Katie The Traveling Lactation Consultant
Katie The Traveling Lactation Consultant
Ep 38 Avery Young
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In this podcast episode, Katie Oshita and Avery young discuss the blinding focus on tongue tie and oral function that is leaving many families in worse shape after support. First by not know know to immediately stop breastfeeding pain, too many families are rushed to release by providers- Avery Young strives to change this by teaching other IBCLC's all about how to engage baby's feeding reflexes for a deeper, pain-free latch. Then many families are still treated in this mono-focused way with other providers who support oral function, but know nothing about how to see and care for a dyad. Avery Young has created a visual to try and bring awareness to the importance of prioritizing parental and infant wellness and breastfeeding relationship above oral function. Listen as this and much more is discussed.
Podcast Guest: Avery Young is an International Board Certified Lactation Consultant licensed by the state of Georgia who is on a mission to help change the way we latch and feed infants. She has master's degrees in both Biology and Science Education and has been in private practice as a lactation consultant since 2014.
She spent the first half of her career teaching Biology to anyone who would listen, from middle school through college. She began her practice as a lactation consultant in 2014, after the birth of her second child, with the goal of helping to empower families with the resources and confidence to make decisions that were right for their own families.
Her own journey into motherhood and her quest to understand the needs of her own neurodiverse family led her to a deeper study of infant reflexes, neurology, and brain plasticity. It was during this study that Avery began to understand the significance of reflexes and she began to observe and learn from babies during the latching and feeding process.
She began to notice that babies have a highly repetitive and predictable sequence of behaviors that occur during the latching process. She quickly realized that those sequences of behaviors - which she calls the Cascade of Feeding Reflexes - have a far bigger role than just helping an infant to latch. They also establish the foundation of movement.
By helping infants engage their feeding reflexes she believes we can change the developmental trajectory of an infant for the rest of their life, and her mission is to help everyone understand what those reflexes are, and how we can use them to make feeding better.
When she is not working, or researching answers to her own questions, Avery enjoys reading, traveling, and spending time in nature with her husband and three children, in their hometown of Atlanta, Georgia.
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 when related to tongue tie or low supply. Katie is also passionate about finding the root cause of symptoms, using Functional Medicine practices to help client not just survive, but truly thrive. 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 Avery Young, an international board-certified lactation consultant licensed by the state of Georgia, who is on a mission to help and change the way we lact and feed infants. Avery has her master's degree in both biology and science education and has been in private practice as a lactation consultant since 2014. She spent the first half of her career teaching biology to anyone who would listen from middle school through college. Avery began her practice as a lactation consultant in 2014 after the birth of her second child, with the goal of helping to empower families with resources and confidence to make decisions that were right for their own family. Her journey into motherhood and her quest to understand the needs of her own neurodiverse family led her deeper into the study of infant reflexes, neurology, and brain plasticity. It is during this study that Avery began to understand the significance of reflexes and she began to observe and learn from babies during the latching and feeding process. Avery began to notice that babies have a highly repetitive and predictable sequence of behaviors that occur during the latching process. She quickly realized that those sequences of behaviors, which she calls the cascade of feeding reflexes, have a far bigger role than just helping the infant to latch. They also establish the foundation of movement. By helping infants engage in their feeding reflexes, she believes we can change the developmental trajectory of an infant for the rest of their life. When Avery is not working or researching answers to her own questions, Avery enjoys reading, traveling, and spending time in nature with her husband and three children in their hometown of Atlanta, Georgia. So please welcome Avery Young to the podcast today. Thank you so much for joining me today, Avery. I have to say, I was had such a wonderful time at the class in October in Connecticut, and you just completely changed my practice. I've been interested in learning about reflexes slowly, but I feel like doing that in person, especially just being hands-on and in person, really brought everything together so well that it's really changed my practice. And I just knew that we we had to meet, we had to talk about it because I want more people to know about what you're doing and how you're trying to, you know, really support to educate about reflexes and how important that is in the feeding process.
SPEAKER_01Well, thank you for having me here. Yes, this is my passion is to help this become common knowledge. So this should be the thing that I think everybody should understand with their baby and really ourselves, but at least starting with babies and how to how to help babies get better and how to help them feed better and how to help families feed better and to understand why babies have the problems that they have.
SPEAKER_00Right. And it's it's so basic. And I've actually had a couple of different podcasts on this lately, where we've been talking about how we're mammals. Like I recorded with Shaz Tayabi from Vancouver, BC, who made a documentary called We Are Mammals, right? And talks about how we're not feeding in a mammalian way because we are coming in and taking over and wrapping up these babies and doing all these things. And it's as you talk about reflexes and in your class and everything, I think it's so interesting because it has this dichotomy of so basic and yet super complicated, right? Like there the reflexes themselves are really basic. Every baby has them. And when we feed that way, it's so much more in, I don't want to keep saying basic, but like intuitive and mammalian, and like this is how it should be. But it's also really complex once you start learning about all the different reflexes and how they each fire off and how they start a cascade sometimes, right? Because it's not just an individual reflex, like one can lead to another. Right.
SPEAKER_01And I think like I think that's a good point. And I think it's easy to get bogged down in the details, to get bogged down in the little nuances of all the different reflexes and what they do and why they matter. But the truth is, is that that's just our learning about them, right? And I think what makes feeding hard is that we work really hard to rewire the baby's brain. All of those compensations that we're doing, we're doing them because we think that's how it's supposed to go. So we're really trying to teach the baby's brain to do something different. We're asking the baby to do something that they're not biologically designed to do instead of listening and understanding what the baby is biologically designed to do, and then using that to help them make feeding better. So we're asking the baby to work harder so that we don't have to. And that doesn't seem very fair.
SPEAKER_00Right. And it's it's definitely not less work for the parent either when they're doing it this way. I mean, it's they're trying so hard. These parents are taught, you know, from a very beginning of feeding that they need to take all this ownership, that it's their job to latch the baby. And if the baby's not latching right, they're doing something wrong, and they need to sit up and swaddle the baby and hold their breast and do all of this stuff to get the baby on. And the more you understand these reflexes and the more you understand, and really the basic fact that we're mammals, you step back and you're like, wait a second, no other mammals do this.
unknownRight.
SPEAKER_01That's what are we doing? Right. Yeah. It's not hard for any other mammal, right? Other mammals don't have bloody nipples, they're not sore, they're not sad when they're feeding. And they would tell you like you can watch videos of mammals that like cats, for example, that hiss and push their babies away when they hurt. Like they don't lie to their babies about it. But when they're feeding their babies, they're not doing those things. They're purring and they're licking and they're enjoying their experience universally among all mammals, except for humans.
SPEAKER_00Right, right. It's we have a tendency to make things overcomplicated, unfortunately. But this is one of those areas where we really have excelled. And, you know, when I try to tell parents, especially in like a prenatal consult, I did one last night, and I'm talking about, you know, the birth crawl and how it's an event that needs to be repeated, and how all of these reflexes fire off. And they're like, well, why wouldn't why doesn't this just happen? I was like, well, it does happen. I said, the problem is we get in the way, right? Because if you take a baby and swaddle them, they now can't use their hand reflexes of Palmer and Beck, and they can't use their body reflexes of spinal gallant and ATR and stuff to reposition. And so now they're stuck there, right? And then you shove the boob in their face and they can't use any of their other, like their root and their seek and their gape and their attached reflexes. So they're there. We're just not allowing them access, right?
SPEAKER_01And I think some of that has to do with, yes. And I it's I suspect that some of this has to do with medicalized births, right? So babies didn't used to be born in hospitals. We used to be born in environments where there wasn't intervention right after birth. And so so much of what's happened since we shifted labor and delivery into hospitals is everything becomes very standard and very medicalized. And what happens with that is that we have all these procedures that we follow after birth. And when we have medications with birth, that may also prevent these babies from reflexes from firing. So what we see then are babies that are born in a state where their reflexes may not be as active as they would have been otherwise. And then we think that that's normal. So then we make all of these policy and procedure decisions based on these babies that aren't firing normally. And that transfers down to what we think babies are capable of doing because we're not actually seeing what babies really are capable of being.
SPEAKER_00Right. Because we're not seeing the normal. We're not, you know, that's one of the things that I say a lot too, because people ask me, do you see a lot of, you know, like I see a 90% of my clients have tongue tied babies, and I'll say, I knew 90% of babies aren't tongue tied, but you have to remember, I don't see the normal. Like someone's breastfeeding fine, they don't call me and schedule a consult just to hang out. Like I see people who are struggling, and I think it's the same in the hospital. Like you said, there's so many more interventions, and they start that intervention cascade that they're not seeing the normal babies. You know, you go to a home birth or to a birth center, and those babies are acting different, right? They're those reflexes are firing, they haven't been exposed to as much IV fluids, or their weight loss a lot of times, is less dramatic. And they're not having most of the time, those kids aren't having the same, you know, effects of medication during birth either. Right.
SPEAKER_01I think, yeah. And I think the biggest thing is just understanding what's normal and what's not, right? And we're always working from this place that babies that human babies need support to latch, then we're always going to be climbing an uphill battle. But if we always work from the place that human babies are just like every other mammal and being able to latch and move to the breast or chest and feed is a biological imperative, then that should be our default. And then we could just understand why that's not working in certain circumstances for certain babies and help that happen instead of thinking that that's the case for all babies, right? Or all human babies. That's the that's the framework that we need to shift to and our practice and understanding how babies feed.
SPEAKER_00Right. We need to understand the normal before you can treat the abnormal. Yes. And I had a I had a client two days ago that asked me a really interesting question that I hadn't thought of because we were discussing how vaginal births have different gut flora microbiota than C-sections, right? And the client had delivered, this was her second baby, had delivered at a birth center. And she asked, is it different to have a water birth versus a, you know, air or land birth, however you want to call it? Because she said that was the difference in this baby for her, is this baby was a water birth. And I said, you know, in terms of their gut flora. And I said, wow, that's a really interesting question. I said, I don't know. I'm gonna have to look that up. And I was looking at some studies last night and I came across an interesting one that didn't really answer this question. I'm not sure that there are really, I haven't been able at least to find it, but I'm not sure there are studies that really truly compare gut flora in air slash land births versus water. But what I did find was an interesting study that had compared hospital medicalized births with home births. And the home births were actually divided into two categories of water and non. And they didn't find a difference in those. So I had sent this to the client. But what they did find was a difference in the microbiota for baby and mom in the home birth versus the hospital births. What I found really interesting there was that even the mom's gut flora was different in the moms that chose hospital birth versus home birth. And I was like, whoa.
SPEAKER_01I think that's interesting. That's probably more of the demographics of who picks what population, what population picks hospital birth versus the type of population that would pick a home birth.
SPEAKER_00Right. And it was, it was a small study. I think the home birth number was only like 34, and the hospital was something like, you know, 50. And it was, it was very much in the I think this is important for people to remember too. I mean, no studies really ever say this is the way this is what happened. Um, they all say, you know, this is one factor. We've looked at this. It was a small study a lot of times, and more information is needed, right? Like, I don't think studies really ever give us A plus B equals C. They don't really do that unless you're taking a large, a large group of studies and really looking at them. That's not how they're designed to do. They're not designed to just give us the answer. You know, they're designed to look at one specific question and try to get some information, but you you can't study all people at once. But it was an interesting one because I hadn't really thought about that at all. And I hadn't expected the difference in the maternal gut flora. And I think you're right, it's probably a difference in population and who is choosing which, and you know, their gut health, their, you know, all of their choices and their health and everything and their environment as well. I mean, we and these samples were taken after being in the hospital. So, you know, did their microbiota take a hit after being in the hospital?
SPEAKER_01I bet you could also look at how those parents were managed during pregnancy too. So that might also be a factor of like, how are we managing? If you're in a hospital, you're probably with a more um traditional OBGYN team. And if you're at a home group, you're gonna be with a different midwife. But speaking of water births, and we talk about mammals, you know, I don't know that there's any other mammal that intentionally gives birth in water except for aquatic mammals. So that's something else to think about. Like, what other mammal does that? Is that really a normal sort of mammalian birth style, or is that something that we've sort of adapted to because it helps with labor and it feels good and that sort of thing? But did, you know, I think that's kind of an interesting, an interesting thought. I don't know that there are any land-based mammals that intentionally birth in water.
SPEAKER_00Right. I don't I don't know of any either. And I thought it was an interesting question because the basically the client had asked me, we had talked about how sometimes people will do vaginal seeding for C-section babies to help with their gut flora, because we know now that the a vaginal birth is really the largest seeding event of a person's life in terms of their gut flora. And they asked me, they're like, well, should we have done that with a vaginal, I mean with a water birth? And I was like, such a good question that I really had never thought of. And part of what I love about our job and our profession is that, you know, I get clients who are so incredibly intuitive and have all these wonderful thoughts and curiosities and lead me down these holes. And I'm like, I'm super interested in this now. And it was very, it was really nice to have such an um interesting conversation, but just to think about how, yeah, they're these parents are all thinking about these things too, you know.
SPEAKER_01I would speculate on that because I think it's the seeding that happens inside the vaginal canal, though, when they're descending that goes into their mouth and their nose that happens as they're they're crowning and moving through. That I don't know that the I mean, I think that's an excellent question. And I would suspect that the seeding event happens internally and not externally. And so the baby doesn't really come into contact with that water until they, you know, they hit it on the outside. And so they've probably gotten seeded by them, but that would be interesting to look at the you know, gut health or the gut microbiota of those babies across the spectrum. And it's hard to look at gut health stuff because it's so variable anyway, and there's so many other things that can impact that. But I love it when people are asking creative questions. That's amazing.
SPEAKER_00I know that that was actually my answer too, was I was, you know, I said I I don't know of an exact answer here, but my thought process would be the same that that baby has been seated during that descent before it entered the water. Yeah, you know, but it's a good question. It'd be a really interesting study. If anyone out there listening wants to do a study, let me know because that would be such an interesting one and like love to hear how it goes. Um, but it was, you know, it's really interesting when these clients have such good questions and such interesting thoughts, you know. But on on the reflexes part, you're pretty deep in this. Like you do a lot of reflexes and you do a lot of rhythmic movement training as well as a as a like a technique and a method of working with reflexes, correct? Yes. So how did you how did you fall down that particular rabbit hole? Like, because it seems like a big one. You've really dived into this pretty deep.
SPEAKER_01Yeah. So, you know, I learned about reflexes back in 2017, I think, at the IBCLC masterclass through Brennan Um Hayden and went then and thought thought they were interesting. So I I just got enough to find that they were interesting. And then I went to the Rhythmic Movement Training International to take some of their courses. And as I started taking their courses, I wasn't sure why I was taking them, other than I thought they were fascinating. I wasn't 100% sure how it was going to even help in my practice because it was really not about babies, it was really about older children. And I am a family that, and I really kept going because I have children that are neurodivergent. So, and I'm a neurodivergent human with neurodivergent children. And so I kept going down that pathway to learn more and more to help understand, really to start off my own children and my own journey. And then once I started understanding more and more about them, and then the lights started connecting, the dots started connecting in my head, then I went backwards and started really playing with them with babies and starting to really understand them and see them. And so it was really that process of learning about reflexes and taking lots of walks and like having lots of conversations in my head and talking to some of my dearest friends, and they just would sit there while I would do information dumps on them trying to figure things out. And then I started watching babies feed, and I started seeing babies repeat the same sort of patterns over and over again during the feeding process. And it was watching those babies repeat the same patterns and thinking about like babies should be feeding in extension. So, what would happen to help them get into extension? Because it's it's not that babies are supposed to be in extension because we put them in there, they feed in extension because they biologically move their body to get it into an extended position to make feeding better. So watching the babies start to do that and then starting to see them do it from one baby to the next, starting to understand what those look, those look like helped me sort of piece together the reflexive pathway, the cascade of reflexes that babies use for latching to see that really the root leads to an opening the head and neck, which is the seeking reflex, and the seeking reflet sets up a chin plant and that cues the gaping reflex. So that's what cues the babies to open their mouth open wide, and then babies will come forward to attach, and then that initiates the suck, and then we can start with the other reflexes that help them swallow. So it was really just looking at babies and asking babies questions, so many questions. Babies have given me so many answers to sort of see what helped them feed better and to see what babies were doing. That was exactly the same thing. Because when a couple babies are doing it, it's interesting. But when 30 babies do it and 40 babies do it and 50 babies do it, then becomes a little bit more than interesting. It becomes something that has to be present among all babies. And so when I started to see that indeed that was present among all babies, it helped me sort of understand that that feeding is really also reflexively driven. We just don't actually understand the feeding reflexes that babies use. And when we do understand them, it makes feeding so much better because we start to work with how the baby's designed to feed instead of trying to teach the baby's brain something different.
SPEAKER_00Right. I mean, it's it's a pretty amazing thing. When I took your class in person with Jennifer and Sharon Vallone and Dr. Faranay in Connecticut, it was really, it really brought together a lot of the things that I've learned from yours in the masterclass and these other classes, and it brought them together in an in-person way of being able to pull everything together and actually implement it, right? And it was such a such a wonderful course. But I've been playing the last two months really and watching all these babies and go, okay, let's do this. Let's do that root, seek, gape, attach, suck, and let's see what happens. And the first, I have to say, the first time it happened with a client, I'm not sure who was more surprised, me or her. I was like, oh my God, it worked, it worked, yeah, yeah, yeah. Like it was just so wonderful. And to see it and to really be like, oh my gosh, this really is what they're designed to do. We were just getting in the way. And to be able to show parents and say, okay, so instead of sitting and swaddling and positioning and doing all of these things, get really comfy, right? And a lot of times I'll have them lay the baby's cheek on their on their breast or you know, hang out on the chest and let the baby kind of get ready and get into that feeding space. And usually we'll do like a little lift on the breast instead of a C shape if we need to help with that seek reflex and that gape and try to get baby into extension a little, especially because a lot of times the parents still have a really hard time of not doing anything, right? Like if they've been sitting up and swaddling and positioning and holding their breast and doing this for weeks, the idea that I tell them to lay down and let their baby do it is like, wait a second, what do I do? Yeah. So it do give them little things to be like, okay, well, here, look for this, or you can lift your breast, or you can make sure baby's, you know, positioned comfortably for both of you. And or, you know, we'll talk about like baby spine being straight and having their feet planted, things like this, right? But when it happens, it is so I find it very empowering and very, very inspiring for these parents of like, oh my gosh, this actually works. Like, because it's one thing for me to sit there and tell them your baby has these feeding reflexes, and if we touch their hand, they close it on their, you know, like it's one thing, it's all like theoretical. And then when they see it, they're like, oh my gosh, this makes a huge difference in my life.
SPEAKER_01Yes. And I that's the thing about reflexes that I love. Like, you no one has to when I was teaching the classes, like, you don't have to trust me because you'll just see it. So don't believe me. Go practice, go look at it for yourself. Go. See the difference when we get the chin planted to see what that does for the gape reflex and the width of the gape and how deeply how wide the baby can open. Go look for those patterns and then you'll start to see them in every single baby. And then you'll understand it. It isn't because you believe somebody, it's because you see it. And then you just know that to be also true.
SPEAKER_00Right. And that's the thing about this is that it's one of those wonderful things because there's things that we learn that we we get to practice sometimes occasionally, you know, and then there's things that we learn that we really get to do all the time. You know, I mean, for example, I took Jennifer's Jennifer Tao's gut health class, and it was really wonderful and great, but I don't use that in every single consult, right? Because I don't always need to. And this is one of those things that pretty much in almost every consult, I mean, it's a a little different. We talked about this before. It's a little bit different when I see the older babies, right? But if we're seeing these babies under four months in pretty much every one of those consults, this will come up and we will work on feeding in a more reflexive way to really change the dynamic of feeding. And it's yes, it does the it takes away the pain for the mom and it increases transfer for baby. And I tell the parents like those are kind of the side bonuses. I know those seem like the biggest bonuses, but they're really not. The biggest bonus is that baby is doing what they're designed to do, right? Right. The baby is getting to use their brain the way it's meant to be used.
SPEAKER_01Yeah, it feels better, right? And parents feel that that when I work with parents too, and we work on letting their baby do it, they sort of tell me all the time that they innately didn't feel good feeding the baby the other way. It felt funny and awkward to them. And then when they start letting their baby become an active partner in the feeding relationship and giving their baby its space to do the things that that baby's designed to do, then it feels better for everybody. The baby's on their home territory, right? The baby's got that. They know what they're doing. And then your job as the parent just becomes supporting your baby and doing the things that your baby's innately wired to do. And more importantly than being innately wired to do it, they need to do it because it's those reflexive processes that helps the baby learn how to move their body. And learning how to move their body maps their brain so that they have the ability to move the muscles that those reflexes move. And that cascades down to the other skills that the baby has in life. So those latching reflexes are just setting the stage for function that the baby then uses for tummy time and the other phases in life. So it's a win-win all the way around because it's a win for the baby, it's a win for the mom, and it's a win for the family because the baby's going to feel better to you.
SPEAKER_00Absolutely. And you're right about the later stuff. Like it, this, you know, I think sometimes we get in this idea that feeding is just this breastfeeding or bottle feeding is just this like temporary thing before we get them on solids and they get to be like a normal person and all of this, but it's a very necessary part of development. And the skills that they use and practice and learn during breastfeeding or chest feeding are magical and really important in all the next things of tummy time and sitting up and standing and being against gravity and crawling and walking. And all of these are very important. And we definitely see, I mean, I definitely see these babies that were not doing reflexive feeding, we're not allowed to feed in a really neurobe normal neurobehavioral way and had some sort of oral dysfunction, then turns into a lot of times these babies will then have body dysfunction and not, you know, not do tummy time in a comfortable way, not be sitting at a normal expected time, not be able to crawl in a typical quadruped way. And it just, you know, one follows the next. And I think too often we're looking at this breastfeeding as just the next stepping stone of like we just have to do this till we get to solids.
SPEAKER_01Like right. Yeah. I mean, I think we give lip service to the idea that breastfeeding is more than calories, right? We we talk about bonding and connection and all of those things, but I think we really miss the boat a little bit with understanding that breastfeeding is the mechanics for breastfeeding and chest feeding is more than all of those things. The mechanics of breastfeeding and chest feeding is how the baby's brain is wired to learn how to move. And if the baby's brain has problems with breastfeeding or chest feeding, then that means that that pathway, that connection between those muscles that they would need to use in the brain isn't as clear, isn't as well developed as it needs to be. And that's not gonna magically just get better. It gets better through use. If it doesn't get used, then the baby creates a workaround or a compensation. And so that compensation is gonna show up again in tummy time and it's gonna show up again in tummy time. And when that happens, they're not able to develop the skills that they need to develop in tummy time because they didn't have access to those muscles. So now they have a different workaround, a different compensation. And that compensation then shows up when the baby's trying to learn how to sit upright in space because they didn't have access to those muscles again. And so that compensation cascade also happens. And then we end up with a child that when we're finally getting the tone, the compensations that are strong enough to go upright in space, we still don't have access to really those initial muscle sets that we were supposed to have. So it's really important that we understand that feeding is so fundamentally imperative for infants. That's what they do more than they feed 10, 12, 14 times a day, right? If we're feeding so many times, then it has to be super important biologically. And it is, it has such an important role. And I think we don't really embrace the role that feeding has in setting the sort of foundation for development for babies.
SPEAKER_00Right. And I think if you also go back to the fact that we're mammals, I think you can also say we're meant to be carrier mammals as well, both by design of our bodies and babies and by evidence of the composition of our breast milk. You know, it's it's not like a seal's breast milk where they can breastfeed, you know, twice a day because they've got a 45% fat content, right? Like this is we are meant to feed many, many times a day, right? Like you said, sometimes 10, 12, 14, 15 times a day. And that there's a reason for that. And it's not just the composition of the fat and protein and calories, it's not just the fact that we wear our babies. It's got to be because that is the behavior and the practice that that human needs in order to be able to go to that next stage.
SPEAKER_01Yeah, it sets the bodies aren't wasteful. And so we can't biologically afford to be wasteful. So one thing always leads to something else, and feeding is just not different.
SPEAKER_00Right. And it's, you know, it's so interesting to to watch all of these reflexes fire and to watch all of this happen and to think about how much we in this Western medicalized society really get in the way. And I wish, my gosh, I wish this was so common knowledge. Like I've thought about I may have to take a hospital job when I move back to Washington, you know, as a temporary to kind of get benefits from my family as we settle and everything. And I was thinking about it in kind of a like, hush, it'll be interesting to balance that along with private practice. And then part of me thought, what could I do? You know, what would be magical there? And I was like, wouldn't it be magical if I could get a hospital group of nurses all teaching reflexes? Yeah, or just letting the baby or just understanding enough, right?
SPEAKER_01Like allowing babies to go through their reflexive patterns, right? That's my mission. That's my goal is to change how we latch babies, to help babies be able to latch in a way that feels better for them, that's easier and feels better for the whole family, because it's easier for everybody, like you said, when babies are engaging in those reflexes. That's how their brain is wired for it to happen. We're working harder and definitely not working smarter to help babies feed.
SPEAKER_00Right. And it there's a part of me that's like, gosh, if we could start getting this information widespread, like if we could start getting the hospitals are the place where this happens first. And I'm like, they don't need to be, you know, reflex experts. They don't need to understand everything. All they need, all we need to get going with is like the idea that baby knows how to do this, and let's give them the ability to do that, right? Like let's step back a little bit.
SPEAKER_01Yeah, we just need to redefine what normal feeding looks like, right? And we need to define normal feeding as using the reflexes, the baby's own reflexes, to go through the feeding process. That's it.
SPEAKER_00Right. And it would be mind-blowing, right? Like it could just be so huge. And I think about how many clients that I see that it broke down in the very beginning, right? And it's like if we could change that beginning, if we could change how they're taught in that very early days, we could I feel like there's a large percentage of breastfeeding problems that would be changed.
SPEAKER_01Right. What how would outcomes of breastfeeding be different? So there was a study that was done in the early 2000s that looked at like infant pain and latch pain. And it was in uh it was done in Australia. But what they saw in the study was that they did a they looked at a study of of moms who had delivered in an Australian hospital. And they found that like 70, 70% of the women that delivered had latch pain when they when they left the hospital. And it was like 40 plus percent of them, 50% of them had nipple damage, right? And then they came back, I think it was six weeks later, and half the women still had nipple pain, and maybe 25% still had damage, right? Imagine what would be different if we didn't start off with nipple pain, because I think we think that nipple pain is normal, and that there's so many very narratives out there. So the narratives out there about nipple pain is that like nipples just need to toughen up, they're sensitive in the first few days, and tongue ties, nick tongue-tied babies have nipple pain. When the truth is, is that latch pain is unrelated to all of those. Latch pain is related to how wide the baby's mouth is open and their positioning when they're latching. And so, what if we could start everybody off in a way that feeding didn't hurt? Imagine, imagine how different outcomes would be if feeding didn't hurt.
SPEAKER_00Oh, yeah. I mean, what it almost feels slightly crazy to say, well, I'm gonna do something even though it's painful 10 times a day for the next six months. Like, why would you do that? You know what I mean? Like it it's not surprising that parents choose to wean. It's not surprising that they choose to stop breastfeeding because, well, there's some basic biology that says that we don't keep doing things that are painful and damaging. Like that is not that is not good evolution, right? That's that's biology tells us don't do something that's going to keep hurting yourself.
SPEAKER_01So we ask parents to feed on demands, right? But really, and then it hurts. So then they dread feeding on demands. And then what happens is they get into that really gets into this negative feedback loop because then you feel like an awful human because you dread feeding your baby, right? And then you dread feeding your baby, and so that makes that feeding feel so bad. And it's not your fault. Of course, you would dread feeding your baby if it hurt you and it's hurting because we aren't helping a baby use their own skills to latch, and it doesn't have to be that way. It's such an easy fix for most babies. That's the thing that's so amazing about it, right? It really is like a magical switch when they can go through their reflexive patterns. Latch pain stops almost all of the time.
SPEAKER_00Right. And I think one of the things that you brought up, which I loved in the class, was you talked about that study with the jaw. Will you just kind of highlight that again so I don't paraphrase it and miss something?
SPEAKER_01Yeah. So, you know, as you look at the reflexes, they're a cascade that they pass off from one to the next and they have a biological purpose. So besides just passing it off, they sort of set the stage to get to the end goal of where we can swallow safely. And I think feeding is kind of a funny thing because, like, you know, a baby feeds and there's two outcomes that happen at the end of a feed. The one outcome is that they feed and it goes down their esophagus. And the other outcome is that milk goes down there, it goes down into their lungs and they choke and they aspirate, right? So having this pathway where you either swallow or choke and die is kind of bizarre that we would have one outcome going to the same thing, so like to two very different endings. So the body has all of these ways to set up safe swallow, to make sure that A happens instead of B happens. And one of those things is feeding in extension. So when your head goes back into that extended position, what happens is in order to go into that extended position, it starts to activate all of those muscles under your neck, right? Those suprahyoid muscles. And it's those same suprahyoid muscles that are involved in making sure the passageway that the milk goes down is appropriate. Are we going down the airway or are we going into the stomach, right? That's controlled by those suprahyoid muscles. And so when we go into extension, a couple cool things happen. There was a um the study that you were talking about was in the, it was a that was a late study. So that was in the 2020s. And it looked at it was a modeling study. So it looked to see what happened if, if we have this biological model. And what they found was that you cannot get maximum mouth opening. So you can only get your mouth open to its maximum point if your head is in extension to about 110 to 115 degrees. So we have to get into extension before we can get maximum mouth opening. And then what happens is that there are a few muscles that are involved to help the mouth open. The lateral pterygoid muscles are involved, and I believe it's the gastric muscle that is in the digastric muscle is involved, that suprahyoid muscles involved. And what happens is that if you don't open your mouth very widely, then only one set of those muscles are involved. They don't call into play all of the muscles that you use to open your mouth. But when you open your mouth more than halfway, then all of a sudden we start to engage different muscles. We start to engage the whole set of muscles that are used to open the jaw. And those are the muscles that allow the jaw to rock forward. So we don't get the rock forward action, that rocker action of the jaw unless we get maximum mouth opening. We can't get maximum mouth opening unless we get into extension. And when we get that jaw rocker, we start to use all of those muscles. And it is those muscles that help us get that safe swallow. So those reflexes set up the stage for feeding to happen in the safe and beautiful way where everything is working towards the same goal.
SPEAKER_00Yeah, it's such a beautiful cascade of you really think about it and you're like, wow, this nature is just it's really thought of everything, right? Like you know, the head turns side to side in that root to find that horizontal plane of the br of the nipple. And then it turns up and down in that seek to find that vertical plane and really like pinpoint exactly where that nipple is, and then it gets that chin plant and stimulates that gape reflex. And now we're an extension, like you said, right? Like now we get that maximum jaw opening and that rocker function, and we get the attach and the sac reflex, and it's just it's a beautiful cascade. And when you watch it, and you know, when I tell parents beforehand, I always say it's kind of like almost like describing a heartbeat. It's gonna happen fast, like you're gonna miss it almost, you know. Like it's the same thing when I describe what a tongue does during breastfeeding. And I'm like talking about, you know, the extension and the cupping and the, you know, the movement of mid and posterior tongue and what it's doing. And I'm like, it happens really fast, like you would miss it. But when they do all of this and they turn, turn, turn, lift and attach, it's so fast, but it's such a beautiful sequence when you can see how each one leads into the next. Yeah, it is.
SPEAKER_01And that's the thing about nature is and if we skip those, if we ask the baby to do something different, then there's always going to be a trade-off, right? Because if that's the sequence that the body needs to have happen in that order in order for swallowing to be safe, moving away from any part of that sequence is going to take away the body's ability to do what it's designed to do. And that's why I think it's so important that we understand all of these and then use them to the extent that we can as often as we can.
SPEAKER_00Right. And what happens when we do I it'd say that sap reflex, right? That happens if we if we position the baby in a way that we bypass the other reflexes. It's like it skips ahead and you wind up with this baby that they just want to clamp down, right? The second that they feel that nipple against their lips, they just skip. You can't get a baby to go backwards. It's like you can't gape once that nipple is right there.
SPEAKER_01Yes. So all those reflexes are sort of a one-way highway and they kind of are like members of a relay race where we pant off, pass off a baton to the next relay race member and that lap does its job. So you're right. Once we get that reflex done, then the next one takes over and you cannot go backwards. And that's what we do when we compress and shove and tickle and get the baby to open a little bit and then start to suck is we're skipping all of the reflexes that come before it. And so we're losing the opportunity for all of the reflexes to do their job because the baby will suck. Sucking is a pretty strong one for most babies at birth, right? Right. And it's easy to skip those reflexes, but it's so important that we don't.
SPEAKER_00Right. Speaking of oral function, the other thing that you had at that class that I just loved and I really think should become a commonplace visual. You should trademark it and put it out there for everybody. Um, is your little pyramid of, I don't know, what do you call it? Your pyramid of is it a pyramid of function? Okay.
SPEAKER_01Yeah, well, it's that so the hierarchy of infant feeding, right? So that's the pyramid is just the hierarchy of infant feeding of the things that need to happen in order for feeding to be easy. Because feeding is designed biologically to be easy. It's not designed to be hard. It wouldn't make sense for mammalian feeding to be hard. Like that wouldn't have been evolved as a strategy among mammals if feeding your baby was hard. So, in order for feeding to be easy, though, we have to have lots of things that happen. And so there's a pyramid of what our needs are for feeding to be easy. And at the base of the pyramid is maternal wellness. So there's four categories in the pyramid, and it goes maternal wellness and then infant comfort and then latching. And at the very top of the pyramid is oral function. And I think that what we sort of think in right now as a practice is that the reason why feeding isn't easy for babies is because there's tongue tie babies everywhere. And yes, that I think that's a yes and situation, right? So yes, there are tongue tie babies everywhere, and that's not why feeding is hard for everybody. There's so many things below infant feeding on this pyramid that have to be in place in order for feeding to feel easy. So if the feeding it doesn't feel good for the parent, if the parent doesn't have confidence, if their nervous system isn't calm during the feeding process, then they're going to regulate their baby into a place that isn't calm too. Because the baby's nervous system gets its regulation from the parent's nervous system, from the feeding parent's nervous system. So if that feeding parent is worried or an anxious, then we get this negative feedback loop around feeding where the baby, the parent feels anxious because the baby, and the baby feels anxious because the parent, and then it sort of spirals out of control. So we have to have parental wellness being okay. So that's not just emotional wellness, but that's also gut health, because it's the gut health of the parent, like we talked about, or like you mentioned earlier that sets up the gut health. So the bottom of this infant feeding pyramid is parental wellness, right? And on top of that, then the baby has to feel good because the design, part of what feeding does, besides teach the baby how to move, is teach the baby's body what feeling good feels like. So the part of the brain that gets stimulated during feeding is the part of the brain that lets us process and understand pleasure. And so if it doesn't feel good when we're feeding, if feeding hurts us because it is uncomfortable, because our gut hurts, because our belly hurts, then our brain doesn't get the ability to learn what feeling good and satiated and that like, huh, this is great. Feeling feels like, right? And there's gonna be a problem. Feeding's not gonna be easy if that step of the equation is missing. So we also have to look at why can't why doesn't feel feeding feel good for the baby? Is it because it hurts their body to move? Is it because it hurts their belly to move? Is it because their nervous system is always stuck in fight or flight and can't get into the rest and digest phase, right? Those things are super important. And then above infant feeding, infant comfort, I should say, on this hierarchy is latching. So then once we can move with these, then we have to be able to use our body to be able to go through that reflexive latching process to be able to get to the point where we can have a safe swallow. And only then at the very top is where oral function comes into play. So can we take that milk once it comes into our mouth and swallow it safely and comfortably and go down into our stomach? That's the oral function piece of it. And that's kind of where tongue ties kind of fall into play. And I think it's super important that we understand that there's so much work that needs to be done underneath that to help support a feeding dyad to make feeding feel good for everybody.
SPEAKER_00I am so happy that you made that because I feel like it's it really encapsulates and makes it easier to say all of the things some of us have really been trying to say is that this oral function is not the be all end all of everything, right? Like I get that tongue tie is important. I really do. I'm having my own release uh in less than a week at 44. Like I get it. Oral function does matter, but it does not exist in a vacuum, right? And I feel like we're there's such a large tongue tie community right now that's jumped on this bandwagon. Is like oral function is so important. I can do this and I can teach this and I can do that. I'm like, great. So now you have a baby that's really thriving on the bottle that has great oral function, but they're not comfortable in their body, they can't latch to the breast, and the mom feels terrible. Where did we gain something here? Like, what wonderfulness do we have to be, you know, proud of or to say that this is that outcome that the parent wanted, right? It's not. And I feel like it's such an important thing to really talk about and to say that we need to not, I mean, first of all, we need to, as you said earlier, like really separate our outcomes from clients from our own self-worth or practice worth or you know, ability to show that we're knowledgeable and a good provider, whatever. But also we really need to understand and listen to what the client's saying. What is their goal? Is their goal that they want their baby's tongue to be able to like curl and extend and elevate and do all these wonderful things, but only do them at the bottle and never breastfeed again? Why not? Like the clients who are coming to me, that's not their goal. And some of them want a bottle-feeding baby, and that is okay. I have no problem with that. I think the issue is that as a provider, I should be supporting their goals and I should be helping them on a path to get there. I'm not saying it's easy, right? We do hard things a lot of times, but hard things that are on the path to their goal that are going to get them somewhere that they want to be. And unfortunately, when we focus solely on infant function, I feel like that's very rarely a place anyone wants to be.
SPEAKER_01Right. I think that's, I think we're, you know, everybody's in this field helping babies because they want to help babies feed better. But what we really have to stand back and sort of ask ourselves is what's getting, what is the end goal? Is the end goal to help parents meet their own feeding goals? Or is the end goal to have a baby's like tongue move in a specific way that makes us feel good about it? Right. And what it really should be is are we using, how are we using oral function support to help a parent get to their own feeding goals? That should be what's driving this whole thing is for a parent to be able to feed their baby in the way that they want to, and for that to feel good for everybody. And then our job as the professionals that help support them is to help them in the steps and the things that they need to be able to get there. And, you know, oral function is really important, but oral function doesn't in itself help a parent get to the feeding goal, right? The infant, everything on that pyramid has to be in place in order for a parent to get to the feeding goal and make it feel good. There are so many parents that a year and two years removed from their feeding experiences are mad about how their feeding experiences went. Yes. And they're resentful and jealous and angry. And that rise to this whole idea that this profession isn't really about listening to women or feeding parents because we aren't always listening to women and feeding parents because we're asking them to do heroic things for something that shouldn't take a hero. It's something that should be biologically easy for babies to do. And if it takes a hero to get there, why in the world is that true? We need to really step back and look at that and make sure that we're our part is helping the big picture and not laser focused on one little part of it.
SPEAKER_00Absolutely. And it's just, you know, the other word I use a lot that you use in class was ease, that this should be biologically easy. It should be, you know, is your baby in a place of ease? I'll say to them, have does feeding feel easy? Does it feel comfortable and pleasurable and relaxing? And when I first meet with a client and I say that, they like look at me like I'm, you know, I just grew three heads. They're like, what do you mean feeding being easy and pleasurable, uncomfortable? Like that, those don't even go in the same sentence, you know? But once we work on those reflexive feeding and taking the the pressure or the onus off the parent to latch their baby and we let the baby do what it should do, we actually do get to that place, right? Where it becomes easy. And then that's where we can take on that next level and say, okay, is it wonderful and pleasurable for baby? How do they feel? How is the baby feeling today? You know, and we can look at that next one, but it is missing the step when we start at the top of the pyramid. And I know that that's it's like an iceberg and that's what's sticking out and what everybody sees.
SPEAKER_01Yeah, yeah, that's a great analogy. It is like an iceberg, and we're all of the stuff underwater. And yet it's the stuff underwater that really matters to even have the stuff at the top have an impact, right? Because I know you worked with babies and I have that had releases and are in worse shape than when they started, right? It doesn't always make things better. It often makes things worse if we haven't addressed the parts of the pyramid underneath the top before we get to that point. And when we treat it like it's a magic bullet, parents think it's a magic bullet. And so they're going in with all these expectations and all their hopes and all of their outcome is based off of one single day and one single event. And it sells them an idea that there's a magic bullet to fix all of the feeding problems. And it's really not fair to the parents, it's not fair to their expectations, it's not fair to the providers that are doing that. Like we aren't serving anybody when we treat that.
SPEAKER_00Yeah. When we when we kind of say that everything is this magic bullet, and we say that this is how it's going to to kind of go and that it's just going to magically be better, yeah, it really sets up failure. And it's not fair to anyone. It's not fair to any of the providers and the parents. And I think it's really important to, you know, it I feel like there's just a few things that I hear out there from the parent community, especially like, you know, if you're talking about Facebook groups or such like that, you know, I hear either it fixes everything or it does nothing and it makes everything worse. Right. And yeah. You know, I mean, most things the answer is in the middle, right? Like I'm I'm very much a moderate kind of person in the terms of like, I don't tend to have a lot of extremist things when I work with parents. I never say, you know, don't ever use a pacifier or use a pacifier every time. I'll be you know, here's the middle road, here's the real life answer of, you know, pros and cons, and then you make your decision. But I feel like it's the same with Teng Tai that it is not going to fix everything. And it is not, um, it is not hopefully going to be at that end where it makes everything worse. We need to be in that middle zone of yes, it can help. And yes, it is sometimes necessary, but have we ruled out everything else? Have we improved as much as is physically possible without, you know, having surgery? And have we helped this family and this baby get to this point? And are they prepared and ready? And do they think this is the right next step?
SPEAKER_01Right. I think the fact that we see so many parents in these groups doing this tells us how desperate parents are to make things better. It sort of tells us the barometer of where feeding is right now in our country, that these parents are willing to, with relatively little information, pay a lot of money sometimes to take their brand to have a surgical procedure in the hopes that feeding will get better. They're so desperate to make feeding get better that they're willing to do that. And that doesn't mean that that's the wrong choice. Like you said, sometimes it is the wrong, the right choice. But, you know, as providers, we know that that's a really simplistic view of what the process should look like. But that's that's the bellwether of those parents later that are angry and resentful about their feeding journey. There are so many neon flags right now that infant feeding, the way that we're feeding our babies, the way that we're feeding our babies at the breast or the chest in this country is not sustainable and it does not feel good for parents. And we have to help because this isn't okay. And that's, you know, that's what my passion is, is to make this feel better for parents. I know that's what your passion is too. And that's what everybody wants to do is to make that feel better, but we really have to start listening to parents to understand why they're feeling the way that they do.
SPEAKER_00I think it's so sad. I think just like you said, the the fact that these parents are willing to or desperate enough to go to Google and Facebook and ask other parents and say, what do I do? Yeah, that really signifies the lack of support they're getting in this country and the lack of competent, supportive, knowledgeable care that they're getting, right? And we all know that parents don't get enough leave and that they we send them home from the hospital without really support and that birth is seen very medicalized and all these types of things. And it's one thing to know it, and it's another thing to see these families and go, they were so desperate for care that they were willing to do anything and they're not getting it. And it's so incredibly sad. And it's it, it's a we need a drastic change. We need to drastically change the way we think of breast and chest feeding in this country.
SPEAKER_01And just how we support them. And like you said, I think, and I I the thing is, is I don't actually think it's that hard to do. I think that like that's the beautiful part of that. That's the flip side of this, is that we've been working too hard on this. We're doing, we're working harder to get worse results than we would be if we stepped back and did this a little bit easier. So it's actually easier for everybody if we help infants be able to feed, right? It's just understanding how to do it. So I don't think it would make a lot of a shift. I think I fully believe with my whole entire heart that if all we do is have people understand the cascade of latching reflexes and change that on a on a basic level, that everybody understands that that becomes our default, then we could change feeding for so many families. And that's all that that that would change it in itself.
SPEAKER_00I know, and that's that's why we're talking today. And that's why I've taken your classes and that's why I want this out there. And so, you know, put on your schedule for 2023. You need to create like a wonderful class that gets, you know, disseminated to all hospitals or something. I think that's where we need we need to get this to be common knowledge. We need to get providers understanding that babies can latch themselves. And when we do that, it takes, you know, 90% of the work out of feeding. And it would drastically change. I mean, who would keep feeding in pain and when it's exhausting and so much work for that's a full-time job that you're doing eight, 10 hours a day? Like who would do that? So, of course, our breastfeeding rates aren't what people want them to be. And our, you know, our families are weaning early and switching to bottles or formula or pumping. We're a pumping nation. But it's like if we could change this one thing, if we can go, and we can't necessarily always go back to the beginning because there's a lot of clients out there that have older babies that unfortunately didn't have the experience they wanted. But we that's the thing about people, there are babies born every single day. So there's always another chance, and there's a chance for us to to really make a change and to get this knowledge out there and get people treating this different and really shifting our view of what's normal infant feeding looks like.
SPEAKER_01Yeah, because if we can make infant feeding normal, biologically normal, babies using their reflexes, then that, like we said, just the cascade down, it doesn't stop there. It just begins there. So the cascade of impact that I think we could have, not just on babies, but also on families, it would just be so profound.
SPEAKER_00Absolutely. So I'm I'm hopeful that you will have wonderful success getting your class out there and getting more and more people to start this path and to start understanding how this changes their practice. I mean, it's changed mine greatly. And I just I'm very appreciative and I want to see, you know, your knowledge and I will follow along and see how this develops even more. It's so wonderful to watch. So I thank you so much for your time today, Avery. This has been wonderful. And I I hope on a level as well that a lot of people then go online and take your class because it's really beneficial in understanding how this latching process really works from a reflexive point of view and just is dramatically changing to your practice.
SPEAKER_01Yes, thank you so much. I appreciate it. Yeah, I this has changed my practice and it's just made it better and easier. And I just want that for everybody else too.
SPEAKER_00So thank you so much for joining me. All right, thanks a lot. 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.