Hi everyone, and welcome back to another episode of Airway First, the podcast from the Children's
Airway First Foundation. I'm your host, Rebecca St. James. My guest today is Kelsey Baker,
a holistic pediatric occupational therapist. Kelsey has worked in early intervention since
2009 and has been working with children between the ages of 0 to 5 in the Philadelphia area since
2011. Kelsey is focused on proactive care to best support babies in their feeding and overall
development as she believes that feeding is a vital sign and can be indicative of so much happening
within the child's body. She uses a combination of body work and therapeutic modalities to help
regulate nervous systems, increase mobility and strength, and help parents best support their
babies where they are and on the way to where they want to be. You can find out more about Kelsey
at BwellOT.com. And now let's jump into my interview with Kelsey Baker. Okay, great. All right. Thank you so
much and welcome to the show, Kelsey. I really appreciate you being on. Thank you so much for
having me. This podcast has been a great source of education and connection for me. So I'm really
happy to be here. Thank you. Oh, thanks. Oh, I appreciate it. So let's just start at the beginning
just so everybody we're all coming from the same understanding of exactly what is a holistic
occupational therapist and how do you specifically work with kids? So holistic to me is kind of a
buzzword and I kind of, I wasn't sure about using it in my branding and my business name and all
those things. But I think it's important to understand that I'm not just looking at one piece
of a child. I'm looking at the family dynamic. I'm looking at the environment that they're in. I'm
looking at their nutrition. I'm looking at their gross motor, obviously, I'm looking at so many
different pieces and having the ability to zoom out from maybe the problem that is presented to me
and prompting evaluation or something like that and being able to zoom out and really get a good
perspective on what's going on with this child. And that's what holistic means to me. I want to
look at all of the different parts of somebody's life to be able to help pinpoint what needs to be
worked on, but also maybe like, oh, maybe we need to have some more focus on this area first so we
can have better access to the thing that we are here for, but we won't be able to get there just
yet. It just depends.
And what kind of things exactly do parents, you know, what kind of issues do they come to you with?
So most of the time people come to me with oral motor dysfunction, feeding issues and infants,
open mouth breathing in infants and older kiddos, a lot of general feeding challenges and nervous
system regulation difficulties. Those are the big things that I see.
Okay, got it. And I was going to say, I assume, but I really don't want to do this. So is this a,
it's definitely not a one and done, but is this something that happens over the course of months,
or is this something that can be years working with a child, depending on the case?
That's a great question. So I try to have minimal contact, which is kind of counterintuitive, because I
really want to have ongoing communication with parents, but I want our time together to be as
efficient as possible for them, because I know that time finances, just a bandwidth are of a
concern for everybody involved. So usually when I see a baby, I'll do, I kind of have an average of
somewhere between six and 12 sessions, depending on why they're seeing me the age of the child, all of
those things. So there's a little bit of that upfront commitment. And then a lot of times I'll
have families continue with monthly check ins or quarterly check ins. And as of now, I have a lot of
babies that, well, toddlers that I saw as babies that are circling back and we're kind of revisiting
some things that have evolved over the past year or two. So it's an ongoing relationship for sure.
Got it. Is it something that you see kind of, if there's one child in a family, you'll end up working
with multiple? Or does it just fair? Okay.
So a lot of times I'll get the second baby. People don't, haven't heard about me until they
have that second baby, because they're not quote unquote, in the know, they don't have all of the
doors open to them yet. They kind of did the traditional, you know, hospital birth and hospital
lactation visit and had their feeding journey from there. And then the second time they have a better
idea of what they want their feeding journey to look like. So they're really trying to establish a team.
And then they kind of find their way to me for that second. And it's a little backwards sometimes,
but I'll see that baby. And then they start realizing, Oh, their older kiddo has some of these things
going on. And they'll have memories come back about early days with their oldest. And we'll start to
kind of make a plan for the older kiddo as well. Got it. And I'll circle back on the feeding journey,
because I think it ties into something that we've identified that I know we want to talk about
a little bit. But let's take a moment and just step back for a minute after we are reading on the
website, your path into this profession, had kind of a personal journey, if I stand that correctly.
And just would you mind sharing a little bit about that with everybody? Yeah, of course. So I have
my oldest is my stepson. And I met him when he was 15 months old. And we worked on, we worked on,
I introduced him to lots of feeding and sensory things. And I had my therapist stand on things.
And that was fun. And part of my world, I was in early intervention for many years. So getting to
know him and building a relationship with him was kind of an extension of that to a degree. Obviously,
there's more levels to it, building a bond with a child, part of your family, but bringing in some
of my therapist tools and tricks. And then when I got pregnant with my daughter, I started venturing
into the lactation world. Because I was like, Oh, this will support me personally and professionally.
And then when I had her, I had a home birth and I love my midwife. And it was just a crazy,
wonderful ride, as any birth is. But she was born with ties. And I realized that I didn't know anything
about newborns. I mean, I did on paper, but even through all of my schooling, even through all of
my training is even through my lactation courses, I knew about newborns, but I didn't know about
newborns. I was not prepared in the ways that I wish I had been. And I was very set on breastfeeding.
I didn't introduce a passi or a bottle. And I don't think we introduced a bottle until five or six
weeks. I was definitely pushing it. And with that, she refused a bottle after weeks and weeks of
really painful breastfeeding, but kind of grit and bear it. She was not efficient. She would feed
all the time. And I was just like, Okay, she's a high needs baby. I didn't know anything about ties.
I didn't know anything about airway. I knew that she should sleep with her mouth closed. But that
was about it. I didn't know about like getting that tongue suction to the palate. I didn't know about
true tongue mobility at all. So we are here now at six and a half. And she still has ties. And
she's doing really well. But I didn't know all the things that I know now back then. And I wish I
could go back. So we have some some long term impact. But I've mitigated as well as I could.
And there's a lot of just like bandwidth that goes along with that as far as
therapising your own child. And same for my stepson too. So there's things I wish we could do
that just really aren't the cards right now. And that's okay. But we do the best we can. And
I definitely pulled my experiences from early days with both of them to ongoing learnings from
where they are now with ties still intact and what that looks like in a nine and six year old.
And I kind of am able to bring that perspective of like, no, these are not emergent things. These
are quality of life things that can make your life so much better if we're getting restful sleep and
we're eating better foods and it's not a battle and all of those things. Right. Right. And a couple
of things that you said that I really are interested in. I just want to point them out because it's
something that we just hear over and over. One is parents. We all wish we could go back. We,
you know, we all did the best we could. Here we are now. We know what we know now. All we can do
is move forward. And I've heard so many medical professionals come on here and say the same
thing. I didn't know. Now after all of your education and your training, it's just you didn't know.
It's wild to me thinking back about all of the time that I spent learning and how I didn't really
even scratch the surface of what I needed to know until my daughter was probably like 18 months old.
So that's with my background. And then we expect parents that are not in the medical field
to have any clue about any of this is just right insane. Yeah, exactly. Exactly. But you know,
that is part of our goal here is to educate parents. I mean, we're focused on medical
professionals as well. But it's parents because we just didn't know. So, you know, the more we
share, the more we can get out there. Let's kind of pivot a little bit. You have a blog and I'll
anything that we mentioned here, I'll make sure we link in the show notes. But you have a blog post
where you talk about body work. And I found it pretty interesting. And one of the things that
you talk about is that we're using it incorrectly. So I thought maybe we could talk a little bit
about how are we supposed to be using this? And how does it apply specifically to children?
So body work is a big umbrella term that most manual therapists, therapists that are putting
hands on other people will use. And it's kind of turned into this buzzword to a degree, again,
like along with holistic, there's lots of there's lots of these buzzwords that parents
here are thrown around, but we don't have a true understanding of what they mean. So
as a therapist, my understanding of body work is a passive manipulation. I am doing something to
a body and hoping to get some sort of physiological response, either some lengthening or softening
or some sort of tactile cue that something has happened. And then when we add in a therapeutic
piece, it's a little bit more active, I'm demanding something of the body, whether that's
a little bit more active range of motion of turning the head independently with the encouragement
of a toy or mom's face or something like that, rather than me physically turning that
head. Okay, good example. So body work and therapeutic movement go hand in hand, you do
need both. But there's a I think there can be a lapse in understanding when somebody is just
doing body work, if you're just going to the chiropractor, if you're just going to the osteo,
and it's not quote unquote, sticking, you might need to add in some more therapeutic movement to
make it active and have the body and the nervous system truly hold on to those adjustments.
Okay, and when you're doing body work, maybe with an infant, when you're doing it,
are we talking about tummy time and things that you would do with them in that kind of realm?
To a degree, yeah. So body work with an infant is an infants don't have a lot of volitional movement,
right? So we are moving them a lot. There's a lot of hands on manipulation. And then as they
develop more strength and mobility, we're ensuring that that strength is developed through that new
range of motion. So I talk about neck mobility a lot, because that's a lot of what we're talking
about with infants, we need to have good neck range of motion for proper feeding and airway
development. So when I think about body work for the neck and shoulders and decreasing tension there,
we need to work through those layers of tension, but we also need to work on
increasing strength in a balanced way to have balanced extension and flexion,
rather than the baby that is always an extension and arching back all the time.
You're listening to Airway First with today's guest, Kelsey Baker. You can find out more about
the Children's Airway First Foundation and our mission to fix before six on our website at
childrensairwayfirst.org. The CAF website offers tons of great resources for parents and medical
professionals, including videos, blogs, our recommended reading list, comprehensive medical
research, podcasts, and so much more. Parents are encouraged to join the Airway Huddle,
our Facebook support group, which was created for parents of children with Airway and sleep-related
issues. You can access the Airway Huddle support group at facebook.com. Are you a medical professional
or parent that's interested in being a guest on the show, or do you possibly have an idea for an
upcoming episode? Then shoot us a note via the contacts page on our website, or send us an email
directly at info at childrensairwayfirst.org. As a reminder, this podcast and the opinions expressed
here are not a medical diagnosis. If you suspect your child might have an airway issue, contact
your pediatric airway dentist or pediatrician. And now let's jump back into my interview with
today's guest, Kelsey Baker.
So, there's lots of different pieces. Right. Right. So, let's circle back now to more specifically
the feeding journey that we touched on a little bit earlier. With regard to the feeding journey,
let's just talk about tips and things for moms that are trying to breastfeed, but are finding it
difficult. And they know it's important because you've got to get that jaw exercise. You've got
to get that jaw developed for this newborn. What kind of tips can you offer for parents?
I would say that bottle feeding kind of gets a bad rap. I really love to use bottle feeding to
help enhance the breastfeeding relationship. So, don't feel like you need to go all or nothing
in your feeding journey, especially if that feels aligned to you. If you are like, no,
I want exclusively breastfeed. I don't really have a need to do a bottle. That's a great journey.
I don't think it's most people's journey, unfortunately, just because we live in a
capitalistic society. Exactly. Got to work. Yep. Exactly. So, most of the time, the goal is
combo feeding, right? You're pumping while you're gone or supplementing and then you're offering
the breast or chest when you're with baby, but yeah, not having an all or nothing mentality
around that and choosing the bottles that are going to support your breastfeeding journey
rather than potentially hinder it and get in the way. What kind of bottles would be, would you
recommend? Most bottles that are marketed as breastfeeding friendly, quote unquote,
and they look more breast-like are going to encourage a really shallow latch and are more
compression dominant. So, we don't want compression at the breast. We want suction and bottles that
encourage suction and a wide latch would be Dr. Brown's even flow, wide neck and standard neck.
The Dr. Brown's wide neck, I would not recommend. That's a little bit more shallow. Okay. Yeah.
And Lansano is a good one. I will say Lansano's slow flow is not as slow as I would like. So,
the Pigeon Nipple, Pigeon S or SS is the parent company of Lansano and those are interchangeable
with a lot of different bottles. Okay. Yeah. Okay. But these will at least,
or I say they simulate, I guess, the same kind of jaw movements that baby's going to get with mom,
right? So, you're still getting that exercise and it's not going to throw a baby off between
bottle or breast, right? I mean, are they usually able to transition pretty easily back and forth?
Typically. So, usually if there's a strong preference for breast or bottle, it's just a sign
of oral motor dysfunction. It's not necessarily that the bottle and the breast are too dissimilar.
They're going to be different skills. The bottle, even the best bottle, even my favorite bottle,
is going to require a different skill set than at the breast. Okay. Bottles don't change, right?
They don't start out very firm and full of milk and then get softer as the feed goes on. The flow
doesn't change. The mechanics don't have to shift slightly. So, there's more nuance with breast feeding
that is hard to replicate. We can get really close to it and we can still promote that wide
latch that's going to help the jaw develop. But, yeah, nothing can really replace the breast,
unfortunately. Right. So, what are some signs that moms could look for that maybe aren't working with?
First of all, if you can work with a lactation specialist, we've said it before, go all in,
take advantage of it. But if you can't, what are some signs you could look for that things
aren't right? I mean, you yourself said you pushed through the pain. That's what we thought we were
supposed to do. This doesn't feel right. Let's just figure it out. We keep pushing. We get there. But
obviously, we now know that we have this service to both mom and baby. What are some signs that
they should look for that, hey, maybe we need some help. Maybe something's not quite right here.
Yeah. So, pain is the biggest one, right? And that's the most obvious one. If your nipples are
bleeding like mine were, it's a sign to go get help. Don't do what I did. We did get to a good
place over time, but it took a long time and I would not recommend that. So, if we're looking at
kind of like red flags, we are looking at open mouth breathing, right? Sleeping with their mouth open,
having a milk tongue, it looks like a thrush tongue, but it really is just milk residue because the
tongue isn't elevating to the palate on scraping off and kind of naturally cleaning. So, that's a
good sign that the tongue is low and not very high. If you have an idea of what you're looking for
in baby's mouth, a high palate, it almost looks like a thumbprint on the roof of their mouth. It
feels like they could put their thumb right in a little crevice on their palate. We want it to be
almost like a shovel shape. Like somebody put a spoon or a shovel in upside down and formed that
palate and it gets to be that way with the tongue elevated, but if the tongue is low, it doesn't form
that way and it gets higher. All right. And then obviously you work with baby's infants, younger
children with tongue tie releases. What are some things that parents can look for for, hey, I think
my child might have a tongue tie. And then what do you recommend when they get released? What is
the right kind of therapy? What should they be expecting for therapy or at least therapy options?
Great questions. So, I always recommend pre-op therapy, right? If we're even considering getting
a release, but we're not quite sure, we're going to move forward with therapy as if we're trying to
prevent the release almost. We're trying to get to a better place function-wise where it seems like
we might not even need that release. And then depending on where that baby is and timeline of
the family going back to work, just so many other factors that go into it, that's the ideal. And
sometimes we can get to that in two to three weeks. Sometimes it takes a little longer. Just really
depends on the baby. And then we'll have the release. And ideally we're doing six weeks of post-op
therapy. And that looks like three weeks of stretches. A lot of people will just call them
stretches and we're lifting the tongue up to keep that wound open. And there's different
frequencies. People recommend different things in different parts of the country. Different
providers will recommend slight variations. But most of the time it's three weeks of stretches.
I'm a big fan and I will preach to my clients that we do another three weeks and not necessarily
this to the same intensity level by any means. But we are still doing on a weaning down process,
those lifts to keep the scar tissue nice and soft and supple and malleable to be able to
get the tongue to fully elevate. And not just in the front but in the back too. And we're doing
more exercises to strengthen and tone the tongue to get the best result that we possibly can from
that release rather than just kind of relying on what the baby is going to do because they're
going to revert back to the mean. They're going to go back to what they feel is comfortable.
And they're not going to help change the anatomy of that tongue.
Got it. That's true. Yeah. So how do you, I mean obviously you would work with
every child is different in, but when you're thinking about, you know, to get the tongue
all the way back, all the way up, how do you, how do stretches actually help that part of the
process? You know, it makes sense to me because when we talk to people, we all, I know everybody
else does it. I'm not the only one practices with my tongue in the roof of my mouth when I'm
talking to somebody. But how do you get the back when you're working with a child? How do you
teach them to do the back part of that? A lot of it is just different tactile cues playing
underneath the tongue. And I always say we're kind of creating safety with the sensation of the tongue
leaving its parking spot in the back of the mouth. Like we want it to be able to raise up and eventually
get to a new parking spot on the palate, but it's going to take some time. So it feels anchored
down in the back. And that's why a lot of times you'll see babies with just the front of their tongue
suctioned up when we do that rusting tongue posture hold. And it just takes some time
to get the back of the tongue to get with the program and get up there as well.
So that's, and that goes back to it can take weeks. Sometimes this is not a super fast process.
And so these exercises that you send home, they're doing them at home for
for weeks, months, weeks at minimum. And I always kind of describe it as this ebb and flow of
sometimes we're heavy with the exercises. If we notice more drilling, if we notice some more
regression, if we notice, you know, something that clues us in that we could be doing better,
right? If there's more milk loss while feeding or clicking comes back or something like that.
We ramp up the exercises, but overall, they get less and less over time. And then if we hit a
growth spurt or we start teething really heavily or something like that, there's new gradations of
the exercises to kind of get the tongue moving in new ways and encourage that lingual suction as well.
Okay. And you mentioned drilling, I actually haven't heard somebody say that specifically before as
this sign is that is that an oral dysfunction? Is that just a sign of the tongue? Is it where
it's supposed to be? What is what is drilling? How does that signal anything?
Depends on the age, right? So drilling in the newborn phase is not super common. That usually
starts closer to like the three to four month mark when hands start to get to the mouth. And
there's just more overflow because the tongue is moving more and that's expected and really normal.
Closer to like six to nine months when solids are introduced, you get a little bit more control
of your fluids. So, you know, some drilling again is normal, especially if they're congested and
just like everything is kind of a mess. But hopefully that's an acute phase and not just how
they are all the time. They are, that can be lots of other things. But if we see consistent
drilling past like nine, 10 months, there's a sign that there could be some lower muscle
tone in the mouth. It could be that the tongue is just need some more input to be acute swallow.
So it might be a little bit of a sensory thing. And it could also go back to a tie and some
restriction that it takes a lot of energy to get that swallow. So why would I do it to swallow
saliva? And that doesn't really give me anything, but I like to swallow milk. So I'll do that.
That makes sense. So talking about oral dysfunction in the airway, I mean, obviously for us, it's
in our everyday lives. We talk about it. That's all we talk about. But it's becoming more mainstream
because of books like, you know, James Nestor's Breathe and Gasp and things like that. And
then, you know, you're hearing it more in the medical profession as well. So as this moves
more the forefront and becomes something that as first time parents, you're going to be taught
this now in your prenatal classes and your doctors are going to talk to you about it.
How do you see your role as a holistic occupational therapist evolving and playing into this new,
I say new healthcare paradigm, but this, you know, this new world?
I mean, I hope we get there. I sincerely hope that we get there. And I,
Yeah, I say,
Yes, I'm optimistic. And then also sometimes this heartening, depending on which provider I've
spoken with recently. But I see myself as a little bit of a hub or a consultant for helping to
determine what makes the most sense to go for first. Do we need to see an ENT? Do we need to go
for palatal expansion? Do we need to, you know, do the tongue tie? Do we need to, you know,
what makes the most sense to do in which order, depending on the age of the child? And
I think for the itty bitties, which is where I mostly focus for those newborns,
I think, hopefully every baby, it gives a feeding evaluation over time from a trained speech therapist
or occupational therapist who really understands what's going on in the mouth and can look at
the whole body and see how this baby is feeding with their body, because you learn so much.
I only get in the baby's mouth at the end of an evaluation. I go through the whole body first
before I even take a look in the mouth. Wow. And why is that? I can see, I can almost predict what
that tie is going to look like. And sometimes I'm wrong, and I like to kind of play a game with
myself. I'm like, am I going to be right this time? I don't know. And sometimes I'll let the
families in on it. Like, okay, so I'm seeing like really tight this, I think it's going to be, you
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
know. XYZ. But there's so many other things that play into it. And I hope that every baby will get
some level of body work and feeding evaluation from somebody who understands ties and understands
oral function and isn't just going to throw a nipple shield at them and say, have a good day.
Right. Oh, the dream. That's what we're all kind of hoping for.
I know. So at the end of every episode, I always like to hand it back to our guests. I mean,
you are the experts. And just open the floor for anything that you want to share with parents,
especially about other medical providers, anything we may not have covered, anything you want to
emphasize, just you get the last word. Thank you. I think the biggest thing is that it's never too
late, right? We talked about how we just didn't know. And there's always something that you can do
to be in a better place than where you were before and where you are now. Right? 1% better is kind of
my mantra for everything for myself and for my clients. Like these little wins are a big win
in this world. Right. So take them. Absolutely. Well, thank you so much for being on the show today.
I really, really appreciate it. And I know the information that you provided is going to be
very useful to parents. So thank you. Thank you so much for having me. This was wonderful. I really
appreciate everything that you do in this part of the world. So thank you. Thank you.
Thanks again to today's guest, Kelsey Baker for sharing her medical insight into each of you for
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Bye.