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Hi everyone, and welcome back to another episode of Airway First, the podcast from the Children's

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Airway First Foundation. I'm your host, Rebecca St. James. My guest today is Kelsey Baker,

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a holistic pediatric occupational therapist. Kelsey has worked in early intervention since

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2009 and has been working with children between the ages of 0 to 5 in the Philadelphia area since

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2011. Kelsey is focused on proactive care to best support babies in their feeding and overall

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development as she believes that feeding is a vital sign and can be indicative of so much happening

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within the child's body. She uses a combination of body work and therapeutic modalities to help

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regulate nervous systems, increase mobility and strength, and help parents best support their

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babies where they are and on the way to where they want to be. You can find out more about Kelsey

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at BwellOT.com. And now let's jump into my interview with Kelsey Baker. Okay, great. All right. Thank you so

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much and welcome to the show, Kelsey. I really appreciate you being on. Thank you so much for

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having me. This podcast has been a great source of education and connection for me. So I'm really

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happy to be here. Thank you. Oh, thanks. Oh, I appreciate it. So let's just start at the beginning

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just so everybody we're all coming from the same understanding of exactly what is a holistic

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occupational therapist and how do you specifically work with kids? So holistic to me is kind of a

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buzzword and I kind of, I wasn't sure about using it in my branding and my business name and all

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those things. But I think it's important to understand that I'm not just looking at one piece

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of a child. I'm looking at the family dynamic. I'm looking at the environment that they're in. I'm

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looking at their nutrition. I'm looking at their gross motor, obviously, I'm looking at so many

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different pieces and having the ability to zoom out from maybe the problem that is presented to me

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and prompting evaluation or something like that and being able to zoom out and really get a good

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perspective on what's going on with this child. And that's what holistic means to me. I want to

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look at all of the different parts of somebody's life to be able to help pinpoint what needs to be

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worked on, but also maybe like, oh, maybe we need to have some more focus on this area first so we

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can have better access to the thing that we are here for, but we won't be able to get there just

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yet. It just depends.

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And what kind of things exactly do parents, you know, what kind of issues do they come to you with?

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So most of the time people come to me with oral motor dysfunction, feeding issues and infants,

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open mouth breathing in infants and older kiddos, a lot of general feeding challenges and nervous

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system regulation difficulties. Those are the big things that I see.

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Okay, got it. And I was going to say, I assume, but I really don't want to do this. So is this a,

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it's definitely not a one and done, but is this something that happens over the course of months,

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or is this something that can be years working with a child, depending on the case?

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That's a great question. So I try to have minimal contact, which is kind of counterintuitive, because I

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really want to have ongoing communication with parents, but I want our time together to be as

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efficient as possible for them, because I know that time finances, just a bandwidth are of a

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concern for everybody involved. So usually when I see a baby, I'll do, I kind of have an average of

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somewhere between six and 12 sessions, depending on why they're seeing me the age of the child, all of

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those things. So there's a little bit of that upfront commitment. And then a lot of times I'll

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have families continue with monthly check ins or quarterly check ins. And as of now, I have a lot of

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babies that, well, toddlers that I saw as babies that are circling back and we're kind of revisiting

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some things that have evolved over the past year or two. So it's an ongoing relationship for sure.

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Got it. Is it something that you see kind of, if there's one child in a family, you'll end up working

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with multiple? Or does it just fair? Okay.

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So a lot of times I'll get the second baby. People don't, haven't heard about me until they

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have that second baby, because they're not quote unquote, in the know, they don't have all of the

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doors open to them yet. They kind of did the traditional, you know, hospital birth and hospital

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lactation visit and had their feeding journey from there. And then the second time they have a better

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idea of what they want their feeding journey to look like. So they're really trying to establish a team.

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And then they kind of find their way to me for that second. And it's a little backwards sometimes,

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but I'll see that baby. And then they start realizing, Oh, their older kiddo has some of these things

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going on. And they'll have memories come back about early days with their oldest. And we'll start to

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kind of make a plan for the older kiddo as well. Got it. And I'll circle back on the feeding journey,

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because I think it ties into something that we've identified that I know we want to talk about

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a little bit. But let's take a moment and just step back for a minute after we are reading on the

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website, your path into this profession, had kind of a personal journey, if I stand that correctly.

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And just would you mind sharing a little bit about that with everybody? Yeah, of course. So I have

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my oldest is my stepson. And I met him when he was 15 months old. And we worked on, we worked on,

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I introduced him to lots of feeding and sensory things. And I had my therapist stand on things.

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And that was fun. And part of my world, I was in early intervention for many years. So getting to

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know him and building a relationship with him was kind of an extension of that to a degree. Obviously,

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there's more levels to it, building a bond with a child, part of your family, but bringing in some

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of my therapist tools and tricks. And then when I got pregnant with my daughter, I started venturing

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into the lactation world. Because I was like, Oh, this will support me personally and professionally.

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And then when I had her, I had a home birth and I love my midwife. And it was just a crazy,

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wonderful ride, as any birth is. But she was born with ties. And I realized that I didn't know anything

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about newborns. I mean, I did on paper, but even through all of my schooling, even through all of

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my training is even through my lactation courses, I knew about newborns, but I didn't know about

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newborns. I was not prepared in the ways that I wish I had been. And I was very set on breastfeeding.

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I didn't introduce a passi or a bottle. And I don't think we introduced a bottle until five or six

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weeks. I was definitely pushing it. And with that, she refused a bottle after weeks and weeks of

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really painful breastfeeding, but kind of grit and bear it. She was not efficient. She would feed

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all the time. And I was just like, Okay, she's a high needs baby. I didn't know anything about ties.

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I didn't know anything about airway. I knew that she should sleep with her mouth closed. But that

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was about it. I didn't know about like getting that tongue suction to the palate. I didn't know about

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true tongue mobility at all. So we are here now at six and a half. And she still has ties. And

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she's doing really well. But I didn't know all the things that I know now back then. And I wish I

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could go back. So we have some some long term impact. But I've mitigated as well as I could.

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And there's a lot of just like bandwidth that goes along with that as far as

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therapising your own child. And same for my stepson too. So there's things I wish we could do

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that just really aren't the cards right now. And that's okay. But we do the best we can. And

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I definitely pulled my experiences from early days with both of them to ongoing learnings from

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where they are now with ties still intact and what that looks like in a nine and six year old.

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And I kind of am able to bring that perspective of like, no, these are not emergent things. These

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are quality of life things that can make your life so much better if we're getting restful sleep and

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we're eating better foods and it's not a battle and all of those things. Right. Right. And a couple

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of things that you said that I really are interested in. I just want to point them out because it's

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something that we just hear over and over. One is parents. We all wish we could go back. We,

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you know, we all did the best we could. Here we are now. We know what we know now. All we can do

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is move forward. And I've heard so many medical professionals come on here and say the same

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thing. I didn't know. Now after all of your education and your training, it's just you didn't know.

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It's wild to me thinking back about all of the time that I spent learning and how I didn't really

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even scratch the surface of what I needed to know until my daughter was probably like 18 months old.

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So that's with my background. And then we expect parents that are not in the medical field

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to have any clue about any of this is just right insane. Yeah, exactly. Exactly. But you know,

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that is part of our goal here is to educate parents. I mean, we're focused on medical

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professionals as well. But it's parents because we just didn't know. So, you know, the more we

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share, the more we can get out there. Let's kind of pivot a little bit. You have a blog and I'll

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anything that we mentioned here, I'll make sure we link in the show notes. But you have a blog post

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where you talk about body work. And I found it pretty interesting. And one of the things that

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you talk about is that we're using it incorrectly. So I thought maybe we could talk a little bit

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about how are we supposed to be using this? And how does it apply specifically to children?

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So body work is a big umbrella term that most manual therapists, therapists that are putting

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hands on other people will use. And it's kind of turned into this buzzword to a degree, again,

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like along with holistic, there's lots of there's lots of these buzzwords that parents

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here are thrown around, but we don't have a true understanding of what they mean. So

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as a therapist, my understanding of body work is a passive manipulation. I am doing something to

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a body and hoping to get some sort of physiological response, either some lengthening or softening

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or some sort of tactile cue that something has happened. And then when we add in a therapeutic

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piece, it's a little bit more active, I'm demanding something of the body, whether that's

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a little bit more active range of motion of turning the head independently with the encouragement

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of a toy or mom's face or something like that, rather than me physically turning that

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head. Okay, good example. So body work and therapeutic movement go hand in hand, you do

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need both. But there's a I think there can be a lapse in understanding when somebody is just

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doing body work, if you're just going to the chiropractor, if you're just going to the osteo,

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and it's not quote unquote, sticking, you might need to add in some more therapeutic movement to

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make it active and have the body and the nervous system truly hold on to those adjustments.

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Okay, and when you're doing body work, maybe with an infant, when you're doing it,

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are we talking about tummy time and things that you would do with them in that kind of realm?

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To a degree, yeah. So body work with an infant is an infants don't have a lot of volitional movement,

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right? So we are moving them a lot. There's a lot of hands on manipulation. And then as they

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develop more strength and mobility, we're ensuring that that strength is developed through that new

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range of motion. So I talk about neck mobility a lot, because that's a lot of what we're talking

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about with infants, we need to have good neck range of motion for proper feeding and airway

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development. So when I think about body work for the neck and shoulders and decreasing tension there,

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we need to work through those layers of tension, but we also need to work on

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increasing strength in a balanced way to have balanced extension and flexion,

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rather than the baby that is always an extension and arching back all the time.

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You're listening to Airway First with today's guest, Kelsey Baker. You can find out more about

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the Children's Airway First Foundation and our mission to fix before six on our website at

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childrensairwayfirst.org. The CAF website offers tons of great resources for parents and medical

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professionals, including videos, blogs, our recommended reading list, comprehensive medical

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research, podcasts, and so much more. Parents are encouraged to join the Airway Huddle,

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our Facebook support group, which was created for parents of children with Airway and sleep-related

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issues. You can access the Airway Huddle support group at facebook.com. Are you a medical professional

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or parent that's interested in being a guest on the show, or do you possibly have an idea for an

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upcoming episode? Then shoot us a note via the contacts page on our website, or send us an email

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directly at info at childrensairwayfirst.org. As a reminder, this podcast and the opinions expressed

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here are not a medical diagnosis. If you suspect your child might have an airway issue, contact

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your pediatric airway dentist or pediatrician. And now let's jump back into my interview with

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today's guest, Kelsey Baker.

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So, there's lots of different pieces. Right. Right. So, let's circle back now to more specifically

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the feeding journey that we touched on a little bit earlier. With regard to the feeding journey,

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let's just talk about tips and things for moms that are trying to breastfeed, but are finding it

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difficult. And they know it's important because you've got to get that jaw exercise. You've got

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to get that jaw developed for this newborn. What kind of tips can you offer for parents?

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I would say that bottle feeding kind of gets a bad rap. I really love to use bottle feeding to

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help enhance the breastfeeding relationship. So, don't feel like you need to go all or nothing

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in your feeding journey, especially if that feels aligned to you. If you are like, no,

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I want exclusively breastfeed. I don't really have a need to do a bottle. That's a great journey.

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I don't think it's most people's journey, unfortunately, just because we live in a

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capitalistic society. Exactly. Got to work. Yep. Exactly. So, most of the time, the goal is

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combo feeding, right? You're pumping while you're gone or supplementing and then you're offering

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the breast or chest when you're with baby, but yeah, not having an all or nothing mentality

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around that and choosing the bottles that are going to support your breastfeeding journey

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rather than potentially hinder it and get in the way. What kind of bottles would be, would you

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recommend? Most bottles that are marketed as breastfeeding friendly, quote unquote,

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and they look more breast-like are going to encourage a really shallow latch and are more

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compression dominant. So, we don't want compression at the breast. We want suction and bottles that

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encourage suction and a wide latch would be Dr. Brown's even flow, wide neck and standard neck.

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The Dr. Brown's wide neck, I would not recommend. That's a little bit more shallow. Okay. Yeah.

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And Lansano is a good one. I will say Lansano's slow flow is not as slow as I would like. So,

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the Pigeon Nipple, Pigeon S or SS is the parent company of Lansano and those are interchangeable

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with a lot of different bottles. Okay. Yeah. Okay. But these will at least,

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or I say they simulate, I guess, the same kind of jaw movements that baby's going to get with mom,

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right? So, you're still getting that exercise and it's not going to throw a baby off between

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bottle or breast, right? I mean, are they usually able to transition pretty easily back and forth?

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Typically. So, usually if there's a strong preference for breast or bottle, it's just a sign

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of oral motor dysfunction. It's not necessarily that the bottle and the breast are too dissimilar.

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They're going to be different skills. The bottle, even the best bottle, even my favorite bottle,

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is going to require a different skill set than at the breast. Okay. Bottles don't change, right?

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They don't start out very firm and full of milk and then get softer as the feed goes on. The flow

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doesn't change. The mechanics don't have to shift slightly. So, there's more nuance with breast feeding

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that is hard to replicate. We can get really close to it and we can still promote that wide

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latch that's going to help the jaw develop. But, yeah, nothing can really replace the breast,

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unfortunately. Right. So, what are some signs that moms could look for that maybe aren't working with?

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First of all, if you can work with a lactation specialist, we've said it before, go all in,

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take advantage of it. But if you can't, what are some signs you could look for that things

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aren't right? I mean, you yourself said you pushed through the pain. That's what we thought we were

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supposed to do. This doesn't feel right. Let's just figure it out. We keep pushing. We get there. But

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obviously, we now know that we have this service to both mom and baby. What are some signs that

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they should look for that, hey, maybe we need some help. Maybe something's not quite right here.

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Yeah. So, pain is the biggest one, right? And that's the most obvious one. If your nipples are

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bleeding like mine were, it's a sign to go get help. Don't do what I did. We did get to a good

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place over time, but it took a long time and I would not recommend that. So, if we're looking at

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kind of like red flags, we are looking at open mouth breathing, right? Sleeping with their mouth open,

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having a milk tongue, it looks like a thrush tongue, but it really is just milk residue because the

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tongue isn't elevating to the palate on scraping off and kind of naturally cleaning. So, that's a

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good sign that the tongue is low and not very high. If you have an idea of what you're looking for

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in baby's mouth, a high palate, it almost looks like a thumbprint on the roof of their mouth. It

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feels like they could put their thumb right in a little crevice on their palate. We want it to be

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almost like a shovel shape. Like somebody put a spoon or a shovel in upside down and formed that

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palate and it gets to be that way with the tongue elevated, but if the tongue is low, it doesn't form

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that way and it gets higher. All right. And then obviously you work with baby's infants, younger

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children with tongue tie releases. What are some things that parents can look for for, hey, I think

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my child might have a tongue tie. And then what do you recommend when they get released? What is

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the right kind of therapy? What should they be expecting for therapy or at least therapy options?

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Great questions. So, I always recommend pre-op therapy, right? If we're even considering getting

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a release, but we're not quite sure, we're going to move forward with therapy as if we're trying to

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prevent the release almost. We're trying to get to a better place function-wise where it seems like

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we might not even need that release. And then depending on where that baby is and timeline of

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the family going back to work, just so many other factors that go into it, that's the ideal. And

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sometimes we can get to that in two to three weeks. Sometimes it takes a little longer. Just really

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depends on the baby. And then we'll have the release. And ideally we're doing six weeks of post-op

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therapy. And that looks like three weeks of stretches. A lot of people will just call them

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stretches and we're lifting the tongue up to keep that wound open. And there's different

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frequencies. People recommend different things in different parts of the country. Different

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providers will recommend slight variations. But most of the time it's three weeks of stretches.

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I'm a big fan and I will preach to my clients that we do another three weeks and not necessarily

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this to the same intensity level by any means. But we are still doing on a weaning down process,

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those lifts to keep the scar tissue nice and soft and supple and malleable to be able to

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get the tongue to fully elevate. And not just in the front but in the back too. And we're doing

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more exercises to strengthen and tone the tongue to get the best result that we possibly can from

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that release rather than just kind of relying on what the baby is going to do because they're

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going to revert back to the mean. They're going to go back to what they feel is comfortable.

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And they're not going to help change the anatomy of that tongue.

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Got it. That's true. Yeah. So how do you, I mean obviously you would work with

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every child is different in, but when you're thinking about, you know, to get the tongue

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all the way back, all the way up, how do you, how do stretches actually help that part of the

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process? You know, it makes sense to me because when we talk to people, we all, I know everybody

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else does it. I'm not the only one practices with my tongue in the roof of my mouth when I'm

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talking to somebody. But how do you get the back when you're working with a child? How do you

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teach them to do the back part of that? A lot of it is just different tactile cues playing

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underneath the tongue. And I always say we're kind of creating safety with the sensation of the tongue

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leaving its parking spot in the back of the mouth. Like we want it to be able to raise up and eventually

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get to a new parking spot on the palate, but it's going to take some time. So it feels anchored

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down in the back. And that's why a lot of times you'll see babies with just the front of their tongue

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suctioned up when we do that rusting tongue posture hold. And it just takes some time

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to get the back of the tongue to get with the program and get up there as well.

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So that's, and that goes back to it can take weeks. Sometimes this is not a super fast process.

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And so these exercises that you send home, they're doing them at home for

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for weeks, months, weeks at minimum. And I always kind of describe it as this ebb and flow of

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sometimes we're heavy with the exercises. If we notice more drilling, if we notice some more

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regression, if we notice, you know, something that clues us in that we could be doing better,

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right? If there's more milk loss while feeding or clicking comes back or something like that.

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We ramp up the exercises, but overall, they get less and less over time. And then if we hit a

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growth spurt or we start teething really heavily or something like that, there's new gradations of

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the exercises to kind of get the tongue moving in new ways and encourage that lingual suction as well.

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Okay. And you mentioned drilling, I actually haven't heard somebody say that specifically before as

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this sign is that is that an oral dysfunction? Is that just a sign of the tongue? Is it where

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it's supposed to be? What is what is drilling? How does that signal anything?

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Depends on the age, right? So drilling in the newborn phase is not super common. That usually

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starts closer to like the three to four month mark when hands start to get to the mouth. And

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there's just more overflow because the tongue is moving more and that's expected and really normal.

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Closer to like six to nine months when solids are introduced, you get a little bit more control

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of your fluids. So, you know, some drilling again is normal, especially if they're congested and

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just like everything is kind of a mess. But hopefully that's an acute phase and not just how

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they are all the time. They are, that can be lots of other things. But if we see consistent

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drilling past like nine, 10 months, there's a sign that there could be some lower muscle

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tone in the mouth. It could be that the tongue is just need some more input to be acute swallow.

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So it might be a little bit of a sensory thing. And it could also go back to a tie and some

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restriction that it takes a lot of energy to get that swallow. So why would I do it to swallow

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saliva? And that doesn't really give me anything, but I like to swallow milk. So I'll do that.

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That makes sense. So talking about oral dysfunction in the airway, I mean, obviously for us, it's

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in our everyday lives. We talk about it. That's all we talk about. But it's becoming more mainstream

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because of books like, you know, James Nestor's Breathe and Gasp and things like that. And

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then, you know, you're hearing it more in the medical profession as well. So as this moves

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more the forefront and becomes something that as first time parents, you're going to be taught

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this now in your prenatal classes and your doctors are going to talk to you about it.

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How do you see your role as a holistic occupational therapist evolving and playing into this new,

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I say new healthcare paradigm, but this, you know, this new world?

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I mean, I hope we get there. I sincerely hope that we get there. And I,

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Yeah, I say,

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Yes, I'm optimistic. And then also sometimes this heartening, depending on which provider I've

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spoken with recently. But I see myself as a little bit of a hub or a consultant for helping to

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determine what makes the most sense to go for first. Do we need to see an ENT? Do we need to go

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for palatal expansion? Do we need to, you know, do the tongue tie? Do we need to, you know,

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what makes the most sense to do in which order, depending on the age of the child? And

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I think for the itty bitties, which is where I mostly focus for those newborns,

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I think, hopefully every baby, it gives a feeding evaluation over time from a trained speech therapist

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or occupational therapist who really understands what's going on in the mouth and can look at

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the whole body and see how this baby is feeding with their body, because you learn so much.

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I only get in the baby's mouth at the end of an evaluation. I go through the whole body first

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before I even take a look in the mouth. Wow. And why is that? I can see, I can almost predict what

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that tie is going to look like. And sometimes I'm wrong, and I like to kind of play a game with

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myself. I'm like, am I going to be right this time? I don't know. And sometimes I'll let the

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families in on it. Like, okay, so I'm seeing like really tight this, I think it's going to be, you

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know, XYZ. But I'm not sure. I don't know. I don't know. I don't know. I don't know. I don't

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know. XYZ. But there's so many other things that play into it. And I hope that every baby will get

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some level of body work and feeding evaluation from somebody who understands ties and understands

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oral function and isn't just going to throw a nipple shield at them and say, have a good day.

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Right. Oh, the dream. That's what we're all kind of hoping for.

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I know. So at the end of every episode, I always like to hand it back to our guests. I mean,

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you are the experts. And just open the floor for anything that you want to share with parents,

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especially about other medical providers, anything we may not have covered, anything you want to

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emphasize, just you get the last word. Thank you. I think the biggest thing is that it's never too

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late, right? We talked about how we just didn't know. And there's always something that you can do

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to be in a better place than where you were before and where you are now. Right? 1% better is kind of

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my mantra for everything for myself and for my clients. Like these little wins are a big win

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in this world. Right. So take them. Absolutely. Well, thank you so much for being on the show today.

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I really, really appreciate it. And I know the information that you provided is going to be

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very useful to parents. So thank you. Thank you so much for having me. This was wonderful. I really

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appreciate everything that you do in this part of the world. So thank you. Thank you.

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Thanks again to today's guest, Kelsey Baker for sharing her medical insight into each of you for

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listening to today's episode. If you're new to our podcast, please don't forget to subscribe.

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And if you enjoyed today's episode, leave us a review or comment telling us about what you enjoyed

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most. You can stay connected with the Children's Airway First Foundation by following us on Instagram,

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The Airway Huddle, at facebook.com backslash groups backslash airway huddle. Looking for more

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from Kath, then check out our YouTube channel. You can find a variety of informative original

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via the contacts page on our website or send us an email directly at info at childrensairwayfirst.org.

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And finally, thanks to all the parents and medical professionals out there that are working hard to

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help make the lives of kids around the globe just a little bit better. Take care, stay safe,

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and happy breathing everyone.

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Bye.