Lactation & Development Resources

The best results are achieved when a team approach is utilized 💜💙💛💚🧡❤️

For breastfeeding 🤱🏾🤱🏽🤱🏼🤱🏻in particular… a provider who doesn’t work with breastfeeding dyads in depth as a specialist cannot say with certainty that releasing baby’s oral ties will solve their feeding issues. Also, breastfeeding is a group activity involving at least 2 bodies (3+ if family has multiples).

Here are a few examples to demonstrate this point:

A family says “we want a frenectomy because baby doesn’t breastfeed well.” Provider does a surgical release without family ever having seen a skilled IBCLC. Post op, if nothing improves, they finally go see an IBCLC, and…

😳 It turns out mom/lactating parent has a complex breast surgery history with related low milk supply despite good breast stimulation from baby and/or pump.

😳 It turns out mom/lactating parent has an undiagnosed thyroid condition leading to chronic low supply despite good breast stimulation from baby and/or pump.

😳 It turns out mom/lactating parent did not know how to position baby at breast/chest optimally.

😳 It turns out baby has weak orofacial muscles and therefore doesn’t do any better with feeding despite improved tongue range of motion.

😳 It turns out that baby has Torticollis which impacts the tongue’s ability to move optimally.

😳 It turns out that baby is delayed in their gross motor development which impacts their oral motor skills since babies develop proximal to distal.

Happy IBCLC Day!!
🤱🏾🤱🏽🤱🏼🤱🏻🍼🥛👶🏾👶🏽👶🏼👶🏻💗💙💚

💕I was inspired to write this post after speaking with one of my sweet clients who decided to change her goals.

There are a lot of opinions out there about what moms *should* do, how moms *should* feed their babies, what breastfeeding *should* look like, and on and on.... I want to remind all of you following along on instagram that *it’s okay to change your goals.* You may feel like you’re being wishy-washy or you may feel like you're letting yourself down or like you’re letting somebody else down. 😔

💗 Know that those who love you and support you truly just want you to feel good about the choices you are making regardless of how their comments might come across. 💗

Sometimes it requires a quiet meditative moment 🧘‍♀️, a bath or a shower alone 🛀, or a peaceful walk in nature 🍃 to shut out all of the *other* voices, opinions, and advice in order to connect with what *you* really want based on *your* current situation.

I hope that these words may help you find peace with *your* decision about *your* goals. Thinking of you all 💭 Remember to be kind to yourselves and to others around you. 💗

If mutually desired, breastfeeding beyond age 1 is absolutely beneficial for both mother and child.

“Extended breastfeeding” is breastfeeding. Mothers are often made to feel like they are doing something wrong if they continue breastfeeding beyond baby’s first birthday despite it being extremely beneficial for both mother and baby -- and despite it being a very personal decision. In other countries, breastfeeding well beyond age 1 is common and normal. The U.S. trails far behind other developed countries with its breastfeeding rates for a wide variety of reasons.

This is tough but you are tougher.

I often share these words with the mothers at .

This is a quote from my own mother. She would tell me this throughout my childhood, and she continues to share these words with me now when I need to dig deep and find my inner strength.

YOU can and will get through this difficult time. Remind yourself that you can do tough things… really, really tough things. Remind yourself of this on the days when you feel hopeless. Remind yourself of this and then ask for help. Asking for help is one of the bravest things you can do. You are not alone.

💜 Marissa

Abdominal Distention in infants 🎈

Root cause?
Abdominal distension is commonly caused by:
🎈aerophagia (air swallowing) during feedings which can be associated with tongue/lip/cheek ties, suboptimal positioning and latch technique, orofacial muscle weakness and associated difficulty
🎈food allergies
🎈food sensitivities
🎈food intolerances
🎈in rare cases, a more serious intestinal problem

How can abdominal distension impact infant development?
Babies whose abdomens are distended tend to roll early from tummy to back. While trying to balance on their tummies (which is full of air/gas like a little beach ball), they end up falling out of tummy time in an uncoordinated way. This is in contrast to a skilled roll from tummy to back which involves baby activating muscles in the front and back of their body synergistically in sequence. Babies with abdominal distension also tend to have weak abdominal muscles related to them being overstretched (similar to how these muscles are overstretched in mothers during pregnancy). Developmentally appropriate strength of babies trunk flexors and trunk extensors is crucial for the acquisition of age appropriate gross motor milestones (improving endurance in tummy time, moving limbs against gravity while playing on their back, rolling, sitting, crawling, standing, walking, etc) and each milestone builds on the previous one.

What can be done about abdominal distension?
Working to identify the root cause is certainly recommended (as opposed to treating symptoms). This would start with a discussion with your pediatrician and an evaluation with an infant feeding specialist (a referral is not needed to see an IBCLC, a referral may be needed to see a feeding therapist). To treat symptoms in the meantime, you can implement positive associations with play in tummy time and on baby’s back, utilize colic massage with strokes in clockwise direction for baby’s abdomen, and “bicycle” baby’s legs.

Happy Holidays!

We have another therapist joining us! Dr. Amie Dougherty, PT, DPT with Milestones At Play will be treating infants and toddlers ages 0-3 years at the office beginning in January! We cannot wait until her sessions begin in just a few short weeks 🎉 Make sure to request an appointment right away if you’d like to get on her schedule as we expect spots to fill quickly!

Dr. Amie has over a decade of pediatric home health experience helping kids gain independence and reach their fullest potential. She has worked with families and children ranging from 0-18 years of age with a wide variety of gross motor impairments from developmental delay to medically complex orthopedic, neurological, and genetic diagnoses. Dr. Amie is skilled with neurodevelopmental treatment (NDT) handling/facilitation techniques, kinesotaping and strapping techniques specifically for pediatrics, and utilizes a variety of tools and hands-on techniques to facilitate optimal posture and sequencing to promote independent gross motor development through play.

As a family of 5 — her husband, one kiddo, and two fur babies — they enjoy outdoor adventures, travel, and family bike rides. When not working you can find her in “Mom Mode”, on the Peloton (), or doing handstands around the world.

“Does my baby have reflux?” 🤔

According to the American Academy of Pediatrics, Reflux is defined as “the passage of gastric contents into the esophagus.” (Eichenwald, 2018)

Colic, on the other hand, is defined as “crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy.” (Roberts et al., 2004)

Here are 4 common causes of reflux:
1) aerophagia (air swallowing)
2) reflux induced by a food allergy, sensitivity, or intolerance
3) overfeeding
4) body tension (can also be a symptom)

Signs and symptoms for each can look like...

Aerophagia (air swallowing):
-Spitting up 🤮
-Frequent nasal congestion 🤧 (silent reflux)
-Painful cry 😭
-Arching of neck and back while crying
-Frequent hiccups
-Constipation (skipping 1 or more days between 💩 diapers)
-Straining to p**p 💩
-Painful gas
-Distended abdomen (firm, large belly that bulges at the sides)

Food allergy, sensitivity, or intolerance:
-Spitting up 🤮
-Frequent nasal congestion (silent reflux) 🤧
-Painful cry 😭
-Arching of neck and back while crying
-Mucus in p**p 💩 (looks stringy or shiny)
-Rash and/or eczema on body, typically starting on cheeks and moving to upper chest, back, arms, then legs
-Cradle cap
-Dry and flaky skin
-Reflux that does not improve as aerophagia decreases and/or latch improves 👎

Overfeeding or body tension:
-Spitting up 🤮
-Frequent nasal congestion (silent reflux) 🤧
-Painful cry 😭
-Arching of neck and back while crying

🤯 Are you thinking “this sounds like my baby”?

A great next step is to hire an IBCLC if you are breastfeeding (whether directly at breast/chest or indirectly with a bottle) and/or a feeding therapist if you are exclusively formula feeding. The key 🔑 here is to make sure that this provider is knowledgeable about reflux in infants specifically.

Of course, always keep your pediatrician up-to-date with what’s going on with your baby. But, know that reflux medication is NOT your only option!

We see the best surgical outcomes with wound care stretches done approx 5-6x/day (with no more than one 6-hour break during a 24 hour period). We follow this frequency for approximately 3 weeks then decrease to 4, 3, 2, then 1 x/day for another 1-2 weeks (4-5 weeks of wound care total). It’s important to note that this is only for a *full release.* If the frenectomy was just a small snip of the anterior portion of the lingual frenulum, often wound care is not needed since the wound is very small and less likely to stick/adhere to itself (“reattach”).

Unfortunately there is a lot of misinformation in the parent and professional community about wound care, which often leads to suboptimal wound healing. No wound care, wound care done with too much force, and wound care done too gingerly all lead to poor wound healing and suboptimal functional outcomes. Parents are frustrated and do not know what to do or who to trust. This is when many of our clients find us at .

We often evaluate infants for the first time a few weeks after a failed procedure. In these cases, we usually find a posterior tongue tie from an incomplete surgical release, thick scarring related to reattachment, or a new tight/restricted lingual frenulum. Sometimes we can salvage the situation conservatively with occupational therapy and scar management techniques alone. Other times, we plan for a revision (a 2nd surgery).

The best way to achieve an optimal functional outcome the *first time* the tongue tie is released is to establish care with trusted healthcare professionals before an initial procedure.

“Marissa was recommended to our family when we discovered our son had a tongue and lip tie at 7 weeks old. Not only was he having trouble feeding, but he was extremely fussy and visibly uncomfortable. I was overwhelmed with how to breakdown and work through all of the potential issues (dairy allergy, reflux, torticollis, frenectomy recovery). After our first visit, I was blown away by how knowledgeable Marissa was about all things breastfeeding, therapy and development. She was the positivity and encouragement I needed! She is an advocate for your goals, whatever they may be. I highly recommend Marissa for any moms out there that need guidance in these areas. She really turned things around and our son is now a happy little guy!”

Read more at www.lactdev.com/testimonials and on our google business page! Thank you everyone for leaving a review💗🙏 Sharing your story is the absolute best way to help other families get a sense for what to expect when working with us!

https://www.tulipsfeeding.com/
Exciting news! 🎉 Mitra Shirmanesh, M.S., CCC-SLP (Speech-language pathologist and feeding therapist) will be seeing patients ages 0-3 at the Lactation & Development Resources office 1 day per week in addition to her work at Children’s Health Specialty Center in Richardson.

She is skilled in supporting families with:
* Bottle feeding difficulties
* Tube weaning
* Picky eating
* Difficulty chewing
* Difficulty with certain food textures or food groups
* Difficulty with cup and straw drinking
* Feeding refusal
* Speech delay at 12 months old (by 12 months old, children should be able to imitate sounds, say a few words, understand simple instructions, recognize words for common items)
* Speech delay at 18 months old (by 18 months old, children should be able to recognize names of familiar objects, follow simple directions, say at least 10 words, identify body parts, point to wanted objects, imitate words)

Mitra makes therapy fun and has a way of instilling hope and confidence in the families she treats. She believes that parents are an integral part of the therapeutic process and encourages their participation in therapy sessions. When working with Mitra through Tulips Feeding & Speech Resources, families will benefit from longer sessions (60min for feeding, 45min for speech) as compared to 20-30min at most therapy centers. Families will also enjoy the home-like environment at the Lactation & Development Resources office with its cozy arm chairs and Montessori-inspired playroom.

Mitra shares our passion for intervening early when there are less obvious signs that feeding and development are off track. By intervening early, we can establish a solid foundation upon which future skills and milestones will build. This can look like a child only needing 4-6 therapy sessions at 7 months old as opposed to 18-24 therapy sessions at 3 years old.

To request an appointment: https://www.tulipsfeeding.com/

Babies are expected to return to and then surpass their birth weight by 7-14 days old. After which point, babies are expected to stay on their own growth curve by packing on the ounces at a consistent rate based on their age (6-10 ounces gained per week during months 1-3 of life, 3-5 ounces gained per week during month 4-5, and 2-4 ounces gained per week during months 6-12). Here are some examples looking at percentiles on the WHO growth chart with a baby born very large and a baby born very small, since these cases cause the most confusion.

Optimal weight trend:
Example 1) 15th, 12th, 14th, 13th ✅
Example 2) 15th, 12th, 18th, 25th ✅
Example 3) 97th, 80th, 85th, 83th ✅
Example 4) 97th, 95th, 96th, 95th ✅

Concerning weight trend:
Example 1) 15th, 12th, 6th, 3rd 🚩
Example 2) 15th, 12th, 2nd, 1st 🚩⚠️
Example 3) 97th, 80th, 68th, 50th 🚩
Example 4) 97th, 80th, 35th, 21st 🚩⚠️

“The term failure to thrive is a descriptive term used to depict inadequate weight gain over time, often used when weight for age crosses two percentile isopleths or when weight for age falls below the third percentile for age…. Most failure to thrive, by Waterlow criteria, is marked by decreased weight for height, with initial sparing of height for age and head circumference for age, with gradual loss in height and head circumference for age as the undernourished state continues. A more accurate description of this abnormal pattern of growth can be classified as inadequate intake, maldigestion, malabsorption, ineffective use of calories, or increased metabolic demand.”
-Source: (Basil J. Zitelli MD, in Zitelli and Davis' Atlas of Pediatric Physical Diagnosis, 2018)

So when to intervene? Right away! If baby is not back to birth weight by 7-14 days old, it’s time to get with an infant feeding specialist. The longer families wait, the harder it is to reverse the growth trend. If baby receives human milk, that provider is a skilled IBCLC. If baby receives exclusively formula, that provider is either a skilled IBCLC or a skilled infant feeding therapist depending on your local options.