, you know, that that's what we should all be doing. And that was like, this whole elevation, movement thing that I created, you know, kind of by accident 3 1/2 years ago, I guess it was where it was like, I'm just so tired. I was tired of the gatekeeping in, like, this space. I was tired of. I'm like, we're only hurting patients if we're not willing to help each other. And so, like, what's the. What's the point? And I was also tired of going to classes and leaving and being like, okay, I have ideas of, like, what to do next with, like, three kids on my caseload, but I don't know what to do after that. And I don't know to do with, like, the other 17 kids on my case. I was like, okay, what is happening? And so I just was like, all right, I'm done. I'm done. Some, like, no, more, like, we need to have something that speaks to, like, what. What I wish I had as a new grad so that I could. Or even, like, later in my career just so that, like, there's a jumping off point. There's something that makes me start to think critically. Like, I was like, I feel like I'm leaving these courses and I'm just like, I don't. I don't know. Like, I don't know what to do next. And it was more through, like, my clinical experience and talking with other colleagues who kind of helped me bounce ideas back and forth, that I kind of started to go like, okay, yeah, let's try this with this kid. And, like, I don't care if there's an article that supports that or not, because it's what works for this child. And that, in my opinion, is the best. Therapists can think critically.

Yes.

And work with the child and kind of feel what's going on. And that takes experience, too. So I always tell, like, our new grads. I'm like, like, breathe. It's going to take time. Yeah, going to take time. And, like, you're going to feel like, you're probably going to feel really uncomfortable in the beginning because you're going to be like, I don't know what this feels like. But the more you get your hands on, like, more faces and bodies and everything, the more you'll start to understand. So, like, just give yourself time. And there's no magic number. Some people after five babies are gonna be like, okay, I'm starting to feel it. And some people after, like, 25 babies are like, okay, I'm starting to feel it. So. And I'm very hands on. So, like, for me, it's like a pretty quick, like, I feel one versus the other. And I'm like, oh, all right. That one felt different than that one. I'm not sure what's going on yet, but they're not the same. Okay, let's figure this out. So that's where I try to, like, just give everyone a little, like, glimmer of Hope, especially like therapists that, like, so badly want to be in this space to, you know, being kind to yourself, be patient with yourself and, like, let yourself just work with the little ones that are in front of you and try to tap into, like, everything.

Patients are our best teachers, you know.

Yeah, yeah.

And it's okay to not have the answers. It's okay to say, I don't know.

Yeah. And you can say, you know, I.

Will find someone that knows and get back to you, or I will do some research and get back to you. As a new grad, I always felt like I had to have the answers. And what if this parent asked me this question in an email and I don't know, I'm gonna look so bad and you know, no, you will never know everything. So if you don't know, you don't know. And a parent feels much better hearing you say that than coming up with some fluff because you feel like you have to say something. Say something, fill the space. But it does take time and it does, you know, it can leave you feeling uneasy. But yeah, saying no is okay. Like, you're.

And you're human. You're human. It's like, stay in integrity with yourself. Don't make something up if you don't know it. And like you said, the parent is going to be so much more appreciative. You're like, you know, hey, I don't know, but let me, let me connect with a colleague and I'll get back to you. I think a parent's going to be like, oh, my gosh, you're actually going to, like, go talk to somebody else to try and get me an answer versus, like, just, you know, they may believe what you tell them, whether it's true or not, unfortunately. But, you know, that's where I just go back to, like, just tap into, like, what you're feeling in the moment, who's in front of you, like, and you. Nobody knows everything. I don't know everything. I know you guys don't know everything. I know the educators that are like 30 plus years older than us, that teach in the space don't know everything. And, you know, I think that these are things that are not, like, being human is not discussed ever. So, yeah, just remember, it's okay to be human. And one of the things too that, like, in the beginning when I was working with infants, I was straightforward with my patients because I was like, they're private paying. I want them to know that, like, I really used to working with toddlers, but I have recently done a lot of education in the space. I'm collaborating with a lot of colleagues, we're doing some co treat type of things, you know, but at the same time, like, I'm new to working with infants and so I always tell parents straight up like I'm a feeding therapist, but my, my expertise really has been 12 months plus. I'm newer to working with infants and I'm here for you and I'm. We're going to work through this together. But I just want you to know that. And you know, and I think when you kind of lay it out on the table and you're honest, you know, even being like, I'm a new grad, but I'm here and I want to help you, I want to help you and your child do this. Like, let's work together. I think that goes so much further than being like, you know, trying to hide that, this, that you're new to the space because they're going to, to sense that something is off with your energy. And I know this goes like a little too woo for some people, but like energetically people are going to sense like the nervous systems talk, you know, to each other. They're going to sense that just like a parent and infant, you know, their nervous systems talk to more than that too. Yeah, everyone senses it and nothing goes well when we're all kind of like, you know, hiding behind masks. So it's like let's, you know, let's really like kind of take the mask off. Like just be real, be human. And I think parents again are, are so appreciative that, you know, once in a while you'll get a parent who's like, no, you know what, I want someone who has like 10 years that's not the right patient for you anyways.

Yeah, yeah.

So they're gonna probably drive you like, so. Which is fine, let them go somewhere else, you know, but it's like. Yeah, I just, I, I love the humanizing part of the whole process because that unfortunately, I think is the biggest piece that's missing in today's current medical model. Insurance based medical model, I should say.

Yes.

So. Yeah. So is there anything else that like, we haven't discussed that you guys wanted to ad?

I don't think so.

All right, well then tell us where they can find you.

Well, we both are somewhat active on our Instagrams. Not a ton.

I'm not so much. Yeah.

Have good content on there.

Content on there. So mine is moving munchkins on Instagram.

And mine is food is fun. Let's eat on Instagram. And we both work out of Love Strong Wellness, which is a center in in North County San Diego. We also both work out of Little Star Breathe, which is a pediatric dental office with Dr. Hanenbosch in Carmel Valley, San Diego. So yeah, awesome.

Well, we'll also make sure that we have that linked below the episode so they know how to reach you if they they want, if they live out there. Because I think everybody who does should probably come see you guys. Thank you so much for joining me today to so was so much fun. I know we could just talk for hours and hours.

It was fun. Thank you so much for having us.

Yeah, I appreciate being here talking and we'll we'll talk again, I'm sure.

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