Katie The Traveling Lactation Consultant
Katie The Traveling Lactation Consultant
Ep 31 Joan Comrie
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Joan Comrie is a SLP who has worked closely with IBCLC's to support tongue tie families. In a world where IBCLC's and SLP don't always see eye to eye on how to work with families struggling with infant feeding, Joan was able to work on a "dream team" with an IBCLC in a NICU for many years. While SLPs are more focused on suck and swallow mechanics, and IBCLCs are more focused on supporting the dyad, they both can educate and support each other as professionals to help families with complex feeding issues.
Podcast guest: Joan Comrie is a speech pathologist that has worked in pediatric dysphagia for over 35 years. She started in the NICU helping mommies and babies fulfill their breastfeeding goal through creating a “Dream Team” with Lactation. She transitioned to her own practice in the 90s. Joan has helped over 10 thousand patients many with complex issues related to TOTs, airway and GI issues. Joan is a constant learner earing multiple continuing education award through her national certification (ASHA). She is a teacher at heart. She always opened her practice to grad students. She has lectured and consulted to organizations internationally and here in the US, lectured at the graduate level and presented at conferences including ASHA, NOMAS, Neonatal Network and ILCA. There are many parent and professional how-to’s in publication which anyone can download on our website feeding.com, as well as
many parent how-to videos on her youtube channel. In her mission to teach, she provides a course in which LC can learn about the coordination of suck swallow breathe and the sensory motor patterns of feeding to help the LC understand infant feeding and when to engage the help of a SLP on the feeding dream team. You can find her course at feedingacademy/thinkific.com
Podcast host: Katie Oshita, RN, BSN, IBCLC has over 22 years of experience working in Maternal-Infant Medicine. Katie is a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs. Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially tongue tie and gut/allergy related issues. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com
Disclaimer, this content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a loved one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Ostadt, 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 Joan Comrie, a speech pathologist who has worked in pediatric dysphagia for over 35 years. Joan started in the NICU helping moms and babies fulfill their breastfeeding goals through creating a dream team with lactation. She transitioned to her own practice in the 90s. Joan has helped over 10,000 patients with many complex issues related to tongue tie, airway, and GI issues. Joan is a constant learner, earning multiple continuing education awards through her national certification, Asha. She is a true teacher at heart. Joan has always opened her practice to grad students and has lectured and consulted at organizations internationally and here in the US, lectured at the graduate level and presented at conferences including Asha, N O M A S, the Neonatal Network, and IlCUP. There are many parent and professional how-to in publications in which anyone can download on our website at feeding.com, as well as many parent how-to videos on her YouTube channel. In Joan's mission to teach, she provides a course in which LCs can learn about the coordination of sex while the breathe and the sensory motor patterns of feeding to help IBCLCs understand infant feeding and when to engage the help of an SLP on a feeding dream team. You can find her course at feedingacademy backslash thinkorific.com. So welcome Joan. I'm so glad that we could meet together today, Joan. Thank you so much for joining me.
SPEAKER_00Well, I appreciate you doing this. I've listened to all of your podcasts and they're so helpful. And I feel like it's a great way to get people communicating with each other about what we have passion about, which is feeding babies and helping mommies and babies being successful.
SPEAKER_02Oh, thank you. I mean, I I am glad that it's really helpful to others. I mean, I it kind of sounds bad to admit, but I did start this from like a selfish perspective and the fact that I'm traveling the country and I am so cool. I mean, I'm driving by all these amazing providers and I just wanted to meet them. And I wanted, I wanted us all to share more knowledge because, you know, when I worked with moms in the hospital or even the outpatient, it was kind of like lactation and the bomb. But I'm finding when I work with these really complex dyads where they've got tongue tie and lip tie, or sometimes these older babies and they've got a ton of issues, torticollis, plagiocephaly, all sorts of things, they need a team. They don't need one person, right? And I wanted to start understanding and seeing things from different perspectives and start, you know, start getting a better perspective of what do the other teammates see? What does the bodyworker see? What is an SLP see? What does the release provider see? Like how is their lens make it different? So that was that was kind of my my selfish plan here was I just wanted to learn more. I mean, I'm I'm a huge education person. I think I renewed my license December 31st last year, and I have five years on ours. And I have over half my units done already.
SPEAKER_00Right. Oh, yeah.
SPEAKER_02There's just so amazing classes.
SPEAKER_00Mine started January 1, and I'm I've already met what I need for the next three years. But I just want to learn. And the more you know, the more you see, the more better you see. And and certainly what you're saying, I mean, what you're doing that I love is that you're helping people realize that it takes a village. I mean, and that, you know, that's like an old cliche, but it really does sometimes take everyone's different eyeglasses because we're all looking at the same thing, but what I see is probably a little bit different than what you see, which is a little different probably than any body worker sees. And it's just so interesting that if we can all be communicating, we can help that baby get to where it needs to be a lot faster. Because, and I've always done when I worked in the hospital, especially, I've always co-treated with somebody. One, when I worked at Vanderbilt, it was an occupational therapist who we still keep in contact and you know, problem solve and share our experiences so we both can learn. And I learned so much from her. And then the second hospital that I worked with worked in the NICU was in um Raleigh, and it was a physical therapist that I worked with. And it just, even though you learn your piece in whatever school you're in, you can't just stay at that piece. The whole body is involved in everything that happens. And so you need to really understand that you know what happens at your lips is because of something that happened at your hips, or maybe it's your feet or whatever. But you don't just go to the lips to make a change. You have to look at what is supporting that and what's happening. And I think by interacting with and consulting with and working together as a team, even if you're maybe not like when I was in the hospital, we were in the same physical place. Now, you know, that I'm in private practice, I'm not so lucky, but you still can collaborate and it makes it so much easier now with Zoom and things like that, or even just the cell phone and be able to like have conversations with people and and work together on the same baby or the you know, same dyad of groups. And it just it's so wonderful.
SPEAKER_02Absolutely. I mean, I have a couple of older babies that I'm seeing right now, they're both almost two on opposite coasts of the country, and they are really complex. And I I'm actually finding, in addition to tongue tie, because tongue tie is definitely my my first and foremost love because it's affected my family as well. But I'm loving working with these older babies. And I love, I mean, I love, you know, there's nothing like holding a, you know, four-day old or seeing these little two-week or three-week old babies turn around and everything. But what I'm finding with these moms, with these babies that are between one and two, is they're really determined and they've worked so hard and frequently been really ignored and told there wasn't a problem and brushed off sometimes by pediatricians, sometimes, sometimes by IBC LCs. I have a couple of clients who they've seen three other IBC L Cs and they kept telling them there wasn't a problem. And, you know, I have such an issue with that because, first of all, it's so dismissive. Whether you see the problem or not, that comes from your side. But the fact that the client or patient is telling you there's a problem, that makes it a problem. It's not really a disputable issue. So when I work with these older kids, though, they really they give you so many clues and you know, they show you in everything what's happening by how they move and how they talk and how they don't move. You know, it's really fascinating. But I'm finding the the moms are just very determined because they've worked very hard and they haven't gotten to where they wanted to, and they felt very ignored. And I think the team thing is so important here too, because it would be easy to fall into that like savior thing of like, well, here I know what to do, and that's a place I really don't want to go. I don't want any mom thinking that I'm gonna come and fix their problems. Right. That's not what it is. And I tell them all the time, I'm here to give you the tools. You're the one doing the hard work, you're fixing your own problem.
SPEAKER_00I'm gonna empower you so that you have the tools to make the change. Because if you see the baby, even if you see them three times a week, which is unusual, because now with insurance and the economy is kind of in a weird place and people can't afford to get in like in the old days. Oh my gosh, it was so wonderful because you can see kids multiple times a week, and boy, you could make some changes very quickly. Um so you know, it's more and more important now that we provide those tools for the parents because you know, I may be doing manual work with that baby for that one session that I see, but they have to then go home. And what I always do is do a little bit of work first and then hand the baby to the mom and then teach her what to do. And a lot of times they're kind of nervous or, you know, they don't feel super comfortable putting their fingers in their baby's mouth. But if they're going to get a tongue release, they absolutely have to be comfortable getting their fingers in their mouth.
SPEAKER_02Absolutely. And that's a big part of it. I actually had a mom recently that baby's seven weeks, and she's feeling bad that it was just released last week, and she's feeling bad that she didn't have it done earlier.
SPEAKER_00And the baby wasn't ready, right?
SPEAKER_02Well, the baby was actually ready a good week or two before mom, but mom wasn't ready. And I said, you know, this is just as important as baby being ready because we won't find success if you're not ready. If you're not prepared to put your bait hands in that mouth, we're not gonna maintain a good release.
SPEAKER_01Yeah, right.
SPEAKER_02Absolutely, you know, I think as moms too, we put ourselves in that spot a lot of times with the mom guilt, and we're, you know, saying, well, we should have, we should have. And it's like everyone has limitations and everyone has what they can do today. And you just needed a little bit more time. A lot of her stuff came from feeling like she was worried that she was putting the baby through it for her and for not for the baby. And so she felt like she should tough it out, you know. But it's really hard on these moms. And I tell them, you guys all have to be prepped. It is not an easy thing to have the tongue released, like it's not a super complex procedure, no, but it's a process, not a procedure, and you have to be willing to do the work. If you're not, then we shouldn't do the release.
SPEAKER_00Yeah. And I find it interesting, you know, I was in Raleigh for so long, and of course, I was so connected there, but I feel like the babies there had better results than the babies here. And in thinking, like, why did why were there less like revisions? You know, they get the release that didn't really do what it was supposed to, so they go and get it done again. Sometimes, three times I've had babies finally get to me after like the third or going towards a third release. And I think it's because kind of what happened in Raleigh is the lactation consultants obviously would get the babies first, and then they would call me to come in and help work on the motor patterns and get the mouth ready, and then they'd get the release. And what I find here, just because I'm not as well known in the circle, uh mostly, not always, it's starting to get a little better. This year I feel like things have gotten better. And then, of course, of course, COVID kind of made everything crazy. And that was a big part of the time that I moved, you know, was here in Florida. But a lot of times I would get the baby, they'd have the release, they'd continue to work with the lactation consultant or whomever, and things still weren't working. And then finally, someone's like, I think there's motor patterns going on that we need to like reintegrate and we need to do some neuromuscular retraining. And then they would come to me, but I was like, oh my gosh. I don't say this to the moms because I don't want them to feel bad. But I'm thinking only could have got you before that release, things might be different. You never know, maybe they wouldn't be. But and of course I never kept data because I just thought that's how things worked um until I came here. And that's not how things always were.
SPEAKER_02Well, I feel it all the time. I mean, I can't tell you how many clients reach out and they're like, oh, we had the release last week and saw the provider today and they said it's all looking good. They suggested that I reach out to Lactation. I was like, they're like, when should I see you? And I was like, about a month ago. Yeah, exactly. It's a week post-release. Okay, this is gonna be challenging, you know, it's and you don't want to scare the parents or make them feel bad for it.
SPEAKER_00And it's not if they knew they would they would do something different, right? Right.
SPEAKER_02It's not their failure, it's the system. We are failing them as providers by not bringing in team members that are necessary, by not getting them prepped. And by just, I think a lot of it, especially with these tongue tai babies, is that they're not being heard by their pediatrician on the whole. I mean, there's unicorns everywhere, but on the whole, pediatricians are not supportive of tongue tai. And then some of them are not getting support from IBC LCs or the IBC LCs just don't have the skills, right? They just kind of don't know what to do. So they're like, oh, baby's transferring. We're good. Right.
SPEAKER_00Um, you know, and sometimes I I feel like that some of the lactation consultants, depending on their skill, of course, everyone has a different range of skill, but sometimes they, you know, the posterior tongue can be moving, but that doesn't mean they're transferring milk. And, you know, I've had some lactation consultants send a baby to me saying, you know, I'm just so confused because they're eating so well. And then I do a pre and post-weight, and they didn't transfer hardly anything. And so, you know, you have to understand what that sex swallow breathe sounds like. It's not just, I mean, I find looking at the posterior tongue does not do a lot because they're so tiny, the anatomy and physio, you know, their anatomy is so small that just movements of the posterior tongue doesn't mean that you just initiated a swallow and transferred milk. And you can have a baby that just moves their tongue a lot and it looks like they're actually swallowing when they're really not swallowing.
SPEAKER_02See, I think I'm not a huge um scale fan. I think that the it has its place. It's not that I'm saying we shouldn't ever weigh a baby, but I think it's become a huge crutch. And we're doing too many weighted feeds and not enough assessment of actually what's happening because you can have a weighted feed where that baby transfers 75 mls and it's still be clicking, swallowing a ton of air, reflecting, colicky, gassy, miserable baby. And yet somebody will look at that and go, they transferred 75. You're great, go home. So I think it's a problem because it's too easy to get kind of that false sense of security with that number and be like, oh, everything's fine. And in my mind, that's kind of just as bad as a pediatrician's looking only at the weight and saying everything's fine. So I don't miss my scale at all. When I went completely telehealth during COVID, I thought, oh my God, how am I gonna do this? And I don't mind, I don't miss it at all. If I'm seeing, and in general, I'm really not seeing premies. I saw someone I was in the office, and you know, if I'm seeing a baby that really needs weekly weights, we're either doing it with the pediatrician and they will go into the office and get a weight every week, or I might refer to somebody in person if they're that one case that really needs to follow weight closely. But 95% of babies don't need that. That's not the indicator of everything, you know, that's not how you measure success.
SPEAKER_00Right. And you're gonna miss that baby who maybe mom is an experienced breastfeeder, you know, she's breastfed a baby or more before the this one, and the baby's just stimulating letdown, and the mom has such a good supply, she's the baby's basically just chugging. And then that baby's gonna have trouble in the next few weeks or for sure by three months. The baby's not gonna know how to transfer beyond that initial letdown.
SPEAKER_02Right. We call those babies riding the letdown, and exactly those are the other thing we'll call them is the fat, hardy, fussy babies because they're gaining really well until around three, four months, and they're really gassy, they're really colicky, but otherwise they're pretty easygoing as long as they don't have a bunch of gas, you know.
SPEAKER_00So it's and they're probably chugging, which means that they're swallowing air. And there's that air of phagea that's the chuggy, gassy little baby that it doesn't stink gas, it's just they're losing their, you know, they just swallowed a ton of air trying to keep up with mom's flow. And then, of course, you know, you know, the anatomy and physiology changes a lot between three and six months of age. And so you have babies that from birth to three months, they're doing fine with very poor oral function. And then as the, you know, anatomy changes neurologically, it moves from that reflexive feeder to more volitional feeding. They can't like do that sleep feeding where they put their themselves in such a low level of alertness that they they just can just reflexively feed and then they start having trouble. And it's just a shame that they don't get observed earlier because it's so much easier to change motor patterns when they're a few weeks old than when they're several months old.
SPEAKER_02Right. Yeah, that's definitely a big thing. But I also I think that it's an important thing that all of these breastfed babies are also seeing an IBCLC because it's not just the baby, it's the dyad. Right. And that's something that as an SLP, you really see the baby side and very in-depthly. But, you know, as an IBCLC, I'm looking at them as a whole. And um, you know, I don't it can get missed. It can get because it's not just baby or mom, you know, it's it's a combination and where they are today. And that three to four months is I call it a perfect storm because it is babies' things, like you said, those that rooting and sucking reflex integrate. We've lost that reflex of feeding, and now it is a choice, but it's also mom. It's also her hormones have dropped. She's gone to supply and demand instead of hormone-led milk supply. A lot of times, this is a very common age, unfortunately, for sleep training. It's also a very common age to go back to work. So it's it's very much a perfect storm. You've got a whole bunch of things that initially everything felt not really fine, but kind of like they thought it was fine, right? Right. Because they thought that was normal. Right. But they they thought it was normal and they were told it was normal. They went to the pediatrician, they were like, this is just some babies cry, you know, come back in a few months. I mean, it's it's incredibly helpful. And so they thought that everything was going fine. And even though you and I know it wasn't, and we can look back and see all of the signs, from the parent side, they were like, it comes out of nowhere.
SPEAKER_01Yeah.
SPEAKER_02And I'm always trying to tell them, you know, when I have a client that's in the early days and they're not going to release because they're scared or they they think it's unnecessary or whatever. I'm always telling them that, you know, this is the next time to watch for. Really watch that three to four month window because that's when babies fall off the growth curve. That's when mom's milk supply totally tanks. And if you're watching for it, you can find it before it reaches bottom, right? Right.
SPEAKER_00Before you get to that critical point.
SPEAKER_02Oh, yeah. It's always heartbreaking when I get a mom that reaches out at like four or five months saying, I don't know what happened. I used to make 30 ounces a day. And I say, How much are you making now? Oh, like four. I'm like, no. I'm like, that didn't happen overnight. Unless you've had like double mastitis, it did not happen overnight. Right.
unknownYeah.
SPEAKER_02And it's hard. It's hard. But I want to talk more about your time in the NICU because you working, you know, kind of hand in hand in the NICU with an IBCLC or an OT or PT, I'm so curious about how that looked. I also have a tiny bit of NICU experience. I worked for a couple of years in a level three, and then I went back to labor and delivery because NICU just wasn't my thing. But, you know, I'm really curious at how that team worked for you guys and what were the pieces that each person was looking at.
SPEAKER_00Well, the the hospital I was at the longest was the one in Raleigh, North Carolina. And we had a developmental team. So even though I was a speech pathologist, I was not hired under speech pathology. I was hired under the NICU. And so we had a pediatric psychologist, we had a developmental specialist, a PT, and then they hired me to come in and do the feeding piece because the PT and the developmental specialist was doing it, but they realized, you know, we we really need to like upgrade this. And our NICU was very, very developmental. We worked very closely with Heidi Alzheimer's the synactive theory. And of course, I'm NIDCAP trained, and we did a lot of NIDCAP training in our NICU and the developmental specialist, Dr. Jim Helm and um Dr. Melissa Johnson. She was the psychologist, and they would go training with Heidi and other people that are that worked on that, and they'd go to hospitals and train all that. So the lovely thing about it is I was hired in the NICU, and that was my job. I did the follow-up clinics, I did PEADs, but I wasn't part of speech pathology, which really helped me be able to spend time working closely with the other disciplines because, you know, hospitals are so productivity driven that it makes it really hard. It doesn't facilitate that process unless you really go out and seek it. So I was almost like at the hips, people thought the physical therapists and myself were sisters because we were sort of the same height. We had dark hair, we looked very different, but I still thought we were, because we came in as a team. But the way it really developed is my first son was preterm and he went to my NICU. And I was like, oh my goodness, like, thank you, God, for my baby, but really why? Why did you send him to the NICU? But I think what what I got, you know, trying to be positive, what you get out of that is what an incredible Incredible experience to be a mom in the NICU. And I became instantly like such a better therapist because I just understood more about what it's like to be so stressed out, like what it's like to go home and your baby doesn't come with you. And, you know, it was really intense. And I know that working in a baby's mouth is so important. And I am not advocating for what I'm going to tell you. But and I don't, you know, now it's going to be public because it's on your four, on your podcast. But when my son was intubated and no one was watching, I was in his mouth doing some manual work to his tongue. Because you know, the babies that are intubated, when they get extubated, their tongues are just in a bad place. And my son did not have a suck reflex when he was born. And I remember when I went back to work, my neonatologist that I worked with said, Joan, I can't believe that your baby was nursing and feeding well. And I said, Well, I was working in his mouth when you guys weren't watching, praying to God I don't extubate my baby. And of course, that's nothing a speech pathologist could do. And I never did with any other baby, but it was my baby. I knew what I was doing. And I really wanted to, I wanted to optimize his pattern so that when he was ready to feed, he could feed. And of course, in the NICU, you know, if I was still there, I'd try to change things a little bit, but the bottle always had to be first. Right. So he was bottle feeding, and then when can I nurse? When can I nurse? When can I nurse? And then he didn't do so well nursing. And so Mary Rose Tully, who unfortunately is no longer with us to cancer, um, she was the lactation consultant. And as she was helping me nurse my baby, we looked at each other and we're like, this is a dream team. Why are we not working with every breastfeeding mom in the NICU? Like we were like, why is this? Why did this not happen? And, you know, the dream team was born at that moment. And I think it's just so important to have that combination of what lactations know, what speech pathologists know, with our anatomy and physiology of swallowing, because obviously in the NICU, there's so many issues that can interfere with correct feeding patterns and successful breastfeeding. Just being in that NICU alone is hard enough with all of the intubation and OG tubes, NG tubes, oxygen, just on and on and on and on with the experience. It's a very hard place. It's a very hard place to be a baby. When I when I do my talking and courses, you know, I always show the picture of like the newborn baby that's with the mom and the dad or whoever the partner is, and they're like snuggled up together, and then there's the baby like laying out in the you know, incubator with tubes everywhere. I mean, it it was very challenging for my husband because he didn't understand. And I knew in my heart that unless something really crazy happened, my baby was gonna come home with me at some point, but you never know like what's gonna happen because that place is so scary, you know.
SPEAKER_02And it's very, I mean, my time in the NICU was brief. I think it was about 18 to 20 months, I don't remember exactly. And I, in that time period, had six babies that I lost on my shift. And I think part of that was higher than normal because being, you know, a new trainee, they kind of bring you into all the tough stuff. They want to show you everything in the first, you know, six months to a year. They're like, oh, we have a tough cardiac one, come over and see it. Oh, we've got a you know, gastroschesis, come over here. And so I did see everything, and it was a very busy high-level, you know, level three that was a very busy NICU, but it was it was really hard. And those families and those babies, and it's just incredibly difficult, but you know, they're not in the normal range. They don't get to have, you know, a lot of those babies, like you said, are born without a sucreflex because that wasn't fully developed yet in utero.
SPEAKER_01Right.
SPEAKER_02And things, you know, they're meant to have some time for these things to come together and they're meant to have their time for their reflexes to be expressed. And and even in the best case scenario, even in a term vaginal delivery, I find way too often they're still not getting a chance to do things because they are really pushed. Someone said the other day to me, they said their lactation consultant in the hospital said, Well, we're just gonna hold the baby right here and then we're gonna chef with love. And I was like, oh my god. I was like, that is really and they're like, Well, the baby was sleepy, and so this is how to wake it up. And I'm like, oh my God, oh my god, oh my god, there's so many things I want to address with that, but not with the mom. So I was like, okay.
unknownExactly.
SPEAKER_02So let's go back to reflexive feeding, let's go back to birth reflexes and these primitive reflexes and why they're here. I'm a big, big proponent in postural stability for baby during feeding and reflexes. And I think when you just take this baby and you shove it on, acting like it's a mouth and a breast coming together, you have no understanding of what feeding is because breastfeeding is a full body-to-body experience. And we're, you know, that baby is using all of their reflexes to do this. I'm like, there's a reason babies are born with a step reflex. It's not to just look cute. Same thing with the poly. Like it's not just there to hold their parents' hands, you know?
SPEAKER_00Right. Yeah, and the body is there to support, I mean, it supports the head, the neck, the jaws, the tongue. I mean, it's all like when I talk to parents, and because they're like, well, you know, you're just supposed to do the mouth. And I'm like, I don't just do the mouth because, you know, it's like building a house. If you don't have a good, sturdy foundation, you can't build your house. So if you don't have good stability through the thoracic spine or through the hips, or your legs aren't in the right spot and your feet aren't supported, there's no chance that your head is going to be able to be where it needs to be so that the jaw can be where it needs to be, so the tongue can work. And then you've got breathing, of course, you know, and that makes everything kind of complicated. Of, you know, you can't breathe, you can't eat, you can't do anything. So it's yeah, it's completely, you know, it's a great system, but yeah, it's everything is so important.
SPEAKER_02Yeah, people really don't understand the importance of the feet, too. I talk a lot about that with my parents, and I'm like, those feet should not just be dangling off a pillow into space, like they need to be planted somewhere. There's a reason for every part of your baby's body that all works together, right?
SPEAKER_00And there's that's like we like to eat, you know, with our feet planted. We you know, for me, you know, bar stools I don't like so much because my feet dangle. I like to be, I like to be very supported when I eat. And and you don't think about that like until you just said that. But you know, then I'm like, why don't I like those tall bar top places when you go eat outside or whatever? It's because you're not you're not well supported. And if you're not well supported, you're just not gonna eat well.
SPEAKER_02Yeah. And actually, if you look, most of the time the bar stools will either some of them will have a back, but if they don't have a back, they'll usually have a few rungs near the bottom for you to put your feet on, right? Right. And I tell parents that breastfeeding the baby on like the my breast friend, when the baby is not even touching mom and it's just like mouth to boob, it's like trying to eat on one of those bar stools with no rungs, nothing. So you're just kind of balancing and you're focusing so much of your energy and your stability on balancing that you don't have enough left to really concentrate on swallowing and chewing and stuff because you want to be stable, you don't want to fall over.
SPEAKER_00Right.
SPEAKER_02You know, and these these babies just need to be have some um stability, some postural stability, and it makes a huge difference in feeding that and coming from a point of actually using reflexes and understanding what the reflexes are meant to do and why it's a problem when they're not there. You know, I stopped sending a lot of reports to pediatricians. I I was doing it and then it gets so frustrating, I go in kind of spurts because it can be frustrating when you get nothing back, you know, five million times. Right, you know, and the few times that I did connect, I'd I would talk to them about how it's really important that we, you know, that baby is stable or something like this, and they're like, uh, you know, whatever.
SPEAKER_00But I look at it, like every time I send a report to either a lactation consultant or, you know, the pediatrician, I'd look at it as an opportunity for teaching. So maybe the pediatrician will be like, after like the 500th baby, that you send them a report, maybe they'll be like, you know what, this is really important. I need to send more babies to Joan Comrie or whoever the lactation consultant is or whomever, just because they, you know, I feel bad for them because they go through medical school, they have to learn so much. I mean, it's even like speech pathology. My daughter right now is in graduate school. She knows that she wants to do feeding, she knows that she wants to do breastfeeding, especially. And, you know, to get your hours in speech pathology, you've got to do stuttering, you've got to do aphasia, you have to do dysarthria, you have to do augmentative communication, like things that she's like, I don't even want to learn about. But to be able to get into your specialty, you just really need to do a lot of training. And that's what the pediatricians do. They have to learn a little bit about everything. And they don't like when I worked at Wake Med and in Raleigh, luckily, every rotation that the residents came in, they got two two-hour talks from me on feeding and swallowing disorders. And but I know that that only happened because the head doc that would bring all the residents in from the University of North Carolina, he wanted people to learn this stuff. And he was a great teacher. But I know most residents, they learn nothing about nutrition. They learn nothing about breastfeeding for sure. They don't even learn anything about feeding. So I feel like the more we can, yeah, the more we can educate them. Like when I moved here to Florida, I, you know, tried to figure out who's the top pediatrician because I know they'd run grand rounds of some sort. So I spoke at grand rounds about tongue tie. They knew nothing about tongue tie, nothing. And they thought, I mean, they some of them basically said it's a cash cow for the dentists because I know so offensive. Yeah. And I was like, no, actually, it's really not. This is why you need to address it early, and this is why you need to get work through it before you actually get that release. And a couple of them actually has come around, and it just takes time and it takes them understanding what's going on because they never probably even heard of it, you know.
SPEAKER_02I know it's kind of a one of the things that stuck out in my mind was a couple of the pediatric dentists that I've met with and stuff like Richard Baxter. He said they spent more time in pediatric dental school on, you know, super rare mouth cancers and and issues that are, you know, one in a million kind of thing. And they didn't address tongue tie at all. And tongue tie is, you know, one in three, one in four babies. And I'm like, you know, so it's they're learning some of the most obscure things out there. And yeah, that's good to have a little bit of wide knowledge and, you know, be able to catch that super rare zebra. But how about, you know, how about all those other kids in front of you that have the normal things going on that we're missing? That, you know, it we're just missing this all the time. And it's really unfortunate. So I just want to ask Joan, when you were working, you know, closely with that IBCLC, how did you guys work together with families? Like what, you know, what piece was each of you doing? And how was it that you guys were able to collaborate so well? And I'm asking also from a perspective of you guys were the unicorn. I don't know if you're totally aware of that or not, but it's pretty rare for SLPs and IBCLCs to work closely with breastfeeding families and tongue tie and stuff. And it's, I don't know if it's just a turf thing or if it's a that people haven't been able to share. I don't, I don't know what it is, but it's I haven't seen this combination very often. And so that's why I'm really curious as to how you work together because what I see usually is a more of a turf kind of like, no, this you can't do this job, only I should do this job, and then back to the other one saying, no, no, no, only I have the right perspective kind of thing, which is really unfortunate because the family's the one that loses out in that, as opposed to having a team approach.
SPEAKER_00Honestly, I guess I can tell you that I don't really know the answer to that question. Like, how did we get to work together? I've always, since graduate school, I've always grabbed on and teamed up with another discipline that had similar interests. Like I said at Vanderbilt, it was the OT. She had some feeding experience, but I really helped train her a little bit. And, you know, but she gave me her perspective. I gave her my perspective. And then, like I said, in the NICU, when I had my baby, that that was like the connection. And I really think I think it takes personalities. I think it takes someone who can build a relationship on trust because I never felt like she was gonna jump into my territory, I was never gonna jump into hers. But the more we learn together, the more she did a little bit of things that maybe I would have done if I wasn't around. And maybe I did a little more like lactation things. And I just feel like if you can be open-minded, if you have that personality where you love to collaborate, you love to learn, and you don't ever feel like someone's taking your business. I mean, we obviously have enough babies that have issues and we know where our strengths are. And I don't know, I just really looking forward to developing those relationships here in Florida because I just you learn so much when you work with someone that wears a different pair of glasses than you have. I mean, you can't a really good experienced lactation consultant has so much knowledge that would really help me in my work. And obviously, my, you know, 35 plus years of experience working with newborn babies and breastfeeding. I mean, I certainly have a lot of information that helps them. So I, you know, I think you just have to, and then I think what really probably helped a lot is I didn't work for Speech Path, I worked for the developmental team. You know, just saying that word, developmental team, you are a team, you work together, you know, you that's pretty much what you do. And I think it just building the relationship and collaborating with each other. I think there is no room for territory. I mean, I remember when I worked at Vanderbilt, the OTs and the PTs were battling about something. And they really did like basically fight over patients and who should be doing what. And I think our roles, you know, I feel for me anyways, that lactation is different enough from what I do as speech path that we can collaborate and really make things better for the baby. And I'm, I don't want to, I mean, I know a fair amount just because I've taken a lot of lactation courses. I mean, I did the when I was teaching the training in lieu of getting a stipend, I said, let me sit in on this 40-hour week-long lactation course that's prepping them for your, I don't know what your exam is called. IBCLC or the IBC L E. Yeah. Okay, so ours is called a praxis, yours is just the exam. Um so I I learned all that stuff, but I my interest is really on looking at what are the problems. So, you know, a a poor latch is a symptom. Right. Okay, so what creates that poor latch? Or what is the reason that mom's nipple is flattened when she comes up when the baby pulls off and is not elongated like it should be. What those are symptoms? You have to go back and figure out, okay, what's not happening to be able to get that process to work more optimally and more functionally. And I think, you know, having a lactation consultant and a speech pathologist or an OT or whomever is doing the manual oral function work, you know, that combination together is what's going to help the baby. And I think if both disciplines, you know, you know where your lane is and you can cross, but you're not going to take over. And I think if you have personalities that are for me, man, I want to learn everything you can tell me as a lactation consultant, because that's going to help me do my manual work better because I look at things differently because of what gifts you've given me by teaching me. And I'm hoping that I can do the same, which is like what I said, why I did the lactation course that looks at the function of swallowing and the function of feeding, because at least, you know, in my opinion, is could be wrong, but I feel like the lactation consultant does not get enough of that training. And like I've said before, I don't want to train a lactation consultant to become a speech pathologist, but I want to train you so that your eyes are open and you look at these issues and you go, this is who needs to treat this baby in combination of what I'm doing, so that the baby gets what they need.
SPEAKER_02Yeah. That's a long answer. No, that's that's a message. I don't really know, but yeah, that's kind of how I look at bodywork too, is I'm like, I've recorded and spent days watching bodyworkers, and I've spent a lot of time with chiropractors, and my girls had my own fascial release before their tongues were done. And, you know, so I've I've spent a lot of time learning about different bodywork and they're all so complimentary and I learn a lot and I don't want to, you know, I took a few courses on it, and I don't want to be able, I'm not trying to to treat body issues, you know, I'm not gonna deal with subluxations or or tension or all this type of stuff. Like that's not my role, but by understanding the reflexes, by being able to look at a body and see where the tension is and how baby moves and how they don't move and being able to refer and understanding it enough to explain to the parents why they need a referral, especially because a lot of times they're being told by the pediatrician they don't need a referral, right? So if I were to just say to the parents, oh, you should go get your baby body work or you should also see an SLP or this or whatever, they'd kind of be like, Well, the pediatrician said no. And I would have nothing to really back it up with. And so I find when I come to a place, especially for like when I see a baby that needs body work because of their tongue, you know, we'll sit there, I'll sit there with the parents virtually and we'll look at how is the baby turning right to left? You know, how is it when it lays on its side, lays on its tummy? How is it on its back? How does the baby move to the breast? You know, all of these things and we'll watch it and I'll talk to the parents and show them, oh, do you see how the ATR reflex is showing really nicely on the right, but on the left we get nothing? Do you see how the baby isn't turning their head to the left at all? Do you see how, you know, when they come to the breast on their left side that they're not nursing well? Right. And so we'll pull, I'll pull it all together for them. And then the parents have enough that they feel confident to tell the pediatrician, no, no, they do need it. And this is why. But if I were to just say go do it and didn't have any understanding, it wouldn't really educate and support the parents enough. So it's really important, I think, too, to really understand what other people are doing. And it's why I I enjoy doing this. I mean, I didn't, I didn't know anything about myofascial release before my daughters this year. I I'd heard of it, but I had not, I mean, and I was working before traveling in the San Francisco Bay Area. We do not have a single myofascial therapist there that works with babies. Isn't that insane? I'm like, do you know how many millions of people live in the San Francisco Bay Area? Well, I mean, the San Francisco Bay Area is kind of a weird spot too, because there's only one really good release provider and he'll only release babies under seven months. And yeah, and so any babies over that, they're traveling to LA or to Portland or San Diego. Like they really, there's no one else in the Bay Area that does a good release. And there's still no myofascial because ever since understanding it, now I want to send more babies to it, and there's no one to send them to in the Bay Area. And I still get a decent amount of clients from there. So it's, you know, it's really unfortunate. Some areas are just completely devoid of specialties. But what I also find is, you know, this may make sense in the SLP kind of thing too, is that it's less important what your certification or degree is in. And it's more important to me what you do every day, where you spend your education, what you're passionate about. Right. Right. And that's, I mean, that's harder. It's much easier to look up someone's degree, you know, and just try to find someone who's a chiropractor or an SLP or whatever. But taking the time for me to reach out to them and to collaborate and to try to say, hey, you know, what are your thoughts on this? What do you? What do you see when you do this? And how you know how often do you see babies? You know, and and understanding that it makes a big difference because I think as we fairly established, despite the fact that these degree programs felt huge when we started, I mean, I will say they all felt felt huge. Nursing school was big, as was lactation. It doesn't seem like they taught us nearly enough, right? Right. And there's just the the need for constant education and the the changes and the advances in it too, and the changes in the way we think about things, you know. I mean, it's so different than it was.
SPEAKER_00When I was in Raleigh, I had the practice, PD pediatric dysphagia. It was, you know, where you went. And then as people started learning a little bit more, they'd go take a course. Like this is what they almost always took the um, I think it's called more course, where you um, I took that course before it was actually a course where it's like sensory. You like lick something, kiss something, do something. And I tell you what, we had so many, like, I would call them boo-boots, that kids were in therapy for a year. They never made any progress. They come to us, and within like the first evaluation, the parents were like, oh my gosh, you taught me more than I learned being in therapy with this person for over a year. And this the sad thing is, is I mean, the good thing is we have state-run programs that help families, you know, with therapy, speech therapy, occupational, physical therapy. The sad thing is, is they just have to give you therapy. They can give you a beat up VW bug that's from the 19, you know, 80s, right? That barely works. They don't have to give you a smooth Mercedes where you can actually have a comfortable car. They just give you something. And parents don't know that there's a difference. They know this person does feeding. And so when I, you know, I have a YouTube channel that I have a lot of feeding tips on there. And so I get a lot of people asking me, like in this part of the country, what do I do? And I'm like, most important questions that you ask them is how many babies do you have on your caseload? And let's say you've got a three-month-old, how many babies do you have on the caseload that you have a three-month-old that's having trouble breastfeeding right now? And if they can't tell you that most of their caseload is that baby, you don't want to go there because you're gonna, even if the therapy is free, you actually lost a lot of time and money in time where the baby's, you know, patterns, their reflexes should be integrating and they're not integrating, or they should be activating when they're not activating. And, you know, you just if you don't clear those restrictions through things like, you know, myofossal release or manual techniques to help create good function, you're not going to get the motor control. And so you've lost all of that. And you're you're so right, like your training is all about you. And, you know, as a speech pathologist, we have to get a certain amount of training in every three years. The state is every two years, but they don't tell you what you have to train in. And so you could just go take some free online courses just to get your numbers in, or you can be someone who's like me, a lifelong learner that exceeds the amount of continuing ed that you need, most of your certification requirements, and you hone in on something that's so specialized. And parents don't know. You know, they just don't know. They don't understand the importance of finding someone who's actually really trained. Same thing with lactation consultants or what are the other ones called? Certified counselors or lactation counselors?
SPEAKER_02There's certified breastfeeding counselors, there's certified lactation counselors, certified breastfeeding specialists, I think certified lactation educator. They, you know, it's like they made an alphabet soup to keep everyone confused. But I think the bottom line for people to remember, and I tell people this, is anything besides an IBCLC is for basic babies, for you know, normal having trouble at the breast. But if we're tongue-tied, if we have low milk supply, if we have a fluff palate, if we have twins, if we're inducing lactation, if we're having swallowing disorder, if we're doing any of these other things within lactation, they should only be seen by an IBCLC. I'm not saying that they don't need other team members. That's not what I mean. But the CLCs and everybody else, they don't have the level of training that an IBCLC does. And so they're meant for the norm. You know, there's like there's the peer counselors, then there's all the three-letter, you know, CBS, CLC, all of those, and then there's the IBCLC. And, you know, they all have their place. It's not a bad thing to have, you know, a CBS who's running your breastfeeding class at the hospital. It's not a bad thing. They just need to, I think for other providers and for families to understand that those are meant for the norm. And for a lot of people, they have enough training and experience to be helpful and get somebody on track, you know, but for families struggling with these more complex feeding issues, they are not. They don't have the training for that. So that is a big difference there for families. And it gets a little confusing because they made them all the same stupid initials and everything. Right. It's a little confusing for everybody.
SPEAKER_00It is. It's hard for the parent to know, to know that one may be more optional. And and if you just things cost money, unfortunately. But if you look at it, if you get that person that knows what they're doing, you may have a lot less time and frustration that you need to put into it before you get the results you want, versus someone who's kind of, you know, I tell parents, don't pick somebody who's learning on your baby. Like, you know, we all had to learn, of course. That's kind of how it happens. But if you have the option to get someone who is experienced, you'll have a much better experience.
SPEAKER_02And it is, it is so much, like you said, it is so much what we do after our degree. I mean, I'm part of a Facebook group with IBC LCs from all over the I have a couple different ones, and one of them's from all over the world, and one of them's a Bay Area group, and a couple different ones. Well, one of my local groups said recently, somebody who's been an IBC LC for 15 years, she came on and was like, Oh, you know, my license is overdue and I got an extension because I had to have surgery. So where can I get a whole bunch of I need units? And I said, Well, how many do you need? And she said, Well, I need 75. And I'm like, We need 75 every five years. You haven't done any? And she's like, No. I'm like, it's been five years. How have you not taken a class? Yeah. Like there are those in every profession. I mean, there really are. I had I my husband was a teacher for a long time and never stopped planning lessons and changing things and everything else. But I remember my daughter's third grade teacher had been her teacher for, I'm sorry, had been a third grade teacher for like 27, 28 years. And she used to brag about how, oh, I've been teaching this same lesson plan for the last 25 years. And I'm like, do you think you could change it up a little? Do you could you take a class or learn a new technique or learn how to teach different learning styles? Like, you know, you wouldn't go to an accountant who hasn't read the recent tax law in 20 years. You know, things change. Right. And absolutely education is huge importance. And I something I even put on my website and I will list on their classes that I've been taking and tell people that's really important. You want, you want someone who's really invested in their profession and who's passionate about it and willing to share that with you. I'm not right for everybody. You know, like I said, I don't, I don't do multiples. I've barely worked with them. It's not that I can't, it's just that I'm really not the best person for it. I don't have a whole big tool bag for multiples. I just don't. I don't do cleft palette. I don't do Down syndrome babies. And again, not because there's anything wrong with it. It's just that over time I've specialized in tongue tie and these older babies, and that's where my love is, you know. And so I'm more than happy to say, oh, you've got a cleft palette, baby. I know someone I will refer you. They do this all the time. You don't want me doing it, even if I've done it once in five years. Like you just don't.
SPEAKER_00Right. Absolutely. Absolutely.
SPEAKER_02I mean, it's just, it's so critical that we start that people start to understand that we're not all the same. You know, I mean, you can't just compare all SLPs or all lactation consultants. I mean, most SLPs have no understanding of breastfeeding that I've interacted with. They don't have any training in it. Now you've taken classes, but most of them don't. They don't, they're focused on the baby, right? They're not seeing the mom at all. And they're not, you know, that the last SLP that I was working with, she would assess the baby at the bottle, but she never assessed mom and she never assessed during breastfeeding because that wasn't her experience or expertise. And that's not wrong. You know, that's it's important for her to stay in her lane, but she needs an IBCLC in that team because otherwise she's missing part of the picture.
SPEAKER_00And sadly, for me, I feel like those SLPs are the ones that are creating the challenge for me to be able to work with the newborn babies as soon as they are ready to or are showing difficulties with their oral function, you know, because people feel, I mean, there's so many speech pathologists that are like, I don't do that. So many speech pathologists that don't do feeding. And it's good. Like if you don't want to do it, don't, please don't, you know, right. But if you're going to do it, you better be trained, especially in breastfeeding, because that's such a fragile relationship. And it's time-based. I mean, if you lose your milk supply, you know better than me. It's really, really hard to get back. You know, it takes a ton of energy on the mom's part. And she's already depleted because she lost her milk supply. Yeah. You know, or, you know, lost a bit of the milk supply. Yeah. Because I know, like for me, with my first son, you know, I had great milk supply. And then I went at about six, well, so then I called Mary Rose Tully, my, you know, my partner. And I'm like, Mary, why am I losing my milk supply all of a sudden? We went through X, Y, Z, A, B, C, whatever. And then she's like, hmm, did you go to the OBGYN for your follow-up? And I'm like, yeah. And she said, so she put you on the mini pill, right? Yep. She's like, well, there went your milk supply. And I was like, she knew I was breastfeeding. Why would she do that? I don't know. But you know, like those things are just like, really? I mean, it was, it's just hard enough to be a mom who's pumping because she's going to work and she's breastfeeding when she's with the baby and and you know, trying to stockpile a little bit just in case something, you know, God forbid, somebody spills a whole thing of milk and you like don't have a have a you know extra and oh my goodness. Yeah.
SPEAKER_02And then what's even worse is ever since COVID, there are a lot of hospitals that are putting IUDs in immediately post-delivery because they don't want the mom to come back at six weeks. So they're literally the placenta delivers, and they're like, here's your IUD. And it's in there before I've had a few patients saying, they asked me after delivery, and I didn't even think about it and didn't know what I was doing. And they had a heck of a time with their milk supply. And I'm like, Well, yeah, your body didn't get to go through the normal transitions, and those are very hormonal. And we put something with hormones in your body. Not to mention the fact that their uterus and cervix and everything has just had a huge trauma and maybe could use a little recovery time.
SPEAKER_00I didn't realize that was happening. Oh my god. It is.
SPEAKER_02It was a very it was a big problem where I was in California. A lot of the hospitals were doing it, or they were pushing birth control pills, but they really liked putting in the IUD. And they just they were like, okay, now we don't even have to see you at six weeks. You can just go on. And too much of the six-week visit has become the quote unquote clearance for having sex too. And it's like, that's really not what they should be doing. I mean, should should you not be assessing mom's physical health, her mental health, other things of, you know, how is she doing rather than just saying, okay, everything looks good. You can go have relations with your partner. And it's like, well, it's it's a very backward system. And these, especially during COVID, families have been shunted so much and like just kind of not getting the amount of appointments they would before. And they weren't getting enough appointments before. I mean, really to go six weeks postpartum without a visit is even the I think it was it was ACOG, I think, that said a couple of years ago that they were recommending now a three-week visit, especially so for in general, but especially for anything for anyone who had been considered high risk. And that's, you know, all your advanced maternal age, all of your high blood pressures, your gestational diabetes, your thyroid issues, that's a lot of the population and they aren't getting it because the insurances weren't covering it. And so despite the fact that ACOG recommended it, nobody was doing the visits, you know, and so yeah, these these families are just kind of left out there to flounder, especially if I find it even worse when the baby is gaining, because they'll go in for their first appointment and then at two weeks, and then if baby is regained, then they'll say, okay, I'll see you in a few months for shots, and that's it, you know, and they're not, they're just not even looking at it. And I understand they have no feeding education. I mean, I think most medical school and residency programs, they get like zero to two hours of feeding, infant feeding, period. That's breast, bottle, solids, anything. But I just wish that there was more referring. I mean, in my dream, my dream team is that someday, you know, every pediatrician office would have an IBCLC. Oh, that's just, you know, a CBS or somebody who could be in there and doing the normals and then turfing the other ones and saying, okay, these ones aren't doing well. But there's so much we do besides just, you know, the infant feeding. It's like, who is talking to them about developmental things? You know, I just recorded um a couple of weeks ago with Dr. Martin Rosen from Boston, who is a really wonderful, very knowledgeable pediatric chiropractor who's been doing this for 40 years and teaching pediatric chiropractic. And he said during COVID that he wrote this book called It's All in the Head for parents because parents aren't understanding what's normal anymore. And after the CDC changed all those patients, right? I know that was just terrible. And so parents don't know. You know, for example, my second daughter, not surprisingly, crawled really funky. She had like an army crawl, dragged one leg or scooted on her butt. And everyone was like, Oh, how cute. Look how babies always find a way to get around. I didn't know that that wasn't normal because nobody told me. And my pediatrician sure didn't. They she said, is she crawling? And I described it and she's like, okay, she's moving, you know. And now we've changed these standards. Instead of realizing that we're failing babies, we've lowered the standards to say, hey, we're doing a good job.
SPEAKER_00Well, and at some point, luckily it hasn't hit me yet. But the insurance companies, I'm sure, are looking at those numbers and they're like, I'm not covering that because that's typical, right? And you know, before they made the change, that was a delay. Well, kids are still delayed. You know, it's kind of like health, right? Because, you know, Americans are so obese that your like A1C numbers are now change shifting. Like probably in the 60s, if somebody had what's typical normal now, in the 60s, you'd be like pre-diabetic. Yeah. You know, it just we're why are we shifting numbers because the population is getting less healthy? I just makes my head spin.
SPEAKER_02I think they didn't even want to acknowledge that we were failing and they didn't want to have to change the system. And so instead, the easy answer was move the bar and now we don't have to do any other work.
SPEAKER_00Right.
unknownYeah.
SPEAKER_02But I think it's going to be very interesting in you know, five, eight years when you get all of these babies that are going to be in school and they're going to have delays.
SPEAKER_00Yes. Yes.
SPEAKER_02It's going to be very challenging because you and I both know the earlier we work with someone, the easier it is. And I've seen it as a parent too. You know, I tell when parents ask me about tongue tie stuff, I tell them from my perspective as a parent, too, who's different from a provider. But I have a 10-year-old or almost 11 now in oral expansion. Okay. If I had done her tongue tie as a baby, since we breastfed for two years, she probably would have had a nice palate. But now we get to do palate expansion, which let me tell you is really expensive and not at all fun. And we're only at phase one, you know. So it's like these things are so much better when we deal with them early, and yet we keep changing it so that we don't deal with them early and that we can leave them later and later. You know, I it was, I think it was Dr. Cotlow in Albany who told me recently that he accepts Medicare and he tries to release Medicare kids because he's the only one around who will and he knows that these kids need it. And he said the weird thing was he struggled for years because they would only pay to release kids six and up. And he's like, wait a second, if I identify a tongue tie on a one-year-old, you want them to wait five years to be released? Like, how does that make any sense?
SPEAKER_00Wow.
SPEAKER_02Yeah. But that's sometimes the way insurance works. And they will treat the problem, but they won't do anything that's preventative or early intervention.
SPEAKER_00Right, for sure. It's terrible.
SPEAKER_02It is. And it's so much more time consuming money, and you just you don't ever get the same results when you're dealing with it much later in life.
SPEAKER_00Well, right, because all those restrictions that you had created compensatory patterns. And we know compensatory patterns are never typical, they're just compensating. And so then the older they are, you have to like completely change and get rid of that compensation pattern to train, you know, neuromuscularly train the correct patterns. And it's hard when you're talking about something that's like sort of autonomic, like you're not thinking, oh, I need to eat this way or chew this way or whatever. Your body just kind of learns it. And if it doesn't learn it, you something in the whole system is off and you need to be trained. And the earlier you can do all those trainings, the better you're gonna be. And then you'll end up being, you know, a 50 or 60-year-old person who's snoring and your partner's hitting you in the ribs all night long because you're mouth breathing and you're snoring, and you had a tongue tie, and that can make a huge difference. Yeah, you know, it's very interesting.
SPEAKER_02It is, and unfortunately, it's kind of the way things are right now, and it's this uphill battle of trying to get early intervention and trying to reach these families because they're in general, a lot of them are ignored by Western medicine. And so, I mean, I'm sure you mentioned your YouTube and I have my Instagram, and it's like we're trying to educate the parents because a lot of the providers are turning a deaf ear. And so, you know, educating the parents on what's normal. And a lot of times these parents know it in their gut. They went into the the office saying, Hey, I think something's a little weird here. Why is my baby not crawling when everybody else is? Or why why do they only turn to the left, you know?
SPEAKER_00And they get told their hands flat on one side and not the other.
SPEAKER_02But they just they have this in their gut. They're like, no, I it just doesn't seem right. And they just get turned down too many times. So I think educating the parents is just a really big importance now, you know.
SPEAKER_00I have parents call me and say, is it too early to come in? And then are you worried? Yes, then it's not too early to come in. And you know, it a lot of the insurances they don't require pre-auth for dysphagia work. So they don't need to have. I like to have the pediatrician write a consult for me because I like to have them on board with me and it helps with medical necessity if insurance wants to be stinky. But you don't have, I don't have to have that order to treat. And so I'm like, if your doctor won't give you an order, you can still come in. I prefer that you would talk them into giving you one so that we're a team. But if they don't want to and you're worried, come on in. I'm like, the worst thing that could happen is you're gonna pay your copay and you're gonna, I'm gonna tell you everything looks great, call me and whatever. But that never happens, honestly. I've never had an evaluation come in that could not have benefited from therapy.
SPEAKER_02Yeah, because these parents know in their gut.
SPEAKER_00They know, you know, they're just taking more than anyone knows about your baby. Right. You know, some of the parents, I'm like, I'm gonna give you suggestions and things to do, but if you don't feel like that's gonna work, you need to let me know because you know your baby best. And if I'm, you know, giving you too much homework or not enough homework, or you don't understand what I'm saying, you know, you're part of the team. You're the one who's kind of running the show because you know you're the one who has all the information about your baby. You know, I get my piece. That may not be enough to really know that I'm gonna do things the way that it needs to be the fastest and the most effective.
SPEAKER_02I know, I know. I think when we get them early, it makes a huge difference. And as we've said, having a team to bring in all those perspectives, it just changes everything for these families. So I think it's wonderful when we can all be part of a team and really put all the ego and turf and stuff to the side and really focus on how we can help families thrive. And I think more providers would also find that we thrive when we're in town.
SPEAKER_00I was gonna say, I mean, we get as much out of it as the families do because we're learning. I mean, it's a if you feel like you know enough that you don't need to continue learning, then you need to get out because I say that all the time.
SPEAKER_02You know, stop learning, it's time to retire.
SPEAKER_00Yeah, it's time to just go sit on the beach and drink a margarita.
SPEAKER_02Yeah, I think it's it's really important that we all value education and understanding that things change. And I learn from my clients all the time. I mean, each human is so unique that I can learn with each baby and I can learn what works and what doesn't, and and take those tools on for the next one because each family is so unique. I just love working with families, and I'm so glad that you're in Florida working with families and that, you know, and with Dr. Maggie and able to get the families the support they need. And I really thank you for your time today as well, Joan. I really I want to get this information out there.
SPEAKER_00Yeah, and that's what you're doing, and that's really what's gonna make it the best for all of us therapists and lactation consultants and the babies and their families. We just need to really make a concerted effort to get together and learn from each other because that's as good as sometimes a continuing ed course, you know. Absolutely.
SPEAKER_02I definitely learned from my time with providers.
SPEAKER_00Yeah, I've I have a sign in my office that says everything that I know, I learned from a baby. And it's it's just incredibly true. They they just are constantly teaching us. It's wonderful.
SPEAKER_02That's so great. Well, thank you so much for your time today.
SPEAKER_00You're welcome. And like I said, thank your podcasts are wonderful. I really appreciate you having me on. Keep up the good work, and I'm a little bit jealous that I'm not on that road with you because that's such a cool thing to do, just be able to just travel and go see things. And that that's just, I think everybody has a dream for that. That's really cool. You're doing it.
SPEAKER_02I'm having fun. Thank you so much. 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.