The Baby Feeding Therapy for Moms to End Tongue Tie Stress with Multidisciplinary Care – Rachel Best - Lo’s Lactation Lab

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Now we've got all three disciplines looking at the same
piece with different lenses.

Speaker 2 (00:05):
And being able to senate.

Speaker 1 (00:06):
I think we need to work on this goal and
this goal, and then that's going to achieve a more
successful latch. Because they have less tension in their cheeks,
they're able to get full rotation of their neck, and
now we can latch, and that lactation consul and can
really actually work on the latch with mom and positioning
and all of that because baby is now able to
actually anatomically achieve a head tilt and gape and we're

(00:31):
just having these moments every single time that we work together.

Speaker 2 (00:34):
Before we begin, I want to share something special with
all of you expecting parents out there. As an internationally
board certified lactation consultant, I've seen firsthand how a little
planning can go a long way to helping you achieve
your baby feeding goals. That's why I'm offering you my
free ebook. It's called Birth Practices to Support Breastfeeding and

(00:58):
it's a work book, so check out the link in
the description below. If you have been in a situation
where your baby was struggling to breastfeed, then you know
that sometimes it takes a team to help your baby
to achieve great oral motor function and be able to
transfer milk from your body. And in those early postpartum days,

(01:23):
every extra appointment you need to make feels nearly impossible.
So that is why I am so excited to share
this interview with Rachel Best. She was on last week
talking about her personal baby feeding experiences. But she's also
an SLP and an IBCLC who runs a few clinics

(01:44):
in both Massachusetts and Rhode Island where they use a
collaborative model to really help babies achieve greater oral motor.

Speaker 1 (01:52):
Function and to help parents to know the best way
to help their kiddos.

Speaker 2 (01:56):
So enjoy Hi, Rachel, welcome.

Speaker 1 (01:58):
Back, Hilo. Thank you for having me again.

Speaker 2 (02:01):
Yes, okay, so you were already on to tell your
baby feeding stories, So that episode is available for people
to listen to. I'll have it in the show notes.
But you are also a speech language pathologist in SLP
and you focus on infants, Well, you do the whole range,
don't you. You do all ages.

Speaker 1 (02:21):
So I'm a speech language pathologist, a certified oral facial biologist,
and as of last month, an International Board certified lactation
consult congratulation.

Speaker 2 (02:35):
I didn't know you were sitting for your exit.

Speaker 1 (02:37):
I passed by the GRISO. God that was a rough one,
but yeah, I'm very excited.

Speaker 2 (02:44):
Awesome, Yeah, that is so exciting. Yeah, and you have
a private practice with multiple locations.

Speaker 1 (02:53):
Three in Rhode Island and two in Massachusetts.

Speaker 2 (02:56):
Wow, I didn't realize it was destiny.

Speaker 1 (02:58):
Yep, five clinics right now, and yeah, always growing always,
you know, the more you learn, the more you realize
you don't know, and the more specialists you need to
bring on board. And yeah, just I love that.

Speaker 2 (03:09):
Yeah, that's great. And it's called Small Steps therapy.

Speaker 1 (03:13):
Small Steps therapy. We've been around since two thousand and thirteen.
So once I started having children, I was working in
first a hospital and then a school, and it was
really hard to keep up with the schedule. So I
decided at that point to open up my own private
practice so I could make my own schedule and kind
of really specialize and feeding, which I always loved and

(03:36):
had a huge passion for. But that the school, obviously
it's much more difficult to specialize in that population. So yeah,
that was about eleven years ago, and here we are now.
With five clinics, forty different clinicians. Yeah, nothing, as many
people as we can.

Speaker 2 (03:53):
Yeah, that's incredible. And is are you in network with internet?
Are any? Yep?

Speaker 1 (03:58):
Yep, you take Okay, so Medicaid aid all the standard
insurances for the most part.

Speaker 2 (04:03):
Okay, that is fantastic. So people can go get insurance
covered care from You have SLPs, speech language.

Speaker 1 (04:10):
Pathologists, IBCLCs, occupational therapists, registered dietitians, and in Rhode Island
we even have a floor time therapist who specializes in,
you know, playing with kids and teaching parents how to
interact with their child who might be neurodivergent.

Speaker 2 (04:27):
Wow, that is so cool. Okay, so you hear about this.
I met you actually at a gathering of people who
want to learn more or work with populations of mostly
babies with tongue tai. And when I first heard about
your practice, I didn't know about your practice before, even

(04:47):
though there's one that I can refer people to in Massachusetts.
I was just blown away at the idea that there
was one place where people could go to get all
the care they needed. Before we started hitting, before we
hit record, I talked about how it is it's so

(05:09):
challenging for a parent when they finally got in the
appointment with the IBCLC. We'll say it starts with the IBCLC,
but for other people it might start with a dentist,
or start with maybe early interventionists say hey, you need
some more help, you should reach out to somebody. But
then it kind of stops there. It's up to the
parent to then make the appointments and figure out who

(05:31):
it is they want to go see for the care
and whether or not insurance will cover it. So tell
me a little bit about your vision of how having
this coordinated care can improve outcomes for babies or for
children and help getting that care be less stressful for parents.

Speaker 1 (05:52):
So I've always been a feeding an oral motor based therapist,
So I would say maybe seven years ago, you know,
as more and more providers were noting tongue ties releasing
tongue ties, families started seeking out that postop care. So
then they started finding me, and I was treating all

(06:12):
of these babies who either were going to have a
release or had had a release, and we were having
great results. At the same time, I was also expanding
the practice to include more ots, and one of the
ots that I hired who is my dear friend today,
Jamie shout out to you. She also enjoyed working with
kids who were kind of going through these through tongue

(06:35):
TA releases. So I would see a baby they would
have great success with the oral motor skills, but still
something wasn't quite right. So then I was constantly like
yelling out the door, Jamie, can you just pop in
and look at this baby? And you know, they would
have those curled toes and their fistball tight, and we
would notice the head tilt to one side. And we
started taking some data and noting that about ninety five

(06:58):
percent of our babies who had a tongue I had
tore a callis. So we've really been looking into that
whole body connection. You know, the tongue is literally connected
to the toes through fascia, so it's not just working
on the mouth or just working on the latch. We
really need to address the entire body so that these
babies really can feel good from head to toe. So

(07:22):
that was a huge game changer for us. And then
we started working with a dietitian. I have a cousin
who is the world's best dietitian. She lived in Connecticut,
and I just for years kept begging her, please come
to Massachusetts and Rhode Island. I need you, We need
your guidance. You know, all of these babies that have
weight gain issues, It's not within my scope of practice

(07:43):
to address that. I'm working on the mouth, Jamie's working
on the body. We need you to help us. She's
also a lactation consultant. So finally we got Alissa shout
out to you joined the team, and it was just
the three of us seeing all these babies. We would
take a whole day of the week and just see
as many kids as we could altogether, which is a
huge game change. Oh, wofessional to be in the room

(08:05):
all together. So yeah, we would be you know, the
baby would go to feed and Alyssa, the dietician, would say, well,
they're really not tilting their head back, and then Jamie
would say, well, they have a lot of tension in
their neck. I don't think that they can tilt their
head back. And then we would say, oh, they can't
open their mouthwide for that gape, and I'd say, well,
their cheeks were so tight, I don't know that they

(08:27):
could achieve that. So now we've got all three disciplines
looking at the same piece with different lenses and being
able to say, I think we need to do this,
We need to work on this goal and this goal,
and then that's going to achieve a more successful latch.
Because they have less tension in their cheeks, they're able
to get full rotation of their neck, and now we

(08:50):
can latch, and that lactatian consultant can really actually work
on the latch with mom and positioning and all that
because baby is now able to actually anatomically achieved till
a gape. And we're just having these moments every single
time that we work together. So here we are seven
years later and every clinic has a baby team. We've

(09:11):
trained multiple therapists to do the work that we're doing.
You know, there isn't you don't get this training and
graduate school. It's all additional education that we've all sought
out or that we've learned from each other. We do.
We love going on the road and speaking at conferences
and sharing what we've learned as a team because I
don't know anybody else who is working this closely with it,

(09:34):
an entire disciplinary team.

Speaker 2 (09:37):
So it's fabulous, it's revolutionary. Yeah, And I think about
how many times I'm seeing a baby and I think, oh,
I just I would love to ask somebody about this
head tilt or you know. And I'm constantly saying it's
not within my scope to diagnose toward hollis or it's

(09:57):
not within my scope too. But here's what i' telling
you that I'm seeing, and I think you would really
benefit by going to see somebody. But you know, parents
don't always understand the intricacies of the various scopes of practice,
and nor should they. Like I don't always understand what
an SLP is doing or an OT is doing. However,

(10:22):
I know that the work that I'm doing could be
greatly benefited by having these other practitioners in the room.
And I think it's a great point that you bring
up that you didn't learn that in graduate school, because
I always tell my patients, no discipline has enough tongue
TI training as just a standard part of their degree

(10:46):
or their certification. So if you are going to seek
out help for a baby as tongue tie, you need
to go to people who have intentionally sought out additional training.
And that could be any discipline. Right if you find
a great SLP who's really good at tongue tie, they
might be able to really get too far enough to

(11:07):
meet your goals. Same with an OT, same with an IBCLC,
same with a dentist. But if you go to somebody
who just will is going to look in a mouth
and say yes or no, you have tongue ti er,
you don't have tongue tie, that's not going to be
what meets many people.

Speaker 1 (11:22):
Finding a provider who is willing to meet with and
discuss all of the different discipline's concerns. There's so many
providers out there that I really struggle with who are
just like, oh, you just need to see me. I've
got all the answers like you, Just that nobody has
all of the answers. And if a family is investing
this much time, money, and effort into treatment, we need

(11:45):
to as medical providers all be on the same page
and willing to collaborate and reach out because you know,
I'm always going to be a speech language pathologist and
a feeding swallowing specialist first. That is my number one thing,
even though I have all of these additional letters behind
my name and I've done all this other training. That

(12:05):
is always my primary lens, and if I have a
baby who needs really significant lactation support, I'm going to
send them to yu Loo or to somebody else who
can really work on that sole piece. Or if we
need the chiropractor, or if we need a physical therapist,
whoever it may be. We all need to collaborate and

(12:26):
work together, because, like you said, I've got one lens
on and that's the lens I need to wear to
really be good at my job. But I need you,
I need the PT, I need the dentist, the e int,
whoever it may be, to be willing to chat with
me about. Okay, this is what you're saying, this is
what I'm seeing. Oh, let's put these pieces together and
really now we have a complete picture. It's never just

(12:49):
one thing. It's always multiple complex body systems that are
working together to help or are not functioning properly.

Speaker 2 (12:59):
Yeah, this might go this might be a little of
a nerdy deep dive. I'm going to ask it anyway,
and we can decide whether or not parents will benefit
from it. I can feel and hear the conflict in
parents' hearts and minds when you know, when I tell them,
you know, this is a complicated issue, you're going to

(13:19):
need multiple people to help you. And they're thinking, why
is it so hard to feed a baby from my body?
Why does it take so many professionals from so many
disciplines to help my baby feed? And there's a fine
line between recognizing the difficulties that the babies are having

(13:41):
and pathologizing this new little invent who is just learning
their way in the world. So how do you help
people to understand the reasons why so many infants are
having so much difficulty with feeding from the body, feeding, breastfeeding.

Speaker 1 (14:00):
I like to go back as far as we can
in history and talk about the things that have changed.
Was it always this much of an issue, or is
tongue tied just something that's coming up now, And like
really going back in the literature and understanding, especially here
in this country, our culture and what has gotten us
to this point. You know, it was very different two

(14:21):
hundred years ago, when you know, midwives were always there
and people had that support, and you know, we have
a lot of research and documentation on the tools they
would use for during that tongue ti release right after
a baby was delivered, and what the midwife would do
and then that baby's feeding story and all of that
success and support that that family had, and then you

(14:43):
know in this country when midwives were no longer permitted
to even treat and everything became very sterile and hospitals,
and you know, then formula was developed, and you know,
at this point where just a completely different culture, and
the priority is no longer on mom and baby. It's
more on the medical system and the research and you know,
the best science that we had in that day. And

(15:05):
you know, it's it's an unfortunate thing looking back now,
but hindsight is always twenty twenty. That's just where we
were at that time. And then you know, in the
eighties when both of us were were born and there
was finally that push back to breastfeeding. And then now
here we are in twenty twenty four and we're finally
starting to realize, oh, like, all of these things that
we've missed all of this time, all of these airway issues,

(15:29):
you know, just bottle feeding and forcing formula on all
of those babies all of those years. You know, we
did pay a price, and we are finally making some
progress and understanding that. And you know, it's not Tongue
tight is not a fad it's just something we've been
ignoring because we've been you know, encouraging families to breast,
to bottle feed and formula feed, and you know, finally

(15:53):
we're in a place in our culture where we're listening
to women and listening to their pain and you know,
hopefully providing some some support. So it is a situation
for parents, and it's especially tricky when all of their
providers aren't on the same page. But just trying to
give them as much information as much of like, this
is the story behind some of this. This is where

(16:14):
we are as a culture. It's not you, it's not
your baby, it's you know, we're humans. We make mistakes,
we have journeys. We're constantly learning new things, and sometimes
we learned that what we learned twenty years ago was
not as accurate as we wanted it to be. But
you know, we're all doing the best we can with
the information that we have.

Speaker 2 (16:35):
Yeah, exactly, that's a great way to put it. You know,
it's not a thing of blame. Nobody wanted babies and
moms to be in this situation in twenty twenty four,
but that's how it happened. And I also think when
you talk about helping moms to really get a good
latch and looking at all the pieces, you know, is
it the neck, is it the cheeks, is it you know,

(16:55):
full body tension all throughout these things. A lot of
parents think, Okay, well, if my baby can't achieve these
things and they need all this special all these specialists
to help them get there, then maybe it is best
for my baby just to switch to bottle feeding. But
as you're saying, that exacerbates the problem and then we

(17:16):
end up with swallowing difficulties. Or I am forty three
years old and have been diagnosed with sleep ATNA because
I did not have the right type of feeding journey
to begin with, which develops the cheeks and that sucks
swallow breathe coordination, and my musculature wasn't developed properly. And

(17:38):
we also know that there are epigenetic changes now happening
with our jobs, right, So some of that is just
humans have different jaws than we did before. So it's
not just about achieving breastfeeding. It's about what is the
long term health of this baby. And none of us
have crystal balls. I always tell my parents, my parents
that when they're trying to make decisions about out whether

(18:00):
or not they should release the tie or whether they
should go to specialists. I say, in the end, you
have to make the best decision with what you know now,
and none of us have a crystal ball. We can
tell you what we think could happen, but in the end,
we really don't know, and so you just have to
do the best you can with the information.

Speaker 1 (18:19):
Yeah, and we can try to predict even you know,
my oldest is you know, has every symptom I feel
like under the sun of tongue tie. And according to
his dentist, his tie wasn't even that significant. But he
had picky eating, He was always vomiting because food wasn't
the right texture, He never slept, he had a really
hard time with potty training. And it wasn't until we

(18:40):
did all his oral motor work when he was nine
and had his tongue tie released and did his paddle
expansion that we were finally able to make some good progress.
And then my middle child has, you know, maybe a
more significant tie according to measurements and things, but she
doesn't have all of these symptoms. You know, we just
don't know. We don't know.

Speaker 2 (19:00):
Yeah, that well, I think that's what you're bringing up
is a really good point. I always tell my patients
tongue TI diagnosis is a symptomatic diagnosis. It is not
just a visual or textile you know, feeling in the
mouth and looking in the mouth. It is tracking all

(19:22):
of the symptoms. So in a baby, that is how
is the baby doing? You know, what kind of tension
does the baby have? Are they vomiting a lot? Do
they struggle in the car seat? Do they look like
they have really good head control at a really early age.
Are they transferring milk well? Is it dribbling out of

(19:43):
the side of their mouth? And then we look at
the parent. What do the breasts look like after feeding?
What does the nipple look like?

Speaker 1 (19:50):
Are you in it uncomfortable.

Speaker 2 (19:54):
Right? Are you super engorged you know all the time?
Or do you have really low milk supply? Because we
see both ends of the spectrum, right, we see high
supply and moments apply with these TNGU teab babies. And
then we look at the feeding. What is going on
during the actual feeding in addition to the oral motor assessment.
So if you are going to a provider and all
they're doing is putting on your gloves and looking in

(20:16):
the baby's mouth and telling you, yes, there's a tongue tie,
or no, there's not a tongue tie, or yes there's
a tongue tie, but it's not severe. But you're experiencing
all these severe symptoms. That person does not have enough
training and tongue tie to really give you the help.

Speaker 1 (20:33):
You yeah, and just make the referrals too, right, That's
my biggest issue these days. It's just if you don't
have the additional training, you just make the referral. Because
you and I are doing that functional assessment, we are
actually looking at the functional skills. We are not diagnosing
a tongue tie. We are just saying, this is what
this person is at this moment in time, and these

(20:55):
are the skills that they need to develop to have
a successful feeding journey, growth journey, developmental journey. You know,
why are we gatekeeping? Let's just work together and.

Speaker 2 (21:07):
Yes, exactly. Okay, so you have this ideal situation, five
clinics with all of these providers working together, sharing notes,
coordinating care. But let's say there is a parent in
a situation there's not a small steps near them and
they cannot get all of that coordinated care together. What

(21:31):
advice would you give them to try to find practitioners
who are willing to work together and to help them
to coordinate care. It should not be the parent's job,
but if they you know, so many people are in
this situation where they don't. They're just seeing these different
pieces of the puzzle and the pieces aren't coming together ever,

(21:51):
So what advice do you give to parents who are
in that situation?

Speaker 1 (21:54):
And it's so much easier than it was before because
everybody has websites now, So I would say, really look
at a provider's profile and don't be afraid to reach
out to them and just ask what is your training,
what do you specialize in? Do you have a body
worker that you work with, do you have a lactation

(22:14):
specialist that you work with. You're just trying to find
out who is in their network and what their specialties are,
So really asking that question, and you know, I think
a lot of providers it's tricky to have this trends
disciplinary practice. From an insurance perspective, it's not always easy
and it's hard to find the providers. So just asking

(22:35):
those questions. You know, there's a lot of people that
I know that do work together, maybe cross practices. Maybe
this one OT clinic works often with this speech clinic.
So things like that, just asking their their referral network.
Are they willing to collaborate with you know, if you
have a lactation provider already, are they willing to collaborate
with them? Because that's always the number one thing I want.

(22:56):
I want to connect with that IBCLC and say, great,
what have you been working on? Okay, I'm going to
do this differently. I don't want any redundancy of care
because that's not fair to that family. And you know,
time and money are precious and I want to really
be respectful of that.

Speaker 2 (23:14):
That is so true, and I'll say that one of
the things I've done for patients is say, I know
this criminal sycral therapist, or I know this chiropractor, or
I know this SLP. Would you like me to send
the notes? You know, I'll send my notes and I
let them know, Hey, if you have any questions, call me.
And then there have been a few times where we
have coordinated. I do in home visits, so we've coordinated

(23:36):
the in home visits. So I'm going to come and
another practitioner is going to come and we're going to
work together at the same time. And so if you
are seeing multiple people as an IBCLC, if you are
going to a chiropractor and that chiropractor that you know
most chiropractors aren't going to do home visits, I'm happy
to meet you at the chiropractical office, Like, let's let's
meet there, Let's schedule our appointment for that time, and

(23:58):
that way I can see the feedback that your chiropractor
is giving and I'm learning from them simultaneously. It's a
good opportunity. But then you and I, you know, all
it takes is calling the chiropractor and saying, hey, I'd
love to do a lactation visit with this person. Is
there a space we can have after you're done with
your work, And more often than not, they are going to.

Speaker 1 (24:18):
Try to ACCOMPLI Yeah, I've never had anybody tell me no.
I'm sure there's people out there that would, but you know,
those are not the providers that that we would recommend
seeing anyway. We need to understand that we don't know
it all and we need each other. So yeah, I've
been in multiple chiropractors' offices. I've gone to the dentists
many times, you know, been there for the release. It's helpful.

Speaker 2 (24:42):
Yeah, and that helps the practitioners. Don't be afraid to
ask other practitioners if you can coordinate care, if you
can come when your patient is coming. And it might
be that you need to do that on your own
time as a way of building connections. Like maybe you're
not going to be able to build that visit if
you're not actually providing care, but it will have long

(25:06):
term returns on your practice because then you're going to
be the person that that provider falls when they know
that somebody needs of this.

Speaker 1 (25:14):
Absolutely well, we need everybody. We need everybody on this.
I colabrary and support these fans. I know.

Speaker 2 (25:25):
I wish that there was a Small Steps therapy like
in every major area because having one place where people
can go is incredible.

Speaker 1 (25:34):
I'm working on it. Yeah, I can see that that's.

Speaker 2 (25:39):
Come up to north central Massachusetts.

Speaker 1 (25:41):
Yeah, we were getting close. We're in central mass now,
so we're getting.

Speaker 2 (25:45):
I know, yeah, yeah, exactly awesome. Is there anything else
that you feel like we didn't cover when it comes
to this coordinated care that you feel like is important
to discuss before we wrap it up?

Speaker 1 (25:57):
I think as the family, make sure you know your
insurance benefits and your questions. Make sure that you know
if you have copes and deductibles, because it's not a
perfect situation. There are times, but you know, we'll have
three kops and things like that. So just know your benefits,
know your patient rights, know what questions to ask, and
don't be afraid to ask a lot of questions because.

Speaker 2 (26:18):
It only betters all of us, right exactly. So thank
you so much for taking the time to share your
expertise with us and and your personal story as well.
I really appreciate the carrier providing to families on the
East Coast and I'm so excited to see what else happens.

Speaker 1 (26:36):
What's awesome. Thank you so much, Lo, this is so fun.

Speaker 2 (26:39):
Awesome, and all your links will be in the show notes,
so if anyone wants to reach out, everything will be same.

Speaker 1 (26:44):
Thank you, Thank you everybody. So there you have it.

Speaker 3 (26:48):
A team of practitioners that include speech language pathologists, occupational therapists,
IBCLCs and others to help ensure that babies and parents
had breastfeed and meet their baby feeding goals.

Speaker 2 (27:03):
And I feel so lucky to be in an area
where I know so many great practitioners who refer out
to each other. We know our scopes, we know when
we can be the person to help a family and
when somebody else needs to tag in and help a
family to understand what's going on and why breastfeeding has

(27:23):
become so difficult for them. So, if you are struggling
to feed your baby, please reach out. I would love
to be the person to support you or to refer
you out to whoever you may need to see to
achieve your goals.

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The Baby Feeding Therapy for Moms to End Tongue Tie Stress with Multidisciplinary Care – Rachel Best

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}The Baby Feeding Therapy for Moms to End Tongue Tie Stress with Multidisciplinary Care – Rachel Best