Katie The Traveling Lactation Consultant
Katie The Traveling Lactation Consultant
Ep 35 Dr Cordero-Ricardo
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Philadelphia just got a great new pediatric dental practice, Philadelphia Pediatric Dentistry with Dr Maria Cordero-Ricardo. As an experienced and patient teacher, Dr Maria spent the last 10 years in academia teaching and guiding dental students in all the ways of infant oral health and tongue tie. Now that she is in private practice, Dr Maria is passionate about her office being a calm environment for all (low sensory, calm lighting, great spots for parents to sit and very calming presence). Infant oral health, and habits that parents can adopt before the child turns 3 are rarely discussed, but in her office it's a priority for Dr Maria. She knows an ounce of prevention is worth a pound of cure, for oral health and tongue tie! Listen as Katie Oshita and Dr Maria discuss this and more in Ep 35.
Podcast guest: As a mom, pediatric dentist, biomedical engineer, and dental school faculty, Dr. Maria offers families a uniquely tailored approach to children's dental care. She earned her Doctor of Medicine in Dentistry degree at the Rutgers School of Dental Medicine. She went on to complete her specialized Pediatric Dentistry Residency at The Ohio State University and Nationwide Children's Hospital in Columbus, Ohio.
She is a board-certified pediatric dentist with a deep commitment to promoting children’s oral health through nutrition, wellness, prevention, and a focus that includes lactation and infant oral health support. Dr. Maria has extensive pediatric experience in treating children of all ages and has taught hundreds of dental students and residents over the last decade.
Beyond serving families, Dr. Maria describes herself as “a joyful wife and mother of 2 living in the Art Museum neighborhood of Philadelphia. I feel gratitude for living in Philadelphia today and love exploring the museums and green spaces with my family and neighbors.”
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 first. Welcome to the podcast. I'm your host, Katie Ostott, 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, I have Maria Cordera Ricardo, DMD MS, MPH. As a mom, pediatric dentist, biomedical engineer, and dental school faculty, Dr. Maria offers families a uniquely tailored approach to children's dental care. She earned her Doctorate of Medicine and Dentistry degree at the Rudger School of Dental Medicine. She went on to complete her specialized pediatric dentistry residency at the Ohio State University and nationwide children's hospital in Columbus, Ohio. Dr. Maria is a board-certified pediatric dentist with a deep commitment to promoting children's oral health through nutrition, wellness, prevention, and a focus that includes lactation and infant oral health support. Dr. Maria has extensive pediatric experience in treating children of all ages and has taught hundreds of dental students and residents over the last decade. Beyond serving families, Dr. Maria describes herself as a joyful wife and mother of two living in the art museum neighborhood of Philadelphia. She feels gratitude for living in Philly today and loves exploring museums and green spaces with her family and friends. So please welcome Dr. Maria to the podcast today.
SPEAKER_02Well, thank you for letting me come to your space today. And I'm excited that you're having this meeting and that I get to meet you and other providers.
SPEAKER_03It was a lovely piece of timing. I'm really glad you reached out.
SPEAKER_02So this is a new space for you.
SPEAKER_03Yes.
SPEAKER_02And big change from your previous career life.
SPEAKER_03Yes. Right? I started 10 years ago straight out of residency into dental academics and navigated research spaces that focused on population health and diet. So diet and nutrition were always the passion point. It doesn't make it a direct connection, but when you travel along those lines and you start saying, all right, what leads to healthy diet, you start tracking back and tracking back. And that first introduction of nursing starts becoming really interesting.
SPEAKER_02Yeah. And I think when you look at nutrition, you're also on a more holistic path. Yes. Right? You're already in that natural, let's try to have less interventions, let's try to, you know, nurture healthy people instead of fixing problems.
SPEAKER_03And healthy behaviors and habits. I think that makes a lot of sense and explains some of the things I might not have realized I was doing.
SPEAKER_02Yeah. I mean, I think that nutrition is hugely important. And unfortunately, rather feels unstudied in medicine or unfocused on, right?
SPEAKER_03Like I think humbly it's hard to study it. Think about all of the things that make a healthy diet. And to study something to convince enough people to make a change, you would have to isolate one thing. And in nutrition, isolating one thing when I can't even make myself like limit my brownie consumption. So we have a little bit of good science, things like folic acid and spinobida, something along those lines. But others are harder to reproduce and say this is therapeutically going to work for you and every person.
SPEAKER_02Well, even with the folic acid, we're still seeing folic acid being used more than folate. And with the prevalence of MTHFR in the US at large, like, and there's a lot of people who don't know their MTHFR status. I mean, I think most of us don't. And there's some estimates that, you know, I've read that one in five, one in six people, something like that, will have an MTHFR mutation, which means that folic acid is not going to work for them.
SPEAKER_03Yep. No, it's true. It's one of those things that it's hard to move. And you do your best with the information you have, and then you adjust as you get some more.
SPEAKER_02I do think though that nutrition is a little undervalued. Side note, I have chronic pain and have since I was pregnant with my youngest. So for the last 12 years. And I spent a lot of years doing Western medicine stuff and always was kind of told that there was no not going to be any difference based on my nutrition, right? Besides being a healthy weight. And nothing was ever, I was never really that overweight, 15 pounds after kids. But the last two years I've been on my own food journey, everything from working with a dietitian to doing testing to doing autoimmune to at this point, like I'm vegan with restrictions. And it's amazing the difference it's made in my health. And it's amazing the difference it's made in my body. And I think back and I'm like, what if I had known that before? I don't know that it would have mattered. I don't know that I was ready. Right. I think to make drastic changes, there has to be some sort of big impetus. I mean, I think if you think you're going along and everything's fine, and someone says, hey, how about if you give up having food? You might punch them in the face, right? Like you have to have a reason.
SPEAKER_00Yeah.
SPEAKER_02I just, I just wish there was more focus on the fact that what we eat is hugely important. You know, it's hugely important for how we feel and how we can handle everything in the world.
SPEAKER_03There's a, I think it's funny because you're probably right. You wouldn't have changed it 20 years ago. But you come to a point of self-awareness. And when you're honest with yourself, how something you consume makes you feel, you can probably start finding your own. And my perfect example is no matter how much I love baked goods, I get a sugar headache. I get a headache from refined sugar and I know it and I chart it. And what I do for myself now is when that headache happens, I started writing it down because I didn't want to let myself have a buy on okay, you made a choice. This is how you feel. And by charting those things, you can make those small nutritional differences on your own terms when you're ready. So little things that I do.
SPEAKER_02Oh yeah. Cane sugar is a brutal one. I can only have it about once or twice a month, or I have pain flares and headaches. Yep. And it's a very inflammatory food. Yep. It's the more you learn about the less surprising it is that people will have issues with it. I think I didn't realize all the issues I was having before because I had it every single day. So it was kind of hard to see. Right. Right. Pause this just for a second, Jason. So you just to backtrack, you were started in academic life. And was it locally here? Like, did you make a move to come to this location?
SPEAKER_03Or so I grew up outside of Philadelphia. Anybody from Philadelphia will tell you if you're from South Jersey, you're not from Philly. But if you travel the world, you're gonna tell people you're from Philly. And so I've spent my life saying that. And as soon as I went to college, I said, I'm going far, far away to my poor parents. And it took me 15 years to come home. And so I went away for college and then dental school, and I met my now husband, and he was finishing his training as an OBGYN on Long Island. And so when I graduated my residency, we decided to go there to finish up. So I took a position at Stony Brook University. It's a small dental school on Long Island, and I was there pre-doctoral, which is dental student. It's the younger group director for two years, and then one of the youngest program directors that school and anywhere I had really had in a long time after that. So that's really where I started on Long Island.
SPEAKER_02But now you're in private practice, which is totally different. You've got young people, but you're patients instead of your students.
SPEAKER_03I'm really grateful for the 10-year path it took me to come here. And it goes into the categories of I'll nevers. I have said I would never be a dentist. I would never be a pediatric dentist. I would never move to New York. I'm never moving home. I will never teach. I said all these I'll never. And I did absolutely every one of them and have had a really rich experience from it. And so over that 10-year period of time, I really mulled over ideas. And I would enjoy working with my part-timers who would say, it doesn't work like that in private practice. And I would keep trying. I would keep trying to have different communication strategies. I would keep trying new techniques. I absolutely love how few of my patients need advanced behavior management, a little niche thing that I developed from working really hard on trying new things and what will work for them. And so what happens is when you're teaching in academics, you have the novice learner and they're a sponge. They're amazing. You tell a first or a second year dental student a piece of information, they will make pure statements from it. They're not jaded from patient care and insurance and the business of dentistry, and it's wonderful. And then as time goes on, as they're learning in the clinic, you have to give them their answers in very rigid boxes. And it's satisfying if you think in the big picture. And my big picture was I was graduating 140 dental students a year. That was 140 people that now knew how to communicate better because of the way I trained them and understood the disease process of caries differently because of how I trained them. And my passion space was infant oral health because it was an absolute vacancy in the curriculum. So now instead of being comfortable talking to parents of three-year-olds, they were good between six months to a year talking about introduction of solids, talking about supporting the nursing diad for as long as the parent preferred, instead of saying, all right, do it till X and cut it off. We would talk how to support families in hygiene choices, whether or not they were using fluoride toothpaste, how to help them in their dietary introduction of solids. This was a huge course for me that I knew 140 students a year would graduate knowing so much more than the generation before. That was pretty cool, but it wasn't enough. Like that there were so many other things I couldn't do because they weren't ready and I wanted to do it myself. So sometimes you have to put your money where your mouth is. And I did that and I opened my own practice in the midst of COVID. And now I get to do just that. I get to practice that gray area and practice the type of communication and young child focused that I was trying to teach.
SPEAKER_02I will say you're right that infant oral health is a huge vacancy. I mean, I have always told parents that as soon as they get those, because I will see a lot of, especially in pregnancy, I see a lot of older babies. When I was in the hospital, I would see that, you know, those two-day olds, you know, even an outpatient in lactation, I might see a two-week old or four-week old. But right now I have an 18-month-old, six-month-old, a three-month-old. Like I've got I've got the span. I've got a set of twins that I'm working with that's two months, but it's like I've got a span. And I always tell them as they get older, like, once they get too deep, you've got to get in there and get glossing. Most of the families I'm working with have centi. So we're already in the mouth a lot. Right. Right. And so I will tell them when we're done with our oral therapy and everything else, play in the mouth. Keep that a happy place. Let your hands be in there a lot because in a couple months you're going to start glossing. And they're like, really? And I'm like, yeah. The minute they get two teeth together and your hands can be in there and you're going to be responsible for their hygiene. And it's a very uncommon subject. And I will say to them, well, did the pediatrician tell me anything about that? Oh no, they said we can go to the dentist when they're like two or three. I'm like, okay. So as soon as they get some teeth, go to the dentist. Even if they barely do anything, you get to know the dentist, they get to know you. Your child starts getting used to going to the dental office. We want it to be a pleasant experience, right? Right. We want everybody to be happy. Personally, I had a ton of cavities as a kid. Probably not surprising considering I have a temp tie that I didn't even realize until like just about a year ago. And actually, if you look at Richard Baxter's forms, like if you look at his child and form, I was in there looking at it, going, huh, you check off every one of those bodies. Right. Interesting. And so I did not have a good dental experience as a kid. And when my girls were born, I was like, six months, I was like, they're going to the dentist. And my dentist was like, okay, you can bring them back when they're three. And I was like, we'll see you in six months. And we'll see you again in six months after that. And six months after that, and six months after that. I was like, with as many cavities as I had growing up, I figured my kids were high risk and I didn't know if it was genetic or now I know it was a lot more related to my tongue tie. But just all of it, I was like, I don't know what caused me to have all of them. I don't want my kids going through this.
SPEAKER_03So you trained your dentist. Well played.
SPEAKER_02I was like, I'm gonna be here every six months and you're just gonna get used to us.
SPEAKER_03Yeah. So I think I've adapted my practice around this a little bit. But most people say, yeah, you go in, it's quick, in and out. My year one dental visits are 30 minutes. They're not short appointments. I spend so much time with these families. And the reason I do that is because I used to see those two and three-year-olds. And the parents would say, I just wish I knew this sooner. Okay, let's make sure you know this sooner. And so I run workshops in the city. They're called Before You Get Teeth. And that's the idea because I know every parent loves their child. Nobody is making a choice to intentionally hurt their child's health. These are acts of love, well-intended, but sometimes unintended consequences. And I think that sharing information and understanding where you're coming from. And there is culture, there is history, family habits, family beliefs, it all fits in and there is a way to be healthy within everybody's framework.
SPEAKER_02And I think there's just a lot of unintentional things that parents just have no idea that there's consequences. Yeah. You know, one of the dentists down Tampa Tunkai, um, Dr. Casey would say, he said he talks a lot about sugar, right? And the parents would be like, oh, we don't really eat that much sugar. He's like, well, how about polkish crackers? Oh, well, yeah, they eat those every day. Okay, so let's talk about the carbohydrates that are sitting on their teeth.
SPEAKER_03One of my favorite quotes from the original, I'm a Dr. Cordero recorder. That's my last name. But there's a real Dr. C who's who trained me. He was the chairman of my residency program. And he was the one who said, if human beings can ferment it into alcohol, the bacteria in your mouth can make cavities out of it. And so you sit back and you think, you're like, wheat, yep. Corn, yep, rice, yep. Oh, all of it, carbohydrates. We can ferment all of it. It can all create cavities if it sticks around long enough.
SPEAKER_02Yeah. Yeah. Actually, Dr. Casey was the other one who told me too. He's like, he spends a lot of time talking about the importance of chewing and the negative consequences of the puffs and pouches. Oh, yeah. Right. And I'm finding that's a really uncommonly known thing too. And that's something I will say to clients too. I'm like, I don't say a lot of no's, you know, even things that I pretty much hate, like I hate the snoo. I won't tell a client not to use the snoo if they have the snoo. I will talk to them about how to use it limited, how to use it to get their best sleep, but maybe not during the day, how to use it without maybe turning on the motion, right? And so like limited. Same thing with pouches and puffs. I'm like pouches have some purpose. It's something easy you can put in the diaper bag or in the car. You can hand it to them when you need them to be quiet or they're hungry. And like applesauce is a naturally puree food, right? Puffs are a whole other story. I don't really think there's any point in puffs. They're like air that dissolves in their mouth. They don't understand where they come from.
SPEAKER_03But they come from fear. People's fear of their child choking. Yeah. And it's a shame, but it's true.
SPEAKER_02Yeah. Well, and that sometimes it's these products that just get made, and then parents think that they need all of the products because there must be like a sippy cup.
SPEAKER_03Uh-huh. Right. I love talking about this idea of when families are like, well, which one should we use? And I go, well, let's establish the baseline. The sippy cup, it's not a milestone. It's an invention in the 70s. It is helpful. Let's make sure it serves you. But the open cup's the milestone. And that's actually what I want to talk about. I want to make sure you have a chance. Practice that. And then let's make sure your sippy cup doesn't undo what you're practicing.
SPEAKER_02I love that. Yeah, I will send parents a with list of like developmentally appropriate sippy cups that we use on the go in the car, things like that. You know, you need to have something on the go. I mean, I have my water bottle, but yeah, open cup is the way to go. They need to be able to drink out of an open cup.
unknownYep.
SPEAKER_03The my favorite one you can always tell. I'm trying to always be silly or joking enough that they remember what I said without ever being really offensive. Um, so I'll say, you know, have you ever seen your child? And if you give them a cup and you just put a finger of liquid, that's interesting to drink. Fill it about halfway. It's far more interesting to dump it on you. And they're like, yeah. So little solutions like that. I'm always trying to find a way to make it work for what they wanted to do in the first place.
SPEAKER_02So I get the infant health and oral health into tongue tie, but how did it really get there for you? Like, was it just because you were seeing it more often, or was it something that impacted you directly? Like, how did you end up in this particular space?
SPEAKER_03Actually, most people you'll talk to will give you a story of, and I have a tongue tie, or I was nursing and my kids have a tongue tie. And I do have a tongue tie, that is true, and I see some of my own health, but I struggled with both of my children with nursing, and they do not have tongue ties. I had so little help with my first one, and it was so hard. Oh, I'm sorry. And I thought on round two, I'm gonna do better. I've learned so much from this process, and I know the help that I need, and I'm gonna seek it out early and often. And and we struggled again. And it was not necessarily tongue tie, but rather all the other pieces that I think are frequently overlooked, that I didn't avail myself of. And as time went on, I started meeting these people and I was like, this is what I'm missing. I am missing the bod. I am missing the subtraining. And I look at my children now and I'm working with them in these areas to make sure that their oral motor development is helping them, is serving them. But I think it's actually that it was so much harder for me in that little area that I really want to make sure that families who see me hear from me. Please pursue the body work. Your child has a head side preference. How could you comfortably feed on both sides if you can't turn your head evenly to both sides? It's worth it. Please pursue it. Because nobody said that to me. They said, I don't know, maybe. And that wasn't the answer. That was my truth. I look back on it now and I'm like, huh. I kept saying this was a thing and I kept being told it was normal. So that's it was a it's a little bit of a different entry point.
SPEAKER_02We normalize, we normalize dysfunction a lot.
SPEAKER_03Right, because it's common.
SPEAKER_02Because it's common, but that doesn't mean it's healthy, right? I talk a lot about common, not normal, because you know, for example, army crawling, scooting, all these funky crawls. My youngest did that, and I had no idea until like a couple years ago that that was abnormal. And then I went, Oh, yes. I'm like, huh. So that's all of her body stuff. Interesting.
SPEAKER_03And well, you know what they call this survivor's bias. My kid was normal, they did this thing, it must be normal. No, they just you were fortunate, right? But maybe we could do better.
SPEAKER_02And our bodies compensate. Our bodies compensate a lot. You know, I had I had this conversation yesterday with a client, and I was like, of course your baby's going to compensate. And yes, they could continue compensating forever. Yes, you chose to not address it. Think of if you had, you know, a problem with your foot and you're limping, you could limp forever, but eventually your limp is gonna mess up your hips and your back. And then that's gonna change the way you walk, and it might affect your ability to. To play sports or it might affect your social ability, right? You may not feel as comfortable if you have a limp and have trouble getting around on the playground. So all of these things play into it, but are they going to survive? Absolutely. Right. Do we want people to just survive or do we want them to thrive?
SPEAKER_03Thrive every time. Right. Every time.
SPEAKER_02Yeah. I mean, it's interesting. My entire family has Sentai. But when I got into the space, I didn't know that. And I just got into it because I was seeing breastfeeding private practice clients. And generally speaking, if someone's seeking out private practice, they have exhausted a lot of times they've exhausted hospital support. They've exhausted Google and friends. And unfortunately, like I wish I saw them earlier, but a lot of times that's the case. Like they've done everything they could on their own and they're not getting anywhere. And it's really, really hard. And a majority of my clients have tung tie, not all. I'm always always jumped for joy and I'm like, let me do that mouth again. Wow, it really does work. But you know, so many of them had it that I needed to understand it better. And I needed to understand how to help them. And so I took course after course after course. And I always joke, like, I'm such a constant learner. Like that class that I took last weekend was, I don't know, probably 20 CEs because we were there for three days. And I renewed my license in December. We renew every five years, and I need 75 units. And I think that I have 80 units right now. Like it's ridiculous. But there's so many great courses out there. It's like, how can I not? You know, it's like there's so much to learn and understand that I just went down the rabbit hole, you know, and I it won't keep you from being an island.
SPEAKER_03Yes. Because if you don't pursue that CE, you don't find the people who are on a similar journey, but seeing the other part of the elephant, right? The part that you might be missing.
SPEAKER_02Oh, yeah. That's a really important part of it. Body workers are my people. Like I love meeting bodyworkers. And primarily I've always worked really close with chiropractors because I had really great chiropractors in my area. But I've also had like when my girls had their trend to their release, they had myofunctional therapy because we had done chiropractic for a couple of years. And I was like, well, we've done that. I said, I think I want to try something different, and knew that we were doing something more intensive for their release. And so they did myof myofascial. And that was super new to me. And I was like, this is so cool. Yep. You know, and there's other types out there. I mean, there's cranial sacral and cranial fascial, and there's groping and there's osteopaths. But I love meeting what I love about the podcast too is meeting with other providers that are all seeing the same dyad but different viewpoints.
SPEAKER_03That's what tonight's gonna be. So I I felt there was a huge black box that I didn't understand. But I also, you've been around the country. There are tongue tie centers, there are centers of excellence. Philadelphia, we have one of the best children's hospitals in the country. We have an amazing meds and eds, but we don't have a tongue tie center. And I'm not proposing that I'm gonna be one. But what I am is a person that is very used to bridging gaps. That's what I used to do in academics. I used to say, okay, we have this resource. We want to do this sort of research together. This is your area. What can we build together? And so I started making phone calls and saying, I think we all need to get in the same room. We need to share our genius, see what the other person's doing. What I find with each of these individuals that I've worked with is they go, yeah, I know something of this, but I can't really call that. I don't know them that well. Okay, well, maybe we need to get to know one another so that we can do better. So that's what I'm kind of hoping to see tonight.
SPEAKER_02Right. And I, you know, one of the things that I saw happen last weekend at that class was people were a lot of people came with a chiropractor, which was awesome. I was like, oh, one day, one day I'll have my chiropractor buddy once I figure out where I'm living, because I guess I don't want to travel on my RV. But anyways, maybe you do. Maybe they do. I mean, I could probably show I'm kind of full inside at the moment, but but it was really neat to see how they had their groups and how they work together in a few different areas, one in Boulder and one in Phoenix, they have some type groups and they get together. One of them was like every other month, and I think the other one was every quarter, and they have dentists and bodyworkers and lactation consultants and anyone else who feels like that's their space. And they all get together every month or every two or three months and they talk.
SPEAKER_00Nice.
SPEAKER_02And they, you know, everything from exchanging, you know, I read this really great article to, you know, I'm seeing a complex client. And it also, like you said, it opens that door of communication app because that's where we get better results. Yes. So I see clients from all over the country. Right now, I have clients in four or five different states. And when I have a client going for a release or planning that path, or if we just think body work, like I reach out to the bodyworkers too. And I said, So, what are you seeing when you see them? What are you guys working on? Where do you see areas of need, right? What can I bring to the table? What are you bringing to the table? And how can we help the family? So, you know, it's harder to do it that way. I mean, it's nicer when you can live in an area where you can all start to get to know each other and you know, really bridge that. But even as I travel, I do that.
SPEAKER_03And I think they probably appreciate it because they're probably a little lonely. That's the craziest thing. Yeah, I was never meant to be a one-person show. I thrived in institutions because there's usually this point when you're trying to solve a problem where you realize it would be better in teamwork. You only have the resources you have yourself. And so now I have to work a lot harder to find that dissenting opinion or different viewpoint. I have to call that person, or I have to humble myself and say, I'm stuck. Help me. Um, which is not the nature of most people out there on their own.
SPEAKER_02Yeah, it is lonely in private practice. I will say that. That's you know, that class last weekend was my first in-person class in lactation because I've been also now six years, but from COVID, we didn't really have anything. I had classes lined up and then they got canceled. And it's it is very lonely. And it is really helpful to build that network and to have other people because you're right. I mean, I we when we're on our own, it's very easy to start thinking you have all the answers.
SPEAKER_03Because you have to fake it till you make it is what people tell you.
SPEAKER_02Well, and just because there's nobody saying anything else, there's nobody, not even that you're intentionally doing it, but no one's even bringing up another thing that you haven't thought of.
SPEAKER_03Right.
SPEAKER_02No one has another idea because there's nobody else there. And it's so beneficial. Like I have two interns, and just talking with them, you know, sometimes new things will come up. And I'm like, okay, let's explore that. Right. Let's talk about, you know, and it makes such a difference because you have to have someone to talk through things with sounding boards and to, you know, for me, the interns make me have to explain things too, right? Yes. So you need to really know it. Right. You have to know it to be able to explain it and teach it. And if not, then it gives you a moment of, all right, how can I grow here? Yep. That's how can I understand this better to be able to explain to them? What can I use? Who, you know, do I need to learn from? What resources do we have to find this answer out and all of that? And it does really help. What do you want to see for releases and families here? Like, what would be your your ideal? Where do you want it to grow to?
SPEAKER_03So I think it's different for different ages. Definitely. I would love to see children, newborns that have had a good amount of support from lactation before, where they've worked through the little details of positioning and what the latch should be if the anatomy were supportive of it. I'd like to see that. And I'd like to see screening for body asymmetries with conviction instead of you'd like to see the babies have their support beforehand. Yes. And body asymmetry. Body asymmetry screened, and instead of saying wait and see, but actually actively addressed as important as anything else. And I'd like to see that the parents have purposeful therapeutic play. So, like the idea that it's not just put the baby down for tummy time, but perfect, like helpful to them and their goals. And I would like to see that they are in the mouth in that same way. Without those skills in place, I hear a lot of push, just do the release. We'll catch them up after. And I don't think we gain any time. I think that three weeks later we're in the same spot. And if we looked back, the babies that took the time to get all of those pre-work pieces in a row ended at a very successful endpoint with less stress for the family and for the baby. And I think on the other hand, the ones that say just do the procedure and then try and catch up. I think they're parsing the pieces together. And I think that they will sometimes consider themselves better and not realize there are still functional deficits. A really great example of this. I rarely do a phoneectomy without knowing that they've established with an LC. But I had a family, they said, this is my second child. We worked with an LC on the first. We're gonna make an appointment, but it looks just like the brother, and we'd like to make sure just to get the procedure done first. They promised me up and down. They were getting this appointment set up. And I said, Okay. And I talked them through just basic wound care. They seemed confident and competent. I saw them afterwards, after my post-ops, and it was about a month later because their brother came in for an appointment. And the mom says, I'm doing great. And I'm like, Great, tell me more. And she goes, I'm only pumping like four or five times a day. I was like, Oh my goodness, you think triple feeding is normal. That's not okay. And that was maybe my sentinel moment of can't trick me anymore. I I believed, I believed, but I I no longer do. I really think that that pre-work is what sets our standards high for what the outcome should be.
SPEAKER_02Absolutely. And it's hard because I've seen it. I mean, I've been traveling all over and I've watched many, many releases all over the country, and I've seen these parents come in and the mom's sitting there crying, saying, My nipples are bleeding, I know this will help. And here today, just please do it. Please, please, please, right? And it's hard. It's really hard. You know you have the ability to help. And even if you're thinking, well, it won't help as much, but she's in pain, right? So I get it, it's really hard. And that's where that pre-screening comes in in a way, yeah, to keep them out of your office. Because once they get there, the stakes are so high. Yep. You know, they're sitting there crying in your office, and it's really hard to say no, right? So that's where that pre-screening comes in. But another dentist I was talking to also said the same thing. She was pre-screening and was talking to them beforehand. And are you working with an LC? And they would say yes. And then she realized she wasn't asking enough questions because the yes turned out to be they saw an LC in the hospital before the last time.
SPEAKER_03Exactly.
SPEAKER_02And she's like, not the same thing. Right? So not the same thing. And then after she did the release, she said, okay, so where do I send this? And they said, Oh, well, she was at the hospital, so I'm not really sure where. And she went, Oh my god, oh my god, you don't have anyone. You need to see someone like last week. What do we do now? Right. And so that's where that free screening comes in. But I think one of the most important things from the LC side is we need to buy that time. And we can because we can get them nursing without pain. If we can get them, so there's two things. If we can get them nursing without pain, and if we can get the baby gaining, we can slow everything down. Yes. Make it not an emergency. Right. But when mom's nipples are bleeding and you have a baby that hasn't gained anything, everyone's frantic and wants that to be the answer and wants to do it right now. But especially like a baby not gaining. I hate to see a baby not gaining going to release. I'm like, we have a baby that's in a fight or fight. We have a baby now that is, you know, I was working with a baby that was four houses of her birthday at seven weeks old. I'm like, and they wanted to go to release. I'm like, no, no, not at the time. Your baby is very stressed out, right? Very, very, very hungry. We're gonna feed your baby, we're gonna grow your baby, we're gonna work on wildfunction and all this stuff. But right now we're gonna focus on feeding and calming your baby, and later we'll deal with that. Yes. You know, and same thing with the mom. Like, we're not gonna go into this stressful procedure when you're already got bleeding nipples, you're crying in pain, you're not sleeping, like you're already fried.
SPEAKER_03How could you possibly teach your newborn to feed when it still hurts you? I think you just restated what I want. And it you helped me redefine it. I want babies to no longer be in an emergency state so that we can solve it for the long term.
SPEAKER_00Right.
SPEAKER_03That's what you just described for me. And that was really helpful because when you know what you're looking for, you can find it.
SPEAKER_02Well, I'm so glad, but it is, I mean, we can buy that time. And like right now, I'm halfway through this amazing class on reflexes by Brenna Hayden, and we also did reflexes this last weekend. And by using those, that makes a huge difference, right? Because babies innately have this ability. There's way too much in our culture where we sit moms up, we cross cradle hold, we put all the intent on mom. You have to latch your baby. You need to learn how to do this when we completely ignore the fact that the baby has been practicing for weeks and months some reflexes in utero or this exact experience. But we get in the way. We block them from doing it. We swaddle them, we put mittens on, we put them on these breastfeeding pillows with their body way out here, not touching mom. Like we block them from using their reflexes. And it is absolutely possible in almost every case to get a baby breastfeeding with mom without pain. Now, there'll be still be a little bit of pain because she's already broken down until we get another two or three days and we heal and we get better. But we should definitely be able to do that. Occasionally we'll use a nipple shield, totally depends upon the case. I've had some babies where we just really have to because that kid can't hold on. But if we get baby latching properly, as best as they're able to, we can usually get rid of that pain and take out that emergency. And then everyone can breathe. Right. And everyone can relax. And then we can calmly say, okay, and we're calmly gonna think about this. You know, the other thing is I want a baby that has had improvements going into release. So I always tell parents, I know baby is ready for release when we have been improving and we have plateaued. That's when we're ready because we've increased oral function, right? One of the babies I saw yesterday, mom was like, hey, this last like four or five days, every time I put my finger in, he's pulling so much more. And it's just like, I noticed when I do that and I do all the exercises you have me doing right before feeding, he's not leaking on the bottle anymore. And he's able to hold on to the breast battery, just not coming off every minute. I was like, great, see how that's improving? It's wow, yeah, like the parents can start to see that. We need to see improvement before release.
SPEAKER_03I like that. I think that's another great benchmark.
SPEAKER_02You know, that's the other thing is people think that when I say, you know, we want to wait three weeks or four weeks for release, we want to, you know, work on all this stuff. They almost have this idea that we're sitting there going, okay, let's watch the clock. All right, now we're ready. The weeks have gone by. It's not about that. And like we are actively improving. We should be getting better each day, each week. We should not just be sitting there waiting for some magic time to happen for a baby to be ready. That's not how it works.
SPEAKER_03Right, right. That might also be the communication piece that's missing. So here's what I've observed people's motivations speak to who their client is. So as a pediatric dentist, the baby is my client. Um, and maybe that motivates me in a way. But the pediatricians, that's very clear, the pediatrician, the baby is their client. And the the feeding parent is not their client, they don't benchmark anything on that side. They might hear it. Yeah, they only look at weight gain and the urgency to get there. And the feeding parent is a means to that end, or they're a barrier to that end from their perspective. And so when I see the push and urgency from a pediatrician who's trying to be supportive of breastfeeding, and they say, I want, I want it cut right away. I'm sending them to you because I want this done quickly to resolve it, or the flip, not understanding that because I deferred the procedure to allow this baby to develop, I was told that baby almost failed at breastfeeding because you didn't do the procedure. If we could share the goal of what ready looks like instead of time, that would help. I hope. I'm optimistic.
SPEAKER_02I know. I think it's I think it's really important to have a good team. And that team can look different in different areas of the country because there's other people out there. And sometimes you have a great myofascial therapist, but no chiropractors around, right? So it just depends. But if we don't all work together, we don't see, we can't see what what we don't know. Right. Right. And it's amazing the difference these things can make. I mean, when you watch chiropractors with a baby that has a tongue tie but hasn't been released yet, and you go to that first appointment with a really good chiropractor, it's mind blowing. Like it is mind blowing to watch how these tiny adjustments with two fingers barely applying pressure, and all of a sudden the mom will be like, Whoa, what did you do? That latch feels totally different. The baby's pulling my breast now. Wow. Or, oh my gosh, it doesn't hurt anymore at all. How did that happen? Right. And I mean, there are pieces that I am learning and starting to understand. And I'm in no way an anatomy expert. I am not a chiropractor, but I'm beginning to understand how the hyoid bone is hugely important. And the hyoid bone makes sense to me. I mean, it's right here and everything else. The ones that I still struggle to understand with are the condyles back here. I'm like, they're so important for feeding. And yet I'm like, way back there. I don't get it. But that's where that chiropractor and that body will, they're the lever, right? And they do so much. But we don't, you can't see through somebody else's lens if you don't even try. You don't even ask them, what are you seeing? What does it look like from your side?
SPEAKER_03My question is, how can I help you? It's how I built my practice actually. When they I look at what everybody has like a system to start up from, and it might be, all right, you put a ton of money into marketing or you sign up for every insurance. Or and mine was literally going to the people I wanted to work with and saying, What do you need? How can I help you? And they usually knew exactly what they needed, and we're waiting for someone to ask. So I suspect that advice is going to carry.
SPEAKER_02Nice. Why do you like to see your babies back? You mentioned a post op. So when do you usually see them?
SPEAKER_03I've changed how I've done that.
SPEAKER_02And I think that's a sign of a good provider, to be honest, when you have changes. We all should have changes. That shows that we're re-evaluating our systems and our processes, our results and our effectiveness.
SPEAKER_03So I see the families for a one-day post-op because I am asking them to do wound care. And I think it's heartbreaking to spend a couple days to a week doing something inadequately and then being told a week later. So I like to see them on the one-day post op. And I tell the parents, I want you each to take a turn, get your hands wet before you even come see me, and then I will help you with number three and just make sure you feel confident for the rest of the week. So it's a brief visit. It allows me to see what that baby's one-day post-op looks like. And what I'm developing is a little bit of an eye for high inflammation and low inflammation healing. And I think that's biology. I think that's who the child is. And I look at myself, I have fair skin, and I've had to see the dermatologist a lot, and I scar easily. I am a high inflammation healer. And I see that in some of the babies sometimes that the parents are doing everything and they get these thick, thick fibrin coats over those wounds. And you see another baby, the same anatomy, the same release, and it doesn't look that way. So I like to see the one-day post-op and it gives me a little bit of prediction. And then I like the one week post stop so that I can see how they've healed, how they've settled in, get a little bit of feedback on what changes, who I might need to urge them to see along the way, because hopefully they've already started their body work at this point. Maybe they needed the second nudge saying, you know, I think you might see better. Outcomes if you go ahead with this. Maybe you're just waiting for that push. And then I also adjust my post op on that day. So if I have that more inflammation healing, I say, you know, this one really does want to contract. This wants to be thick. Don't let it six times a day. Keep up with the other oral care of the play, but stay the course. And if it's looking pretty positive, I'll drop down to four because I think fatigue is important to acknowledge. And they have other things that they need to be doing. If I can take it off of their plate, I'm happy to do so.
SPEAKER_02Yeah. I mean, I think it's unusual to have that early of a post-op. I think it's beneficial and I think it can be great, but it's not something I commonly see.
SPEAKER_03I saw some reattachments in my earlier cases, and it upset me. It felt like a failure. And it wasn't necessarily a failure, but that's how I felt about it. And I thought, well, what could I do differently? And one was more pre-work, so people were prepared. And the other was catching the human error sooner.
SPEAKER_02Absolutely. Yeah.
SPEAKER_03And the the teams that we have in the city do not feel as confident with fresh wounds. So I said, well, it's my wound. I will care for it then.
SPEAKER_02Right. I think that when I have a client that didn't get the result they were looking for, I always tell them that there's really three options. One is that it was an incomplete release. And especially if I'm seeing them and it was like two months ago, I can't have that. Right. One was we didn't have the best wound care, we didn't keep it open. We had a good release, but we didn't keep it open. And that third one that not everyone really thinks about is it wasn't going to stay open because even though they did those active wound care, baby was living in a place of collection. And that's where that pre-work comes in. If baby is here, we've got that chin tucked on the chest, arms contracted in, baby's in that ball, that tongue stays low all the time. Pushing it and opening it four or five, even six times a day is not going to be enough. No. Maybe that's the high inflammation I'm seeing. We have to get that baby back here. We have to get those babies. That's one of the things that I'll have my parents do. And like on a really crappy day, especially in that first week, post-phenectomy, I'll be like, there are going to be days where you just can't do anything, you know? And sometimes the moms are still recovering. They may have had a really difficult pregnancy in birth, or sometimes they have like a couple of other kids at home. Oh, yeah, right? All these other things, life and factors and everything else. So I will tell them on the days that you can't do anything, you do your active wound care. That's not an option. That always happens, right? And you get that baby into an open head hang position, if nothing else. Like some days we just don't get really good oral function and we just don't get our exercises done. And sometimes that's okay. We restart again the next day, we try to have a better day. But I always like to give them that backup plan basically to say, when you can't do anything else, put the baby on your chest, tip their head back, right? Lay them on an exercise ball, right? There's so many different positions you can do head hang in. But get that neck back, help that baby stretch, get that. I mean, you tip back and your tongue kind of naturally will more tip up against your palate. Yeah. And those babies are just living in that flexion. And that's a lot of times, those are the kids that had no pre-work, right? Absolutely. And they may have had a head preference, but they were also just incredibly tight and tense and tucked. And when you live in flexion, we're not going to get a good outcome.
SPEAKER_03Yep. I'm thinking of a baby I saw today. That's what I was saying to the family. I know they look so cute, curled up like that on your chest, but they're not in the belly anymore. So they don't need to be that shape anymore. And that's the work. That's what you're going to be looking for.
SPEAKER_02Oh yeah. I had a dad doing it recently with my twins' visit, and oh my gosh, he should have taken a picture because he got the best head hang. And I also tell parents there's there's fine lines in everything, right? There is too much of anything. Like we always want to be in a good spot. And you can put a baby in head hang until they basically almost possum, right? So they just like they're not relaxing, they're just super stressed out. And you do have to watch for that. And a lot of it is what state is that baby the rest of the time. Those are those high stress, holicky type symptoms, babies where sometimes they just can't handle that, and we have to work up towards it. But he got this baby in this beautiful head hang and she leaned back and she tipped her head and she smiled. And she was so open, and he was just like, Oh, this looks good. And I'm like, look at how happy she is. Like she looked so relaxed. And I'm like, that's what we want. And it's the same thing with tummy time. Tummy time can be exceptionally therapeutic, but it can also be done very poorly. When babies like all to have parents put the baby on the floor sometimes, and I'll say, Okay, just turn the camera over, let me watch. And they're like, look, the baby's holding up its head. And I'm like, no, no, we're hinging from the waist. Like, that's not what we want, right? So there's eye line in things, right? And we do have to make sure that we're staying on the therapeutic side and not going to the other side. But those are big issues, that body stuff.
SPEAKER_03And we don't recognize it in ourselves. I when I think about that example you gave about hinging at the waist, I'm turning 40 this year. And my husband turned 40 last year. That's what I like about him. He's always older.
SPEAKER_02I know. Mine is the three gift they give us.
SPEAKER_03And so we talk about how things hurt now. But my whole adult life, I've gone through these very athletic activities and periods. And when I think about like my heavier weightlifting time, I think about how my body worked and I compared it to other people. And my flexibility served me very well. And I would see similar size, similar class people not able to do what I could do without injury or not hit the numbers that I was because they didn't actually have full flexibility of their back and shoulders. And you just described it in a newborn, right? Like we don't recognize our compensations because we don't look at them. We just compensate. Yeah, it's interesting.
SPEAKER_02And they're hugely important. I mean, people don't recognize what's happening because they think everything is normal. And a lot of times they're being told everything is normal too. I do a lot because I'm on telehealth, I do a lot of photos. When I'm seeing an older baby, parents will send me a ton of videos. I will take those videos, take a screenshot, write on it. See how your baby's walking around in flexion? See how they never lift up? See how when they stacked the blocks, they tipped back to be able to see they didn't lift their head. Right. Right. And I'll do the same thing breastfeeding. Sometimes I'll take a quick little picture, show them. Look at how those shoulders were on baby's ears. Put your shoulders up here and drink. How's that feel? Right. Right. Or look at how you try how baby was latched with their chin against their chest. Take a sip of something. See how it feels to swallow. Or just try to swallow right now, you know, and tip your chin forward. It does not feel good. You know, and that makes a difference. They're not trying to ignore it, they just don't see it. Right. And it and it's the same thing for all of us. I mean, my myofunctional therapist said to me recently that my daughter's smile on one side was slightly higher than the other. And I was like, really? And I'm looking and I still couldn't see it. And finally she looked at me, yeah, in a picture. And I was like, okay. And so we've been working on, and it was the side that she had had a couple of loose teeth, and then stopped chewing on that side for months. And then after that, just got used to chewing on the other side. Oh, yeah. And it became a pattern. Yes. And so we were starting to see the difference in her face.
SPEAKER_03And that's the thing, small disruptions can become habits. Yes. And I think this is an area, maybe not exactly what you do all the time, but I, because I'm young child focused, I'm seeing the one and the two-year-olds as they go through their intro to daycare colds, that sort of a thing. And I say, you know, part of rural hygiene is nasal hygiene. And you should be clearing out their noses when they're well, not just sucking the noses when they're sick, because you don't want the stuffy nose to be the habitual mouth posture.
SPEAKER_02Oh, yeah.
SPEAKER_03Matters. It totally matters.
SPEAKER_02Super matters. I wish I had known that. I mean, I think that's where my daughter went down the path because both my girls bars fed for over two years.
SPEAKER_00Right.
SPEAKER_02Had very similar outcomes in terms of they both had time tides. One was subnucosal, harder to see. One was nightful tower, very obvious. But my younger one, around five, started getting a ton of more symptoms. And she has really bad deskmite allergy. And that environmental allergy, right? She got inflammation, couldn't breathe through her nose, opened the mouth, started breathing through her mouth all the time. New face, new habit, new faith, new shape of her palate. Now we're at this palate expansion point, right? Because no one and I was asking for years, and I didn't know enough to ask the right questions or to find the right people, right? But we don't know what we don't know. And that was where I was then. And it's just how it is. But yeah, it changes. And that's a big one. That and no one talks about that either. I mean, I liked that you said it.
SPEAKER_03I wish I had known. That's why I have my parenting classes. It's just chock full of the things that people say. I wish someone had told me sooner.
SPEAKER_02Well, I'm, you know, I'm gonna copy something, Helen. Bulkin says on her podcast, Untethered, is that she thinks that pediatric dentists are gonna become like the new pediatrician in like 10 years. And I'm like, I'd love to see it because what you're doing, besides the ten tiny aspect, too, but even in the rest of it, in the infant moral health, is very uncommon and very needed and much more wide, encompassing than people think. Right. And if we can make a difference when they're little, changes everything. Absolutely. I mean, it makes such a difference in all of these long-term outcomes. Yes. So I am excited here. I'm on it. I'm excited too. It was really awesome. And I think we're gonna end this because we have an exciting evening happening soon. We do have more providers. Yes. Thank you so much for joining me.
SPEAKER_01Thank you. When 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.