Katie The Traveling Lactation Consultant
Katie The Traveling Lactation Consultant
Ep 24 Dr Saleha Mahmud-Ritter of Tongue Tie Center of Baltimore
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Dr Saleha Mahmud-Ritter started Tongue Tie Center of Baltimore is a was a General Dentist before becoming a parent. Having her first son she learned all about lactation and tongue ties from the support of her IBCLC. This led Dr Saleha to "quit" general dentistry, and truly jump into all things Tongue tie.
In this episode, Dr Saleha and Katie discuss their families tongue tie journeys, hospital lactation care, Baby-Friendly certifications and how it all comes together.
Podcast host: Katie Oshita, RN, BSN, IBCLC has over 22 years of experience working in Maternal-Infant Medicine. Katie is a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs. Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially tongue tie and gut/allergy related issues. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com
Disclaimer. This content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a loved one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Osta, BSN, RN, IBCLC, and infant feeding specialist. Quench your thirst for knowledge and travel with me across the nation to discover, learn, collaborate, and better serve clients from all over the globe. Let's ride and thrive together. Today on the podcast, we have Dr. Salia Mahmoud Ritter of Moncton, Maryland, who's the owner of Tung Tai Center of Baltimore, a branch of Smile Solutions of Baltimore, where her husband, Dr. Jesse Ritter, practices rehabilitative and airway dentistry. Dr. Salia Ritter is a graduate of the University of Maryland School of Dentistry in 2011 and completed her general practice residency at Sacred Heart Hospital in Allentown, Pennsylvania the following year. After having her first child, Ryan, in 2015, Dr. Salia was exposed to the world of breastfeeding and how TOTS can have a major impact on the success or challenges of nursing. As a first-time mom, she was thrust into the whirlwind of doubt and fear, unsure of how to navigate through all the unknown affairs as it relates to motherhood and breastfeeding. It was during this time that she was first introduced to a lactation consultant who not only diagnosed her son's tenth, but was also a beacon of support during Ryan's first few months of infancy. This experience is what motivated Dr. Ritter to shift her perspective not only on healthcare, but on her career as a general dentist. She and her husband decided to learn more about tots and began treating infants shortly after the birth of their daughter in 2017. Following the birth of her third child in June of 2021, Dr. Sallya Ritter decided to quit general dentistry altogether and pursue her passion of educating families and colleagues about tots, focusing all of her energy on treating tots only. She has been able to dedicate much of her time to enhancing her skills and knowledge in this unique field. So welcome Dr. Salia to the podcast.
SPEAKER_01Cool. I think this is amazing that you do this. So thank you.
SPEAKER_00It's been a lot of fun.
SPEAKER_01So yeah, I bet.
SPEAKER_00Gosh. Thank you for joining me on the podcast this morning. Sally, it's really great to see you again. I loved your office in Baltimore a couple of weeks ago. I was there with you, and it was just such a lovely office and such a great day.
SPEAKER_01Well, thanks so much for coming. I loved having you there. I learned so much from you. So yeah, thanks again for coming out.
SPEAKER_00Yeah, it was awesome. I mean, I just I love seeing different release providers and everybody else working with these tenpe babies and learning from each other and seeing how differently we all see things. You know, I think it gives me a lot of perspective because I look through that lactation lens and then it's like I get a brief glimpse of what it's like through, you know, a release provider lens or through a body worker lens. And it just it helps kind of fill in the picture.
SPEAKER_01Right, right. I think, well, I can say the same thing. I don't know if you could tell, but I was completely engrossed in your exam and how you were talking to the mom and evaluating the babies. I just learned so much. And I know you were there supposed to observe me at work, but I was really spending a lot of time observing you. And trust me, I've taken so much from you from just that one day that you were there.
SPEAKER_00Oh, thank you. I mean, I loved it. I mean, that is, I know you've heard me say this before, but that's my dream. And hey, Maryland's still on the list, it could happen, but my dream is to have that wonderful space where we all work together for families. And it, I think not only will we learn so much from each other and elevate each other's practices, but it offers such continuity for families.
SPEAKER_01Well, let me know. You know, if you if you decide to move, if you decide to move to Maryland, I would love it if you reach out to me and you say, Hey, you know, I'm I'm gonna move there. Let's do this and I'll be there, I'll do it with you. So just let me know.
SPEAKER_00I mean, I think it's such a great setup for families because one of the things that I experienced this last year was finally dealing with my daughter's tongue ties. I didn't realize they had them as babies. Nobody explained why I had lipstick-shaped bleeding nipples, or a baby that, you know, constantly was fussy and needed to be held, or why my second one spit up for nine months of her life and yet was super chubby. Like she was that we call them fat, farty, fussy babies. She was super chunky, but I swear, spit up so much that I was always asking the pediatrician, I'm like, Are you sure nothing's wrong? And she's like, Oh yeah, baby spit up. And I'm like, but this much? Like this much? Right. Like, I couldn't walk four feet in my house without grabbing a burp cloth. And half the time you'd stick your hand in it and find that it was already used. And it would be like, oh, like were they trying to put her on medication? No, I wasn't comfortable with meds. And she was she was qualified as that happy spitter, right? Because she didn't seem to be in pain, which now I know was just aorphasia. But so nobody explained to me what was going on. And my first one had a very obvious Eiffel Tower tongue tie, like those are fairly obvious. My second one had a very deep posterior, but you know, nobody explained anything. And it wasn't until gosh, now at this point, maybe a year and a half. Yeah, probably about a year and a half ago, that we realized that the girls were tongue tied. And then we were traveling and trying to figure out what to do. And even with all of my knowledge about tongue tie, mine's fairly baby focused. And so, you know, meeting with their release provider, Maggie Davis in Tampa or with the orthodontist, that was because my youngest had to start airway expansion or palate expansion for her airway. And that was so overwhelming. I mean, I have pretty decent understanding of this stuff. And it was just like I sat there feeling like a deer in the headlights after we had like an hour and a half consult with the orthodontist.
SPEAKER_01What exactly kind of caught you on to the fact that she has has a tongue tie for both of your daughters? So was there an obvious red flag or were there a little sign here and there? Like what led you to look into this?
SPEAKER_00Yeah, that's a great question. Honestly, it was much more subtle. It was not a huge red flag. I remember it. My second, who's 10 now at five and six, started having things like TMJ and bruxism. That age. And sometimes she would get halatosis too. And she was the TMJ was hard because there'd be times where she only likes raw carrots. And so that was what was going in her lunchbox. And there'd be days that she couldn't eat it, or she couldn't eat a big sandwich, or it hurt to bite an apple. And there were subtle occasional things. The minute they got to be like, wow, it feels like this is all the time, then it would kind of go away. And it would be like, oh, well, maybe it's fine. You know how kids kind of wax and wane. And I'd ask the pediatricians and the dentists, and everybody said, No, our teeth are coming in great. Everything looks fine. There's nothing wrong. It's normal for kids to grind their teeth at night. It's normal for them to have TMJ. And I'm like, but is it really? Because it seems painful. Like it doesn't seem normal that her jaw pops. Like you could hear it pop audibly. And then it got to the point, you know, they weren't sleeping well either of my kiddos. And I was kind of diving into more of the lactation tongue tie stuff. And I started hearing people say, oh yeah, when they're older, this happens. And oh yeah, when they're older. And then I started going down that rabbit hole of like, well, tell me what it looks like when they're older. What does it mean? And so I started learning about it just as a way to help my clients because it's very common that I'll say, you know, to a client, this your baby's tongue looks very restricted to me. This is the movement, this is why, and this is what it would mean. And then they say to me, Well, does that, do you think I have a tongue tight? What about my five-year-old? You know, do you think they have a tongue tight? Because we talk about how it's genetic. And so I thought it would give me more understanding for them, right? And then I just started seeing all of my my 10-year-old has way more symptoms than my 13-year-old did. Okay. She's way more symptoms. It was a definitely a much more problematic tongue tie for her. But I think that it's because she has environmental allergies. So she's exceptionally like off the charts allergic to dust mites. We even tried allergy shots for a while and they were, they were so bad that she went into anaphylaxis with them and we stopped.
SPEAKER_02Um yeah.
SPEAKER_00So she's, I mean, like very allergic to dust mites. And those are one of those that you can just never get rid of, right? I mean, we have everything zippered and everything washed, but those darn stuffed animals. I'm like, I'm not mom that's like, you can't have another stuffed animal. You're only allowed five on your bed.
SPEAKER_01And that's not something you expect to deal with as a parent, you know, that you have to restrict the number of stuffed animals your kids can have because of the dust mates.
SPEAKER_00I know. I'm like, I feel like such a meanie sometimes, but I'm like, honey, these like then they need to go in the wash again or something because yeah, the dust mates are a problem for her. And I think what happened was over those years, from like five to ten, what we had was a lot of environmental allergies that narrowed her airway, her narries. And as it did that, she compensated by mouth breathing. And the more she mouth breathed, the higher her palate went because she breastfed until two and three months. She had a beautiful palate at two, right? Very, very years or two and three months? Two and two years and three months. Two years and three months. Okay, I'm sorry. So she had a long time of breastfeeding and a very nice shaped palate, and her teeth were coming in beautifully. And then I really feel like around five was when I started noticing things. So between five and 10, she definitely started, you know, having a lot more symptoms. And somewhere in there, that palette just went higher and higher. And we got to that point where it all kind of happened in February, too, because I had mentioned to Maggie Davis when I was coming to spend the day with her that my girls could use a cleaning. And she said, sure, bring them in. And she was the one who pulled me aside and said, you know, she's got a really high palate. And she said, we have a really great orthodontist here in the office. He's next door. She's like, I really think you should talk to Dr. Alex that her airway is very small. And she's like, the tongue is the issue, but that airway is is gonna be a big issue. And I just didn't know all about airway expansion and how it can be done as an adult, but it's so much harder, right? So I didn't want to set her up for that. I wanted to expand this airway while we could. She was in a growth phase, and so the orthodontist was like, let's go for it. And so we did everything. I mean, that first visit was like February 10th, and the appliance got put on in March, and their tongues got released in April, and we started doing myofunctional therapy in February, and we're still doing it now. You know, they do their exercises three days a week, and then we meet with the myofunctional therapist. We did body work. And what's interesting to me is how different they are. So my 13-year-old had totally different symptoms. She was getting headaches and neck pain, and she had tortocolis as a baby. And you can still like when I take her to the chiropractor, because we went regularly. We had a great chiropractor in California. We went regularly, like twice a week for two years. And she said she could always still feel Emily's tortois in there where it was tighter on one side. And the release I know the release helped a lot. Like she'll say her neck is still a little tight, and she spends a lot of time. We bought her these. Um, we have a little cranium pillow and this little peanut ball, it's called for her to work on stretching her neck. She's one of those kids that really needs to get her neck off of her chest, basically, her chin off her chest. You know, it's what when I do it with babies, it's what I'll call guppy for the parents. And I'll be like, we want to lay the baby down and get them to stretch their head back, right? Because they spend so much time curved in. You know, sometimes the babies will even have thumbs in, fists closed, arms bent, legs bent, completely curved in. So we need to get them in the opposite position, completely open and exposed, right?
SPEAKER_01Yeah, I loved, I loved when you were you were demonstrating that to some of the families that were in the office because it just made so much sense. When you showed it like that, it was it was amazing. And um, it's interesting to hear that you're kind of doing the same things with your daughter, you know, with your 13-year-old. Yeah. That's very interesting that, you know, she also kind of has that tightness too, that maybe related to the torticolus she had when she was younger.
SPEAKER_00Yeah. And I think honestly, that the guppy stretch or the, you know, however you want to think about like that, it is probably one of the most useful ones because a lot of us as adults spend our time curved in our shoulders curving, we're at the computer or at a small workspace, our arms are tucked in, our chin is down. We're very much curving people. Like we need to like sit up, we need to stretch those shoulders back, we need to pull that neck back. And so that's a really good, like I got the peanut ball for her to do it, but my other one and I are doing it too because I'm like, I feel curved from being at the computer. Like it just happens, you know, and we're naturally kind of curve in. And so it's a really cell phones. Yes, right. Everything, reading a book. I mean, anything, we tend to like just bring it in. And so I find that's a really useful one. But with the parents in the office, I'd say that's my number one most useful one because I might not have the time, especially in like a day with you. I didn't have the time to do a lactation console and you know, to give them three exercises and see them again the next week and do three more or change it up. I tend to stop at three because new parents have a lot going on. But I figure this is the one I can give them one thing to do today that's gonna be the most useful thing. It's that, because it's gonna do a few things. One, it's gonna help get that chin off that chest and it's gonna help open up for baby, right? It's gonna help stretch and give room, but it's gonna make a huge impact for feeding too, because really a biological nursing position, right? That laid back position, it's also it's called biological nursing sometimes. In that position, baby is laying lengthwise on mom's stomach, coming up to the breast with its hands on either side of the breast and extending that chin first, right? So baby should come in that stretched out position.
SPEAKER_01Is that the koala? Did you call that the koala bear?
SPEAKER_00So the koala is basically laid back, but sitting up. So if you sit up and put the baby on you, that's koala. If you lean back, it's laid back. Baby is essentially in the same position, right? They're straight on your body, hands up at the breast. And then I like to plant the feet too, because they really need their feet planted for safety and for arching. And and as it's a neurological thing too to help baby kind of feel safe and relaxed.
SPEAKER_01Right.
SPEAKER_00So yeah, I it makes the guppy makes a huge difference in feeding because I mean, if you try, think about this like tip your chin to your chest and try to take a big bite of a sandwich. Like you can't, you're gonna get the tiny bit of like bread and no sandwich, right? Yeah, I just tried that all right. And it's actually it's really uncomfortable too. If you try, I've had parents do it where I'm like tuck your chin in and then try to drink through a straw. It's actually kind of uncomfortable to swallow that way. Like it just doesn't feel very good. Now, it doesn't feel good either if I tip my head all the way back like I'm a you know, a pez head or something. That doesn't work either. But there is a nice neutral or a slight, I'll call it a slight sniffing position where I'm just up slightly. Either of those are perfect, you know, but even a neutral, you just need your chin to come out straight and not be tucked down. And it makes such a difference on that latch. Babies are born knowing what to do. Mommies are not, but babies are. So I think it's also really important for us to come to it with that idea that when a baby cannot nurse, whether the mom wants to or whether that's their priority or not, I'm not talking about that. I'm talking about babies biologically should be able to nurse, right? That's how we're born, that's survival. When they cannot, that is a problem. Right, right.
SPEAKER_01No, I mean, it's it's so fascinating. And it's funny, you know, you hear the I don't know where I saw this message, but basically, breastfeeding is natural, but so are the way plants grow and you know, the way we tend to our garden. I mean, the the plants will grow the veggies, the fruits, but we have to tend to them and we have to work on it. And same with breastfeeding, you know, it is natural, but it takes some effort. And that's why for every every one of my patients that come to see me, I try to explain to them, you know, this is a natural experience, but it's new. And definitely see a lactation consultant. If you don't have one, please see one because there are so many things as a mom that we're not aware of, right? Like you said, babies, they inherently know what to do, but as a parent, it's new, especially with your first child.
SPEAKER_00Yeah, well, and you have two now. Something I've discovered having a second was it's all new again. Like there's a little bit, but I feel like each child is so different that there's times that to me it's like, you know, yeah, it's not 100% new, but it's still like 80%. Like she's a totally different person.
SPEAKER_01Right. Yeah, and I have three, and I feel like each each one of them were so different. And of course, I was more comfortable and more aware of how they were feeding and whether or not there was tongue tie, or you know, if they have tension throughout their bodies. So, you know, yeah, there were a lot of familiar aspects, but each child kind of had their own challenge. So the stressors were there in different ways, a little bit less as I had the third child because I knew exactly who to go to. Right, right.
SPEAKER_00I feel like some of the differences is more us than them. Like we're just more relaxed and prepared parents.
SPEAKER_01Exactly. Like I didn't even think about, I went to a breastfeeding class uh right before I had my first trial, Ryan. And I thought, oh yeah, I mean, easy. Okay, it's it's not rocket science. And I gotta tell you, it was that was one of the hardest moments in my life because I felt like a failure right off the bat with my son because it wasn't natural for me to breastfeed him. I did not know what I was doing, and it was really my lactation consultant, Dee Dee, that really helped me out. And honestly, she was the one who exposed me to the world of tongue ties. Like, I didn't even think about whether or not my son had a tongue tie, and I'm a dentist. I think I had maybe one lecture on tongue ties in dental school, maybe two, and I learned way more about like Stephen Johnson syndrome or how to grade a tumor or just all these other things.
SPEAKER_00So rare, so rare, right?
SPEAKER_01Yes, and so she was the one she she saw me, she you know, wiped away my tears, she gave me a hug, and then she's like, let's figure this out. And she was a godsend. I feel like lactation consultants, like I I feel like they're they're like guardian angels. Like we should every single mom, and I try to tell any of my friends that are expecting or patients before your baby's even here. If you want to breastfeed, look into getting a lactation consultant because it is a world of a difference when you have one that you can trust and help you navigate, even if it's not your first child. Yeah. Um, because like you said, every child is different.
SPEAKER_00Absolutely. And I'm so glad that you had that support with your with your son that that made such a difference for you and that she could be there to support you. It is, you know, when people ask me, when should when should you look and find a lactation consultant? My answer is always before you need it. Like look when you're pregnant. I mean, it's the most wonderful time because for so many reasons, for one thing, you're not stressed out, right? You're not sleep deprived, you're not in pain, you don't have a screaming baby, your nipples aren't bleeding, like you're relaxed. You're right, you know, sometimes not working anymore, sometimes still working, but you're feeling pretty good. I mean, kind of, you know, big, but not terrible. And it definitely excited for the baby and at a perfect time to learn, right? And to prepare for baby. And honestly, I mean, that alone is enough. But to me, the other thing that happens is people with the best laid plan of like, hey, I'm gonna breastfeed. This is what I'm gonna do. I'm gonna do it for a year, and then they go in the hospital, and before you know it, they're like, oh, baby's lost 8%. So we're just gonna go take them off to the nursery and give them a bottle of formula and we'll bring them right back. And does that still happen? Oh, yeah. Yeah, and oh yeah, I had a client recently that baby had high bilirubin and they wanted to give formula, and mom was pumping and had more than enough milk coming in. And she's like, No, I want to give my milk and I want to breastfeed. And the pediatrician was like, Well, no, it's medically indicated formula, and it took fighting by bringing in the American um breastfeeding medicine has protocols, and those are our like guiding body, and so we will use those. And I give that to the client and say, here, present this and show them that at least number, we're barely doing lights. It's not like we're talking about a super sick baby that can't eat. He can come out to eat for 30 minutes every three hours, and he can be breastfed, and then he can be stopped. Supplemented with pumped milk back under the lights. Like there are ways to preserve breastfeeding, right? But it's not always presented that way to people. And if they don't know to question, you know, if the doctor's saying, well, this is medically necessary, you're gonna say, okay, then I guess we really need it. It was extra frustrating to me because I'm like, we're in a formula shortage. So don't undermine mom's good milk supply that she has on day three by putting in formula right now when you don't even know if she's gonna be able to get that in two weeks at home.
SPEAKER_01Right. Oh, yeah. I mean, that is something you do have to think about these days. Yeah. With the with the shortage, unfortunately, because before it was something that you could kind of lean back on, you know, like, hey, if this doesn't work out, I have this other option. And now with this shortage, it's unfortunately something that a lot of moms, I mean, it's it's not like a sure thing whether or not they have that plan B in place.
SPEAKER_00Oh no, it's become a huge stress. I mean, I have I've had people send me messages and say, have you been able to find this formula in your area? Can you look for this one and send pictures and then I'll tell them about, you know, I found it at this store or this one. But it's it's stressful and it's a necessary stress. And especially if you are pushing that when the parent is pushing breastfeeding, right? That's why I love the prenatal visits because so much can go wrong in that first two days of life.
SPEAKER_01And that and you you're there, so you've seen it. You've seen the different, you've seen a wide spectrum of what can happen.
SPEAKER_00And it gets undermined so easily, and they don't even sometimes know they're doing it, right? I had my girls at the hospital where I worked, and I cannot tell you how many times each night people came in. The nurses were like, let's take her to the nursery. We'll just swallow her and take her, and she'll sleep good for you when she can come back, you know, in three or four hours. And I was like, no, she's sleeping fine on me. We were skin to skin. And they just, I mean, especially with my second. And I was like, no, you don't understand. These are my four days I get with this kiddo alone. That was it. And like, I want every moment of it. And they just wanted to take her to the nursery constantly. Oh, your visitors are here to see you. Let's take the baby to and I'm like, no. I mean, it was just constant. And this was, you know, a really good hospital. Uh, they were not trying to undermine my breastfeeding experience. They were not. They just don't know. And that's the problem, is that they just don't always realize that their actions can have huge consequences. And when that baby goes off to nursery and then somebody gives it a pacifier and now it sleeps for four hours and then it doesn't eat. And then the nurse says, Oh, well, the blood sugar looks, you know, maybe it looks a little jittery. Let's check its blood sugar. And then now it needs medical formula. It's like, well, what if we had left the baby in the room and not given it a pacifier? Would it have woken up earlier? What if we do skin to skin burst? You know, there's so many other options. And it's not to say that formula isn't indicated or a choice for some parents, but there's a lot of there is a lot of unintentional sabotage that happens in every hospital.
SPEAKER_01Right. I wonder, I mean, are the so I know there is the baby friendly hospital initiative uh that's out there. And so I believe that my children, all three of them are born at a baby friendly hospital. And so they didn't really even have a nursery there for them. But I wonder if that's if there is a push to get it, get things going that route where there aren't uh nurseries anymore in the hospitals, or are there still a lot of hospitals that do have nurseries? That's a great point because when your baby's in the nursery, you know, it's they're not like right there for you to just pop them on, you know, because you have more of that skin to skin, more opportunity to build that connection.
SPEAKER_00But yeah, what were you saying? I mean, I tell parents it's you know, keeping that baby skin to skin, they're gonna snack more. It's kind of like, you know, me hanging out in the kitchen when someone's baking chocolate chip cookies. I'm gonna nibble a few more than I would if I was in a different room and I didn't smell them. So, you know, keeping that baby close those first few weeks definitely helps the milk supply come in. You know, as far as the baby friendly hospital initiative, it is a very good thing, but it's not, it's kind of like I almost think of it like organic certifications for farms. It's really expensive to get the baby friendly, actually. Um, I don't know that. Yeah. So it's the way that it's expensive is in the training that it requires for all of the staff. And it can be done really well. I worked at Evergreen in Kirkland in Washington, and it was the first baby-friendly hospital in the country. It was done very well. They had, I want to say maybe 30, 34 lactation consultants for about 400, 450 births a month. So pretty high rate. I mean, they had an outpatient clinic, inpatient. We had 20, about 28 hours of lactation coverage with the overlapping and stuff. We only had from like 2 to 8 a.m. that wasn't covered. So it was done very well, but you have to train everyone, even like your OBTECs who will come around, take the vitals, right? Deliver pads and ice packs and all of that. They have to be trained on pumps to help, they have to understand how to set up a pump and help a mom with the pump. They have to have enough education to understand, you know, we're not offering pacifiers and formulas, encourage the parents if the baby's fussy, to, you know, try skin to skin. So they have to have some education. And so it's not the same education that you give all the RNs on the floor, but even the pediatricians have to take some classes. Like it's it's more education focused, which is a really good thing. But the other expense is that you can no longer accept free formula. Oh, and so there are hospitals. I worked at another one, I worked at Providence in Everett, Washington as well. And their clientele was very different than Evergreens. Their clientele in Providence tended to be lower income, a lot of state insurance, and not the best reimbursement. And so, you know, their manager said we can't afford baby friendly. We can do all the tenants that we can try to do, but they could not afford to pay for the formula instead of accepting it free.
SPEAKER_01Okay. You know, I wonder why they have that contingency. I mean, I guess, you know, there there are the obvious reasons because they want to deter hospitals from pushing formula onto the family members, but at the same time, I mean, I don't know. I don't know how I feel about that.
SPEAKER_00I think it's a hard thing because, like in some cases like this, you've got a hospital that just can't afford it, right? And they're like, well, we have to have formula and we don't have the budget and the re you know, reimbursement for that. But the other side is also, I mean, we've all seen this. You walk into an office where something is free and people are eating way more cookies than they need, and then they're like, man, those cookies weren't even good, but I just ate like four of them. You can probably tell by all my cookie preferences that I'm definitely a sweet tooth. Um when something, I mean, when something is free, you know, even just an office that has free pens, it's like you wind up taking three of them. And it's like I think it just you wind up having people hand it out a lot more and feel very readily to use it all the time as a constant. And just the act of taking formula from the supply open shelf and putting it in the med or the supply pixus to where they're recorded how many we're using for which patients and it gets billed, that alone changes the number of formula that a hospital uses drastically.
SPEAKER_02Right.
SPEAKER_00Anything out on that open shelf in a supply closet on labor and delivery or postpartum is just, and they're the things that you use all the time, you know, the the pads, the panties, you know, baby diapers, all this type of stuff. But those things tend to be fairly cheap too. And they're things that we use all the time. Well, by locking up formula, it drastically changes how much people pull out and use. And so I, you know, I understand where it's coming from. I think it's also a an issue with marketing and kind of acknowledging our own bias. When you get something free from a company, you're even subliminally more likely to recommend that company, right? So, I mean, they've done things where they've looked at hospitals that have emphatil versus Similac and stuff. And if the hospital gets free emphomil, the pediatricians are more likely to recommend that they stay on emphymil. You know, it's the same formula, it's easier. Your baby doesn't have to try something else, you already know it. But you're more likely to recommend it because you already got it for free.
SPEAKER_01And I think the other something else is that the hospital, if they have to pay for that formula, they're more intentional with whom they give it to. They're not just kind of like throwing it at everybody, they're careful with who they give it to because it's not free.
SPEAKER_00Exactly. And, you know, if there's a medical need for it, yes. I've worked at hospitals where we had to have an evergreen, you had to have an order for it. You know, you could say, if mom came in and said she was formula feeding, that superseded. But if mom was come in and said she was planning on breastfeeding, you could not give formula without an order. There had to be some reason, right? You could now, if parents just totally changed their mind and said we're gonna formula feed, they can always supersede. We're not trying to say that parents don't have the choice, but it was a way of trying to make it so that some well-meaning nurse at 2 a.m. didn't go in and say, Oh, your baby seems fussy. Let me just give him a bottle of formula so you guys can get some sleep. You know, and then you've got this baby who just got, you know, he was getting, you know, five or 10 mls of colostrum and now he just got 40 of formula and then he sleeps for four hours, right? Right. But then what happens is he wakes up eventually and he goes back to breastfeeding, and then mom's like, well, he's not sleeping as long. He was sleeping when he had the formula. I'm like, well, yes, it was kind of a rock in his tummy, you know, it was it was a lot of food. So I definitely I am still very shocked, and I shouldn't be, but I get shocked every week at the things that I hear from clients every week. I mean, I still hear things like, oh, just recently I had a client tell me their pediatrician told them um there was no point in breastfeeding after a year because their breast milk turned to water. Oh, what? I don't think our body makes water, but okay.
SPEAKER_01Um that's a first. I've never heard that one before. Yeah.
SPEAKER_00I was like, really? I thought that was something they said in the like 70s. I didn't think that still got said.
SPEAKER_01You know, I mean, yeah.
SPEAKER_00And I just had someone the other day call me because she said her pediatrician wanted her to start solids at four months. And she's like, but she's breastfeeding really well. Do we really have to? And so we talked through all the things and we had a great visit and it was wonderful. But that's because I had already established care with her when she was a prenatal client and then helped her breastfeeding. When you don't have that, you know, and you don't know someone to go to, and the pediatrician just tells you, well, they're four months, you can start food, then you just kind of do, right? So I think it's really unfortunate that pediatricians don't have the ability to also be infant feeding specialists, but they can't. They're covering 18 years, and I get that. I just would love for them to refer more often and to say, you know, like, I'm not an infant feeding specialist, let's get an IBCLC and they can help and talk about when to start solids. They can, you know, talk to you about going back to work, they can talk to you about breastfeeding and bottles and all of this. I mean, my dream is also that eventually one day every parent that goes into the office with their newborn is gonna see the doctor and then they're gonna see a lactation consultant at every visit for the first year. Like there is so much education we could do in that time.
SPEAKER_01Yeah, I think there, I that's such a good point you bring up because these pediatricians they are responsible for these children up until the age of 18. And there's so many different things that happen, you know, especially if you think about an infant, there's so many things that change within that first year itself. And then, you know, to even go beyond that and to expect these pediatricians to know everything and to be experts, you know, it's kind of unfair to them. But at the same time, as you had mentioned, you know, know they should know their limits, you know, because we all have limits. Like I am not going to pretend that I know everything about body work or about, you know, feeding therapy or about lactation because I don't. I know, I know based on my own experiences, but you know, same goes for these pediatricians. And I have met some that are great and they they totally stand by, you know, the lactation consultants they refer to and the feeding therapists. But I think there's still a ways to go in terms of getting these practitioners on the same page and kind of setting their ego aside, or maybe it's not their ego, but maybe being exposed to those solutions that, hey, you know, for this age range, consider these other providers around you and how they can support you and uh most importantly your clients. So I'm I'm glad you brought that up because I do think that that is a huge piece that's missing because you get a lot of parents that come to, you know, come to you or me and they're like, well, my pediatrician didn't say this, or they didn't know about that. And I think that there's so much weight to what you know your pediatrician thinks that it kind of trumps, it can trump other providers' opinions, you know, especially good ones that could really help their baby.
SPEAKER_00Definitely. And I think that there's just so much to be said for one referring for things out of your comfort zone and two being really curious. I mean, I even had a client contact me yesterday for inducing lactation. So she's adopting a baby. And I reached out and I said, I'm more than happy to walk you through this. I said, but I have to tell you, I've only done it a handful of times. It's not my specialty. My specialty is prenatal education and tongue tie. So I said, I'm happy to learn to do this with you. I said, but I'm also very happy to find you someone who does this all the time. So you just let me know. And she said she was going to think about it, let me know. And I said, I am more than happy to find you someone who does it all the time because it's not my thing. Like general breastfeeding, fine, you know, and then I specialize, like I said, in prenatal and tongue tie, but inducing lactation, I've barely done it. Twins, I've I've done less less than five sets of twins, maybe, maybe three or four sets of twins. So it's like it's not my thing, but there's other people out there who do it really, really well. And I think it's important to remember that it's not about me, it's about the client getting the best experience, right? And seeing the best person for them. So I think that that's just a huge thing. And and I think we're also thought of as being brought in just for the, you know, things really aren't going well. And I think if we started looking at lactation as preventative and education, and I mean, there's so much that I cover 100%.
SPEAKER_02Yeah. Right.
SPEAKER_00When I have those insurance visits and I can see them multiple times, it's like, okay, breastfeeding is going great. Let's talk about sleep. Let's talk about how to prepare to go back to work. Let's talk about what it looks like and how you know baby's ready to introduce solids. Let's talk about when baby should start moving and how you can facilitate that. You know, there's so much other stuff too. And those don't get covered a lot of times in those visits because the pediatrician doesn't have enough time.
SPEAKER_01Right. Yeah. I mean, I think even when they, you know, submit insurance, I think that they have specific codes based on the amount of time that they spent with each family and then they get reimbursed that way.
SPEAKER_00I mean, don't quote me on that, but they do, but they they can never, it seems like they can really never have quite enough time because they have the amount they have to cover in their time is enormous. Right. Yeah.
SPEAKER_01Yeah, I totally feel for them. It's a lot on their plate. And like you said, it's not a lot of time and there's so much to cover. Whereas if you have, you know, a one or two hour visit with a lactation consultant and it's you're just one-on-one with them and there's no pressure, there's no rushing, it's just a completely different experience. I mean, personally speaking, it's it was very, very comforting, especially as a new mom, to have that person there to guide me and hold my hand.
SPEAKER_00Yeah. I think lactation is unique too because we treat and see the dyad. And, you know, at the pediatrician's office, they're kind of talking to the mom, but they're not really that into mom's well-being. They're they're into her well-being in the sense of it's attached to the baby, but not that much. If mom has postpartum mood, they're gonna refer her to the OB. If she goes to the OB and she says, Well, my baby isn't gaining well, I'm not sure if I have enough milk, she's gonna refer back to the pediatrician and say, Well, go check out the baby there. Nobody's seeing the two of them together. And I always said the first six months, but when I was talking with Dr. Trill from Free to Feed, she was saying that especially because in her world with these allergy babies, I mean, you know, with the babies that have severe food protein allergies that require elimination diets and everything else for the parents, she said that it's really the first year. And I can see that because I've worked with a few F-Pies parents where these babies had very severe protein allergies and the parents had to take multiple food out of their diet for the first year. And so it's like that first year of life, mom and baby are like a whole little ecosystem, right? They're so intertwined.
SPEAKER_01It's a beautiful thing.
SPEAKER_00It is, it's a beautiful thing, but it's not it's not always seen in healthcare. It's like they're trying to separate the two, you know. It's like I recently had a colleague whose client got hospitalized for mastitis and they wouldn't let the baby come visit. And I'm like, I don't quite understand your point here. Like, yeah, her baby needs to come and breastfeed, it will help the mastitis. Like, so you know that one's kind of tough. But one of the things I definitely wanted to make sure we talked about was because this has been a very big topic, I think, with a lot of people right now is optimal timing of release. Is how do we figure out when it's the right time to release a baby?
SPEAKER_01Right. Yeah, I agree with you. It is such a hot topic. And I remember going back to when we were together a few weeks ago. I remember we had one client in particular. Well, maybe not one, but there were a few. And I remember us discussing how, you know, there are so many different schools of thought and how there sometimes can be too much, too much holding on to certain rules or guidelines, like, oh, this baby or baby should have three sessions of body work at least before they have a release done, or you should wait until they're they weigh this much, or you know, whatever it may be. I think that that can be a slippery slope because, you know, clearly every baby is different, every mom is different. I remember taking tongue tied academy and Dr. Baxter, who is amazing, a prodigy in the field. You know, he talked about taking his daughter on the way home from the hospital and having her tongue tie released right away. You know, it wasn't like, oh, she has to see this lactation consultant and this body worker before I release her, or else things aren't gonna go well, you know. So in that case, like he's familiar, he he knows babies very well and he felt good about it. And I'm sure there are lots of babies that have had releases done that way, and they were fine. Of course, it may not be optimal, but I think that there can be a lot of pressure, and we do have to take into consideration different families' needs and their circumstances because honestly, I get a lot of families that haven't even heard of bodies. Like they're like, What's there like cranial sacral therapy? What is that? Well, how much is it? Does insurance cover it? I'm in so much pain. Can you just release this? You know, I've gotten the whole gamut of things, and I try to take into consideration every family's unique circumstance. I'm not if there's a family that's not gonna go for cranial sacral therapy, I will educate, I will inform them, I will give them resources. But if I see that they're if they have like a tie that's very obvious and it is causing mom a lot of pain and they want to salvage that relationship, I'll probably do the release. Okay. I know that may not be the best answer, the right answer, but I have to tailor it to every family. And um, yeah, I guess that's that's just kind of how I roll. I I try to inform and educate as much as I can. Sometimes families take my advice and they go for that body work, and sometimes they don't. What are your thoughts?
SPEAKER_00It's a very tough one. I would say to people right off the bat that there is not, there's not um criteria. It's not like a baby having surgery where you say, okay, they have to be 12 pounds or they have to be this many months old. We don't have criteria like that, you know. So right off the bat, you can toss out anything that's going to try to apply to all babies. Like you said, they're also different. Each breastfeeding situation is different. Each baby is different. So we need to look at it first and foremost as you know, what's best for this dyad today? The other thing that I always try to tell clients to keep in mind, and I kept in mind with my girls, is I only want to do the release once. Right. So I did not want to do it in a way that I felt was not setting them up for success. Right. And even in my case, I wound up going back and forth with the orthodontist a little bit because he really wanted us to do the release before the palate expansion started. And I was adamant not to. And I had kind of spoken with every other expert I could reach out to. And everybody else said it's usually done, you know, during the expansion or towards the end. And my concern was that we release the tongue and it has nowhere to go because that palette's still too small. So I pushed and we wound up doing it towards the end of expansion because that was what I really felt comfortable with and what I felt was best. But I think so. That's something that I really deeply considered is I only want to do this release once. So when is it going to be best? I think something that's really important for parents and providers to think about is when I say optional timing of release to clients, I'm not just sitting on my hands for two weeks and waiting for the baby to magically be ready. Right. So I'm working with the family. We are doing oral exercises and rhythmic movements. We're working on mom supply. We're working on feeding. Are we getting the baby fed enough? Because as much as an underweight baby needs that tongue to work well, if they're really struggling, some babies can't yet. Sometimes it's just too much to put them through that. Also, what else have they had going on? Had that they just come out of the NICU? Were they under lights? Have they had a lot of stress? It might be better to wait a few days. It depends upon so many factors, right? But body work, while it's important, isn't my number one. My number one is working with a lactation consultant who can work with them because even more than the feeding aspect, because that's, I mean, I'm a lactation consultant. That's pretty much what I do. But even more important than that, because this would apply to even a bottle feeding formula, baby, we're going to work on exercises and rhythmic movement. So I've had plenty of clients who've said to me either they could not afford body work or they were really uncomfortable with it, or there was nobody in their area qualified, right? And not everybody is equal. Let's just be honest about that. We are not all the same at everything we do. So there are going to be lactation consultants who are tongue tie experts like I am, and there are going to be some who really still don't know what tongue tie looks like. There are going to be some who are really great, like I said, it inducing lactation. And that's not me. And that's okay. But it's really important to know that and to also think about that when it pertains to other practitioners like body work, getting them to a cranial cycle therapist. If the cranial cycle therapist usually works with adults, it's likely to not be helpful, right? They may not have the experience and the training to even work with an infant. So I think that's important too. It's really important to look at what's in their area, what they can manage, and not just financially. What can they manage physically and emotionally? Because it's a lot when you've had a baby to now have everyone's like, oh yeah, you should go home and sleep when the baby sleeps and everything, but don't forget to come to the pediatrician this week. And then you're going to come again in two more days for a weight check. And then you should go see the lactation consultant. Don't forget to do body work twice this week, you know? And it's like it's a lot. It's overwhelming. So that's why I think that is so underplayed.
SPEAKER_01You like you bring that up. That's a great point that you bring up. I feel like the mental and emotional well-being of a dyad is so underplayed in all of this because we have like our rule, not I shouldn't say rules, but we have our, you know, like, oh, you should do this, you should do that, you should see an OT, you should see feeding therapists, you should go see the physical therapist at, you know, Kennedy Grieger, you should go here or there. And you also have to wonder, you know, what's going on in the parent's head, you know, are because I've had some of those moms come in and they're in tears because they're running around and they're wondering if any of this is actually working. They just want to have that amazing experience with their baby, and they are just so stressed and tired from running back and forth between these appointments and not just from a from a physical and emotional, but sometimes like financially too. You know, they're like, I, you know, this is a lot for me to handle. I could check to see if my insurance covers this or that. And meanwhile, they just they just want to have that, they just want to bond with their baby, you know, they want to enjoy. And, you know, like you said, it's it is something that it definitely should be a factor when discussing different options with these families. Right.
SPEAKER_00And I think it's just, I think it's so important to think about what a trained LC will be doing with these families. So when I'm when I find a client and we together look at all the symptoms and then the anatomy and say we've got a tongue type baby, and we'll talk about optimal timing of release. Obviously, this totally depends upon each baby, but I'll start usually with three sucking exercises and three rhythmic movements. And if I think that baby is going to need more time, right, then we might schedule. Sometimes I'll even do another 30-minute appointment later in the week just for the exercises again, just to check in and say, okay, let's see where the exercises are at. Let's, you know, show me what baby's been doing, show me how they're moving. And what I love about telehealth is that they're my hands. And so they get to feel and see. And it they always start out every visit, every visit they start out saying, every client's like, I don't, I don't know. I can't feel any of the tension. I don't know what you mean. And I say, okay, let me talk you through it. Let's take baby's arms and they're gonna do little little arm circles. And now you're gonna make them dance the disco and they're gonna move their arms all over the place. And then they start doing it. And after five or 10 seconds, they'll be like, wow, they're like right arm does not want to move every time I go to bring it up. And I'm like, oh, don't bother. That's an area of tension. And so then I talk about that with them and they get so much more from feeling and seeing it than just taking a baby to an appointment. And we can talk about how therapeutic play can be. And you know, I'll tell parents that babies, there's studies that babies can learn to sing before they can talk. So let's turn some music on and make it clear that this is a fun thing or sing to them. And you know, there's a lot of education that goes into it, but rhythmic movements can definitely help, especially if you don't have body work on hand. Yeah, you know, but so creative. Um, we'll make that plan, we'll re-evaluate. And then once baby is ready for release, then I usually will see them two days after release, two to two to four days after, and then we'll keep evaluating from there and we'll keep saying, okay, what's working and what's not. You know, sometimes we'll have a baby that just refuses to do an exercise. And there's I always tell the parents that usually means it's one they need, but we're gonna listen to what they say because there's always another way to do something. So we'll come at it a different way and see if we can't get them the movement they need in a non-painful way. Because if baby's refusing, there's usually a reason, right? Their goal is not to be difficult little people, they're very much guided by instincts. So if they're, you know, not wanting to move onto their right side, maybe it hurts. Let's try working that side from a different way. Let's try putting baby on the exercise ball or let's try putting baby in your lap, you know, like there's so many other things we can do. But I think that it's I have such a big toolkit when it comes to these tongue tie families. And I think that it's important to find someone who has that because it's so much more than just are they latching, are they gaining?
SPEAKER_01Right. How much training would you say you received, like just to get your, you know, straight up IBC L C, right? How much training did you get in in tongue tie? So I told you that I got very little in dental school, you know, in regards to what a tongue tie is, how it affects, you know, a baby or a child or an adult. What about you?
SPEAKER_00Very little. There were maybe maybe two lectures on it in the coursework I did, but I might have been just one. Might have been that it was mentioned in the second one as one of the common things, but it was not, it's not really covered in nursing, medical, school, lactation, dental. It's really not covered. And it's that surprises me for lactation.
SPEAKER_01Like I feel like that would be, you know, one of the main topics that you guys would learn about. I'm hoping the reason I bring this up is because you mentioned that, you know, not every just like not every release provider is the same, not every lactation consultant is the same in terms of different experiences and knowledge. But I excuse me, I know you know, if this is wrong, I mean, but I just assume that um every lactation consultant was familiar with tongue ties. Like I thought that was like a main thing he learned about.
SPEAKER_00No, unfortunately it's not. I'm hoping the education will change as we've gotten so much more evidence that this is really very common. You know, I mean, it's kind of silly for us to learn these one in 200,000 things and not something that's one in three. Um, you're one in four, maybe. But I'm hoping that it will change and get more widely covered, but for now it really hasn't been. And it's, you know, it covers the general lactation stuff, but anything like it doesn't really cover inducing lactation either. The Newman Gold Farb protocol isn't covered. There's a lot of things that aren't that we that's where all the conferences and the classes and everything else come in. And like I'm not someone who I haven't don't think I've had any clients that are LGBT. And not that I wasn't in an area that could, I was in the Bay Area, but I also in California, but I also was only 15 minutes away from another lactation consultant, and that was her specialty. So anyone who found me by accident, I would offer them the same thing. I'd say, I'm happy to help you. I can do this with you, but I want you to know that there's an expert in your in our area that you know does this all the time. Because if it was me, I would want the person who knows this inside and out. You know, I want someone who's done something enough that they're really comfortable with it, not that they're like sitting there reading the protocol and trying to figure out what to do.
SPEAKER_01Yeah.
SPEAKER_00So I think we all have different subsets and stuff, but it tongue tight needs to be covered. It needs to be covered in school so much more and so much more for all of us. It needs pediatricians aren't getting it either.
SPEAKER_01Yeah. Yeah. No, I mean, it's interesting as a dentist. I feel that in dental school you learn so much about what the different specialists in our field do, like people who do root canals or people who, I don't know, do remove teeth, whatever, right? Um, but as I've switched gears and I've decided to just do tongue tie releases only, I feel like my perception has changed in that, you know, before we every dental student gets that exposure to the different fields, like the different specialties. Like we have a basic understanding of what they do. Okay. More than basic, I should say. We've had training, we've had a lot of exposure to what they do. Whereas with what with what I do, I have to look to you guys, right? I have to look to you, to my oromyofunctional therapist, to the speech language pathologist in my area, the body workers. So um it's been very humbling as a dentist, especially, you know, because you come out and you're like, yeah, I'm a doctor, I know all this stuff, blah, blah, blah, blah, blah. And then, you know, now that I've changed gears, shifted my career, I should say, a little bit, I I really find myself very curious and um I feel very humble when I'm when I'm in your guys' presence because I feel like there's so much to learn from you guys. And so I just I appreciate that. I appreciate having you guys there as a resource. And I do love that about this field that it can be very collaborative. But, you know, I also have to be kind of aware of everybody's different MO, um, what their knowledge and skill is, just like they have to know that about me. You know, do I fit the bill for their client? Am I knowledgeable enough? Do I, you know, have the proper skills that they would like for their clients? So um yeah, it's definitely been a very interesting experience for me.
SPEAKER_00I think it's it's very fun to work with all the different providers. I love that aspect of it. You're right. I mean, it's there's so much more collaboration, I feel like, is needed in Tengkai because it's not just about releasing it, it's not just about latching the baby or oral exercises, it's not just about the bodywork or I mean, there's so many aspects of it. And I feel like it's an orchestra, right? Yeah, you could have a soloist, but it doesn't sound the same, and you're not going to get the same outcome. So it's it's about getting it all to work together. And that's the, you know, that's the million-dollar question is how can we all get it to work together? And I've seen some that are kind of working, and I've seen some that are some systems where people are trying to build those offices and those collaborative relationships, and some are working and some of them aren't quite there, and we're all a work in progress.
SPEAKER_01So and you know, sometimes we're, you know, we're for some people and not we're not for everybody, right? Like there are some people that kind of share the same philosophy as us, and then there are some that aren't, and that's totally fine. That's okay. I feel like for me, I know that I found the right person to work with when I can ask them questions and they're not afraid to answer them for me. You know, like if I if I'm curious about something or I'm wondering why something was done one way or the other, not in an accusatory tone, because like I said, I'm not in their field. It's just more because I want to learn from them. I love it when that provider is willing to share their opinion with me or share their philosophy of care or the reasoning behind what they're doing or even what I'm doing. You know, like if I'm if I'm doing something a certain way, I love getting feedback from other providers. I love when you were asking me about why I do things a certain way when I practice, because how am I gonna get better? How am I gonna learn? Right. And vice versa. I so I feel like when I find that provider, it gets me really excited because then I know that we can create some magic um with our clients. So that which is why I really want you to move to Maryland because I like that we had a lot of that back and forth where we were just, you know, excitedly chittering and chattering and asking each other questions. That's what I love about the people that I work with.
SPEAKER_00Yeah, I think you're definitely right. I mean, we just have to, you have to stay humble and you have to stay curious. I think humble is important because not only do you need to have the attitude that you can learn every day from other people, but you can learn from the body, just from a baby's body and how it does things on such a pure level, it can show you, oh, wow, that that worked or that didn't work the way I expected. And why did that happen? And how does how does how does that happen again? And all of that. I mean, I just think that there's so much that we can learn. And so staying curious is just you need to be open to it too. And then you've got to wonder, why did it happen this way? Will it happen again? You know, can I make it happen or is it just spontaneous? Like there's so much that we should be really, really curious for. And that's the only way we're doing it.
SPEAKER_01Like you're you're so right. Like just seeing, you know, working with these dyads, like I've learned I've learned so much. And I've I've even had some of them, you know, question me, like, well, why this way and why not that way? And it's sometimes, you know, it catches you and you have to think, well, why am I doing it this way? You know, but it's good, it's a beautiful thing. And um, I feel like that kind of helps you build a little bit of confidence too. Uh help you build some confidence when you're asked these questions and you kind of learn why you're doing things the way that you are, um, and why you believe in that method.
SPEAKER_00It was such a wonderful day in your office. And I thank you so much for your time, Dr. Sallya. This has just been so great. And I'm I am definitely loving your area. And who knows, maybe I'm ending up in Maryland and we'll end up working together. If nothing else, we're definitely staying in contact because this has just been absolutely been so great to learn from you. And I love how you approach each day, you know, curious with your clients.
SPEAKER_01Well, thank you so much, Katie. I'll always, I'll always remember the day that you were there. And yes, we will definitely stay in touch, and I will definitely be sending you some clients. Thank you so much.
SPEAKER_00When you change the way you look at things, the things you look at change you. I hope that you enjoyed the podcast today and learned something new. If you know someone who would benefit from this podcast, please share.