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Episode 87: Infant Oral Development with Kelsey Baker

, , , October 19, 2022

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Jacqueline Kincer  0:03

Why welcome to the podcast. Kelsey, I am super excited to have you here and have our conversation today. Kelsey, and I connected on Instagram, which is always a fun place to hang out. And she’s an occupational therapist and a lactation counselor. She’s gonna be sharing her perspective on infant feeding, breastfeeding, oral ties and all that fun stuff today. So Kelsey, welcome and tell us a little bit about yourself and where you’re from. And we’d love to get to know more about you.


Kelsey Baker  1:09

Wonderful, thank you so much for having me, Jacqueline. I really have admired your work on Instagram for a long time. And I remember when I first started getting into this little breastfeeding tots holistic world, I found your account and I was just like, oh my gosh, this is amazing. She’s amazing. I love everything that you do. So I definitely am a little a little bit starstruck being on here. So I appreciate it.


Jacqueline Kincer  1:37

You’re welcome, as always feels weird when people say stuff like that, but glad we’re here.


Kelsey Baker  1:42

Yes, me too. Me too. So yeah, I’m originally from upstate New York. But I moved to Philly about 1112 years ago. And I started working in early intervention. So I was with the little one zero to three. And I did that for about 10 years, which gave me a ton of experience. And during that time, I really started to specialize in feedings. So I was talking about picky eating and sensory stuff, and all of those like transitioning to solids and picky toddler area things. And then when I got pregnant, I was like, oh, I should look into lactation because that would be helpful for me. And it’s a nice, kind of like precursor to what I’m already doing, obviously. And that was an area I hadn’t really gotten into. So when I had my daughter, I was like I’m a CLC. Now I’m a feeding therapist, I’m an OT, I know all of that development, this is going to be great. I am the perfect fit for this parenting thing. And then of course, like as every baby does, throws you for a loop, and I was you know, caught off guard by lots of things in that newborn phase that I thought I was going to be really well prepared for and I wasn’t. So I got through about two and a half years of breastfeeding with her and the first few months were really rocky, but we pushed through mostly just because of pure determination. But with that she never took a bottle. So there was a lot of sleepless nights and lots of accommodations to be made in everyone’s schedules to make sure baby was fed. And then from there, I kind of had this happenstance connection with a friend of a friend who happened to be a lactation consultant. And I didn’t really get the lactation support that I should have had when I had my daughter. So I didn’t know a lot of lactation consultants in the city. It just wasn’t a world that I had been, you know, opened up to. And so when I met this ibclc, she was like, Oh, you work with babies. And you’re an OT. I don’t know any other OTS in Philly that do this. And there were but they’re just hard to find. And so I started going into the world of tots and figuring out tethered oral tissues and taking all of the courses associated with that. And I already done so much training and torticollis and plagiocephaly and all of the other things that kind of get in the way of early infant development. So this really tied everything together for me, and it was like kind of perfect, Kismet timing. And then about two years ago I started my private practice be well OT and as of a year ago, I am full time private practice. So that’s kind of where I am now.


Jacqueline Kincer  4:32

Ah, awesome. Thank you so much for filling us in and you know your personal story. I could definitely relate to a lot of what you said as well. And I love that you got connected more into this work from someone in a different field. And I find that that is the world of breastfeeding where it takes many disciplines to make it work and so that collaboration is absolutely key and P But like you, I feel like are sort of few and far between still. So there’s definitely a very specialty niche of OTS out there that can support babies and breastfeeding babies, let alone at that. So I’m super glad that you’re on board and have been able to practice. Yeah, me too.


Kelsey Baker  5:19

I feel like it just worked out so perfectly with my previous experience with myofascial release, and even took some pelvic floor stuff. And obviously, my feeding experience that worked out really well, kind of tying all of the pieces together. And you know, hindsight is 2020. But it seemed like I was just kind of doing random things. But now it all ties together really nicely.


Jacqueline Kincer  5:42

Yeah, yeah, absolutely. And on that note, to just for our listeners who might not be familiar with this, maybe tell us a bit about what is an occupational therapist? What do you do? What are you allowed to do? What do you not do? And maybe how you’re different from a physical therapist, or a speech language pathologist or some other professions that operate in similar spaces?


Kelsey Baker  6:08

Great question. Yeah, occupational therapist is a really confusing label, or title, a lot of people, you know, hear occupational, and think jobs. Occupational therapists can work with anyone throughout the lifespan. And we help people achieve daily activities. And these are really broad terms. OT, occupational therapy was started by nurses post war times, usually, we would take activities that soldiers enjoyed crafts, weaving, leather work that type stuff to regain function. So those are the roots of OT, and that’s really expanded on to taking things that people enjoy and need to do throughout the day, and how to make them successful in them. So that can look like adaptations with like, dressing, adaptive pieces, or ergonomics in work settings. And it can also look like lactation support through infant hood, and helping babies reach milestones. So it’s a really cool job where I can do a lot of different things. And I get to zone in on my passion area, which is helping babies.


Jacqueline Kincer  7:26

Oh, wow. Yeah, those foundations are really interesting. I have no idea. And you know, that makes absolute sense. And what I’m hearing you say is that you’re really focused on the function, like how someone is able to execute daily tasks, would you say that’s accurate?


Kelsey Baker  7:42

That is completely accurate? So


Jacqueline Kincer  7:46

because, you know, physical therapists, yes, they’re working on function. But I would say it’s almost a more structural approach, right? How, how the body is positioned or something like that, but you’re looking at this this function of completing a task or executing it.


Kelsey Baker  8:02

Yeah, so we’re really looking at the whole body, we are looking at structure, function, sensory nervous system, we’re kind of piecing everything together, which gives us a really unique lens to come from.


Jacqueline Kincer  8:16

Hmm, that’s so cool. And obviously, I can see how that’s applicable to breastfeeding, because I’m looking at the whole picture. And then also the mother because there’s a mother baby dyad. There when it comes to breastfeeding, and you know, their relationship with one another and how that’s impacting the whole experience. So when you’re looking at it through an OT lens, what are some of the things that you’re maybe assessing? I guess, when it comes to, you know, breastfeeding or bottle feeding with babies?


Kelsey Baker  8:48

Yeah. So I’m looking at the baby state, I’m seeing what their respiratory looks like, are they panicking and panting when like bottles are presented? Are they able to latch and then immediately just pause because just the fact of latching or the act of latching was exhausting, what they’re able to do with the breast honestly, and where they’re comfortable. babies that have tension usually have a side preference, and that can lead to some supply issues and positioning restrictions that make it really hard for breastfeeding parents to make that sustainable. So we look at the alignment, we look at the actual anatomical structure, and we look at the function because the, the body, the body forms around function. So if we can optimize function, the body forms optimally and ideally pretty symmetrically, and there are there’s a room where there needs to be room and there isn’t room where there shouldn’t be room. So we’re also looking at muscle tone. So Um, babies usually come out with variations of muscle tone, which isn’t necessarily strength, but it is how your muscle fibers are at rest. So higher muscle tone is really, really tight, and everything’s clenched together, which sometimes is hidden by physiological flexion. So newborns really make it tricky because they’ve been scrunched up in the womb for so long, and we expect them to be all balled up. But then if that lasts for a little bit longer than we’d like, you know, if I see a four, six week old with really, really tight, hip flexors, and there, this is always bunched up, and they never seem to relax, that is more of an issue than a one or two week old who is in that same position. So development really impacts what we’re looking at when it comes to breastfeeding as well.


Jacqueline Kincer  10:55

Yeah, that’s, that’s a really great example. And, like you said, there’s so much going on with just the infant and their development and all of that, you know, I know, a common concern or thing that is on the mind of parents is, you know, that development and milestones and things. Right. So when an infant’s you know, not developing appropriate appropriately, I guess, is maybe the word to use. You know, sometimes we see things like, you know, the, you know, ability to rollover, and you know, front to back back to front, right, all those things, and, and those things are impacted. And sometimes parents don’t really know what the issue is, right? Like, I would say, for for the novice, which we all are, when we become parents, let’s be real. But you know, you might just think, Oh, I just need to, like, help my baby rollover, which maybe you do, you know, maybe you actually need to guide them or whatever. But other times, I think that there’s maybe something else going on, and that’s really more of your area, I would say, because I’m more focused on like the actual, you know, breastfeeding part of things. And so when it comes to people like yourself and your expertise, you know, I see that these things can impact breastfeeding, but then I don’t really know, necessarily what the solution always is, if that makes sense. So if a if an infant’s really behind on their milestones, or they’re having some issues with like their reflexes, for instance, what are some ways that you know, parents can go about getting support for babies that are having those issues? Like how do we resolve that, as opposed to just trying to force them into a position or something like that? I don’t know if that’s always the fix. So what can we do about those issues when they come up?


Kelsey Baker  12:36

Great question. And kind of my baseline answer for that is that movement is medicine, a lot of times when babies are uncomfortable, it’s because they are restricted in some way. And that can be a level of torticollis. Or it can be some side bend tension through the thoracic region, and the ribs are kind of pinned down on one side, more so than the other. There are so many ways that babies can be scrunched up in utero, and or have some level of trauma through delivery. And really early days, maybe they didn’t get to go through that breast crawl and kind of like that idyllic birth story that people want. And ideally babies have, but it doesn’t always work out. And obviously, there’s medical things that need to happen. And there’s always, you know, reasons for this, but how can we kind of go back and offer them the opportunities to move? How can we set up the environment to elicit movement? And also, how do we make sure that their muscles and joints are moving to their full potential. So I really look at eye movement as well like, because with newborns, they’re not necessarily starting to roll over. If they are, that’s probably an issue actually. So ideally, I’m seeing them before we even are talking about major milestones like rolling. But if I do get a three or four month old, who isn’t even trying to roll or getting a nice head, turn and tracking opportunity, then we’re definitely going to be trying to figure out what the limiting factor is. And sometimes that has nothing to do with the neck and shoulders. And it’s more based in the hips. And it really depends on what’s going on with baby. So every baby is really unique. And if you have concerns about a head turned preference, or you do see some asymmetry of any sort, including with the baby’s eyes, I would strongly recommend bringing it up to the pediatrician and if you’re not getting any feedback other than wait and see from your pediatrician, I would look and see if there is a PT or an OT in your area that works with their age group and has experience I do Lily with tethered oral tissues or at least an understanding of Lactation Support.


Jacqueline Kincer  15:05

Hmm, yeah. No, that’s, that’s great advice. And it was funny how you said a newborn, like, shouldn’t be rolling over yet. I will never forget this. I’m gonna have to like dig it up and reshare it on Instagram. But I had a client with a baby. She’s no, she’s had her second baby. She’s working on her third. You know, things have been going great. But that baby was seven days old, and seriously tied and just, you know, tough birth, like all the things right? I mean, high tone, like for sure. And he rolled over and I like in my office, you know, and the grandmas there like every the whole family’s there. And the grandma was taking a video and she was like, he rolled over and they were like, he’s a superhuman, you know, Oh, he’s so advanced. And I didn’t want to pop their bubble, you know, but I was like, oh, yeah, he like should not be rolling over. He’s seven days old. Ya know, and it was, you know, but they were so excited. Right? You know, I couldn’t in that moment. Tell them that that was not a good thing. You know, I do see it right. You you as a parent, you’re looking for an explanation, right? There’s was, he’s amazing. And I was like, Yes, he is. But he also has a lot of tension. Yeah,


Kelsey Baker  16:16

he’s amazing. And he needs to relax a little bit.


Jacqueline Kincer  16:21

A lot. Yeah, and that, you know, and it’s, it’s funny, we can kind of talk about that, too, you know, ties, right. So this kid was tongue tied, lip tied. And it was funny, you know, we had that conversation where the grandma, she had a diastema, which is a gap between the teeth on her upper teeth. And she was like, Oh, I always just thought, you know, it’s like genetic. And I was like, well, it is genetic, but it’s also a lip tie. And so, you know, this whole discovery of things where it affects everybody differently. But, you know, in this particular baby’s case, you know, just not only was the tongue and lip tight, but the whole body was tight. And I think that’s the thing that often gets missed with ties is, you know, I have, a lot of times parents will say, you know, well, I’ll just go get the tie cut. And I’m like, that’s great. But that is not what I would expect to fix, you know, the compensatory feeding patterns that your baby’s using the tension throughout the rest of their body. Maybe it’s too soon to get it released. So this is the conversation that I’m excited to have with you, which is, you know, how our Tai is impacting the rest of the body, the nervous system, all of those things, because it goes so much deeper than just, you know, a short little front them.


Kelsey Baker  17:36

Yes, 1,000%. It really is. Kind of the last thing that I look at when I evaluate a baby actually, is an oral exam. I Yeah. So I always start with with their skin looks like what their face looks like. Do they have a lot of like creases intention? Are they like the concerned grandma or grandpa baby? That like just is kerfuffles anytime anything happens, what their state is like, and then I kind of go through and see how their hip range of motion is, what their pelvic floor feels like, what their diaphragm feels like, what their ribcage feels like their shoulder, their cervical region, their neck, and then the jaw and head, and I go through a full assessment of what their body feels like before I even get in the mouth. And that tells me so so much. Because I almost I usually give this kind of visual for families, the fascia runs from tongue to toes, which is, there’s some newer research saying that may not be true. But for the research that we have currently, and we’re going with, I’m going to stick with this visual because usually people seem to get it. If you take a scrunchie and you just look at it at face value, all of the fabric is crinkled up. And that kind of reminds me of what a baby looks like that has some ties, right? If that midline string, going from your tongue to your toes is really, really tight. Your head is going to be cocked your shoulders going to be up your rib cages up and you’re trying to make that midline, shorter. And then once you can release that and help stretch everything out over time, that fabric can lay smoothly on the spreadsheet. So that’s usually what I go and I’m like we don’t want this crunchy baby. We don’t want this head turned to the side all the time. We want free movement and figuring out where their end range of movement should actually be versus where they feel restricted.


Jacqueline Kincer  19:45

Hmm, right. And it doesn’t you know, if there is that, that restriction intention, it doesn’t feel good to constantly have to resist that, you know, you kind of I try to remind people that babies don’t really make behavioral choices, especially really on babies, it’s really based on, you know, a lot more primitive things than that, right? So if it’s uncomfortable to turn their head one direction, they’re just not going to turn it in that direction. It’s not because they like looking to the left all the time. They’re they’re not trying to be difficult, you know. So if a baby is experiencing difficulty, there’s usually something going on in the body. And we have to take a deeper look at that. And I love what you said about grip of babies. I totally know what you mean, you know, and I think about, you know, just that hunched over, you know, kind of posture, and there’s so much going on there. And from a feeding perspective, the tongue controls so much. And like you said, that fascia runs throughout the body. So what’s what’s involved? I guess, with the tie, maybe let’s talk about that, especially with the tongue, you know, so there’s, the tongue is made up of several muscles, we have fascia, we have mucosa. So like, what’s going on when there’s a tongue tie versus when it’s released in terms of that whole system?


Kelsey Baker  20:59

Yeah, great question. So once we release the fascia, right, like, let’s say we go to the release provider, they do a great full release, and the tongue is able to move freely. That restricted freedom, the biomechanical restriction that is keeping the tongue from elevating, is gone now, right, like they have a brand new range of motion, what we need to do on the, on the bookends of that release that we do pre op therapy, ideally, and post op therapy is where preparing the muscles to be able to support that new range of motion, so we’re able to get the tongue to elevate to the palate easily. And, you know, extend easily cup easily around the nipple, create suction, and increase the mobility and strength of the tongue as a group of muscles. And once the tongue is able to get suction to the palate, easily, it’s much easier to regulate your nervous system because you have nerve endings from your vagus nerve, which activates your parasympathetic nervous system. So that’s why it’s really important, among many other reasons, to have a closed mouth, lingual, suction, tongue section to palate, resting posture, when we’re sleeping, and we’re breathing through our noses. That is how we get the most restful sleep. And it’s really important for babies palate formation, there’s actual skull formation, as well as their airway development and getting restful sleep for brain growth and development.


Jacqueline Kincer  22:37

Yes, oh, my gosh, it is it is so much. And you know, I try to remind parents that the mouth really does need to be closed. And they’ll often say, Well, it just drops open. And what do we see lo and behold, that heavy tongue is resting on the floor of the mouth. And of course, the jaw is popping open. Because the baby’s tongue won’t reach to the roof of the mouth. So yeah, it’s just so critical. And, you know, like, you’re saying, there’s this development of the palate and the skull and all of that, you know, what are some of the considerations when we’re looking at teething and solid foods and things like that as well? Because, you know, it starts out with one way of feeding, which is pure liquid diet, but then, you know, what are their effects that can happen later on in infancy and throughout childhood?


Kelsey Baker  23:29

Oh, yes. So we can’t say definitively that a tongue tie will cause picky eating are speech issues, or any of these things. But I can tell you that in my practice, I have had mostly picky eaters that also have ties that were not addressed. I don’t necessarily work on speech therapy, because I have many wonderful colleagues that work specifically on speech therapy. So I focus mostly on feeding. But yeah, ties can definitely impact how your tongue is working, which then impacts how you’re able to manipulate food in your mouth and what feels acceptable to you. Toddlers, as they’re learning how to eat will accept things that are safe, right, and that they see their caregivers exploring. But if they put it in their mouth, and it’s going to a place that their tongue has never been before, because their tongue is restricted, that place feels like no man’s land, and that place feels really scary to them. So there’s a lot of fear involved in trying new foods if you don’t have the proper and optimal tongue movement to get the food to where you want it to be. It’s also really scary if you put something in your mouth and you don’t have the skills or the motor plan to get out. So there’s a lot that goes into introducing foods and making those manageable for kiddos. And I think having a strong mobile tongue is a big piece of that.


Jacqueline Kincer  24:58

Yeah, that makes sense. So is it? Is it maybe certain textures then that are presenting problems with being able to manage orally? Or, like what’s what’s really the issue? Like, do you see a trend and kids only wanting certain types of foods, and if so, which types of foods do you see are generally easier for them? A lot of times,


Kelsey Baker  25:18

as we all know, toddlers like Kid food, we like snacks, we like goldfish, we like carbs, all of the things that I just mentioned are also pretty processed. So they are, everything that you get looks the same each time. So they know it’s going to have this level of crunch, they know it’s going to take up this much space in their mouth. They know that when they chew it, it then turns into this consistency. So all of those things are very predictable when it comes to carbs. When we start talking about fresh fruits and veggies that are a little harder to get our kids to eat, sometimes they are unpredictable. Some blueberries are really sweet. Some are really sour, some strawberries are a little tart and other strawberries are a little mushy. Right. Sometimes you get a Mealy Apple, sometimes you get a really delicious crispy one. And it just depends on the season depends on what you can find at the grocery store depends on so many things depends on preparation. So a lot of times kids that have limited function really thrive on predictability with their food, because it’s easy for them. And they don’t have to think about a new motor plan or how they’re going to navigate a new texture in their mouth. I’ve also seen a lot of times, kiddos with ties have a hard time with purees. And that’s not every kid. But if you have a really high palate, and your tongue isn’t getting suction there frequently, when you eat a puree, and that puree touches your palate, it feels scary. And you’ll usually gag, like mashed potatoes sticky or things like that are also kind of in this group that can get stuck on the palate. And it’s not always a fun time for kids as they’re learning to, you know, navigate that with their tongue. Huh,


Jacqueline Kincer  27:11

yeah, that’s, that’s fascinating. Because I think, you know, parents, still, for the most part, have an idea, you know, start out with purees, which, you know, I’m a I’m a fan of like, I don’t know that we need to go to zero from zero to 60. Right? Yeah,


Kelsey Baker  27:26

I’m a big fan of combo.


Jacqueline Kincer  27:29

Yeah. There’s just like, you know, some people got the wrong idea with baby led weaning. But yeah,


Kelsey Baker  27:37

I’m a big fan of everything in moderation, like, yeah, we need to we as adults also eat purees. So why wouldn’t we feed them to our babies? That’s crazy, right?


Jacqueline Kincer  27:46

I know. I’m like, like, you never eat a mashed food or have a smoothie or something. Yogurt? Are you depriving our babies? Yogurt, scrambled eggs or mushy? I mean, come on. But yeah, no, that’s that’s a really good point. And then do you see like struggles? Or, I don’t know if struggles is the right word. Like, are there differences necessarily, that you might see with a baby that has ties with even bottle feeding, let alone straw cups, open cups, sippy cups, all that kind of stuff.


Kelsey Baker  28:20

So typically, if we have a baby with ties, that has learned a compensatory mechanism, which is usually compression based suck it is they’re using a different type bottle like a como tomo that is not my favorite. And we’re doing a lot of compression based eating. So that is not actually sucking from a bottle. A lot of times we have leakage, a lot of times we have reflux, and so many other things. And then when we transition to straw cups, that looks a lot harder. So a lot of times they’ll compensate by biting on the straw and using that to stabilize and then they can suction rather than getting nice section between their lips and then just sucking easily from the straw. So there’s a lot of impacts with that. Yeah,


Jacqueline Kincer  29:17

absolutely. And these are the babies that are you know, generally causing moms to have nipple damage and pain if they are nursing at the breast and or the nipple is creased, or appears, you know, she liked the end of the fresh tube of lipstick at the end of feeding. Because like you said they’re engaging compression.


Kelsey Baker  29:37

Yes. So we all have, you know, preferences on different bottles. I think you and I would agree on some top favorites that really encouraged that nice tongue cupping and suction rather than allowing the compression and sometimes when I have the baby with ties, we will also allow that compression We’re at a time because obviously we need baby to be eating and taking in calories. But we’re also practicing the newer skill of suction. So everything is about exactly.


Jacqueline Kincer  30:10

And you had said that como tomo is not your favorite model, just so I don’t feel like an echo chamber and the only one saying this, maybe you could explain why that bottle is not your favorite or why bottles like that are not your favorite. And, and the reasoning behind that, because I have a whole podcast episode dedicated to it. It’s nice. Yeah. And I, you know, I refer people to it frequently, because I’m like, it’s all covered there. But you know, someone with your expertise and skill set to I think it’s important to hear what you have to say about bottles. Oh,


Kelsey Baker  30:45

sure. The como tomo will encourage a very shallow latch. And if you are trying to use it, and also breastfeed, if your combo feeding, you’re just really confusing everyone on board. So it’s going to give that shallow latch, it’s going to teach baby to compress that nipple. Typically, the flow is much faster than I would like. And I haven’t seen a baby that looks relaxed eating it, like their face looks tense while they’re eating. And, yeah, I mean, I could go on for a long time. But those are pretty much my main points.


Jacqueline Kincer  31:26

Right. And I think to your point, too, I don’t know if I’ve maybe explained it in this way, you know, on on an episode or anything like that in the past, but we’re trying to get the baby to generate suction. And so if there is a bottle nipple, where it’s just this nipple sticking out from a very wide base, they can’t get suction on that they can’t take this giant wide base that’s bigger than the opening of their mouth and put it in there and get suction. Right. So they have to just sort of, you know, chomp at this tip of the nipple, or like you said, the the flow is so fast, that they kind of do have to compress and chomp to slow it down, which creates that kind of stress, not relaxed appearance when they’re feeling at times too. So yeah, we don’t like those bottles. And I love you know, I get it when people are like my baby took the Como toma and loved it. And I’m like, Well, I mean, your mate, if the if the flow is faster, and it’s not, you know, it’s easier to get the milk, I mean, your baby’s going to drink it. And yeah, they’re probably going to be, you know, feeling good. Like they didn’t have to put in pretty much work or effort there. We want to make feeding hard. But those skills are important, like you’re saying they’re setting a foundation. And if we don’t teach those skills early on, we might end up with a toddler that only wants to eat goldfish for every meal. So we’re not looking for that either.


Kelsey Baker  32:48

No, exactly. Just like crawling is foundational for so many things, reading and writing, climbing things on the playground like all of these things that don’t seem like they’re directly correlated. Crawling is the baseline for and feeding is the baseline of so many things of actual skull growth and development and how you’re forming your muscles to shape your face and your airway for a lifetime, so it’s really important.


Jacqueline Kincer  33:19

Yeah, wow. Okay, now I can see how writing and climbing things is related to crawling. How is crawling related to reading? We’ve got to go on this tangent.


Kelsey Baker  33:29

Oh, so crawling is a great bilateral skill, right? We’re doing contralateral movements. So when I move my right hand forward, my left knee comes forward, and vice versa, right. So we’re going back and forth, we also have neck extension. And we’re training our eyes to kind of like see what’s in front of us. And we’re going up and down. So we’re looking at the floor to make sure we’re not going to trip. And we’re also looking ahead to see where we want to go. This eventually translates to being able to read from left to right, or right to left depending on your language and cross midline smoothly. So a lot of times when kids don’t crawl their visual development is stunted in some way. The visual component is so important. And it’s a piece that I’ve been increasingly adding in to my early infant sessions as well, because a lot of times we kind of right off, but a newborn with a little wonky eye right. A lot of times, the first few weeks, I totally expect newborn eyes to be going in two different directions. And they’re like all all googly eyed everywhere. after that. I want their eyes to be working in a synchronized fashion to see what’s going on around them and also converge like kind of come towards the novice together and then also diverge equally. That way we’re strengthening all of the muscles of the eye without forgetting anything. And so it’s really important, and it definitely carries over through your lifetime development as well. So it’s, um, it’s sometimes just blows my mind how much impact we can make in those first six to 12 months of life and how much that carries over throughout the next, you know, 90 years that will be alive?


Jacqueline Kincer  35:21

Oh, absolutely. I know, it’s wild. And it’s, you know, it’s always very apparent whenever I’ve had the opportunity as an orofacial myology, just to work with adults and correcting their oral function that they just never, they never learned to have a certain pattern or to function in a certain way. And they’re learning as adults. And the difference it makes for them is so crazy. Like I had a guy he constantly mouth breathed and snored, and he was tongue tied, and, you know, had all of these things. And he lived in a bit of a colder climate. And one of the things he told me that he never knew was a problem. Now he was, he was 36 years old. And when he got his tie released, and he was just super stringent about doing all of the exercises that I gave him, like, normally, I just require them three times a day, he did them six times a day, and he was honored. He was like, I’m gonna do this, his baby had ties. So this is how he learned about, you know, his ties and getting all this fixed. And he was like, you know, I always just chalked it up to living in a cold climate that my hands and feet were cold all of the time, and I would wear gloves, and I walked outside a lot. And he was like, they’re not cold anymore. And I was like, Well, that’s because you’re not health breathing, right? You’re getting that proper oxygen, nitric oxide, co2 balance, and all of that, and your circulation is better. And he goes, Yeah, he’s like, this might sound weird, but he was like, I was starting to think that I had Edie, which is erectile dysfunction. And he was like, turns out, I don’t, and he’s like, hands and feet are warm, and everything is working down below. And I was like, Wow, that’s crazy. You know, and really, because, you know, he just wasn’t, he wasn’t getting good circulation. He wasn’t getting good function. He was hunched over all the time. So he’s just like, you know, taking these really shallow breaths, and he’s mouth breathing and all this and that. And it makes sense when you think about it. And it was so cool, because it wasn’t something that I was screening for by any means. But to hear him as an adult, articulate the changes that were so rapidly made and span of a few weeks, because he had done the therapy and gotten so many awesome changes. It was like, wow, you know, so when I tell people, we truly don’t know how it’s going to affect your baby, if you don’t get this treated, or you don’t work to improve things. But there’s a lot of potential possibilities is what I’ve learned.


Kelsey Baker  37:42

Yes. 1,000%. And that makes complete sense. Yeah, like what you said, when you think about it, you’re increasing circulation. And yeah, some other you know, like health wellness podcasts that I listened to, somebody was saying how you know, that everything is working down, there is another vital sign, like, it’s really important to your health, to know that your circulation is working in that manner. So that’s amazing that you were able to help him in that way. And also, no cold hands and feet.


Jacqueline Kincer  38:14

Right. No, it was funny, because obviously, it was working with his wife, and then their baby. And then him. So it was like the whole family, you know, and it was really cool. Because the just to see them, you know, and just they were so happy. You know, she went on to breastfeed for like a couple years. And it was awesome. So yeah. Do you get that from any of your patients or clients?


Kelsey Baker  38:36

Yes, usually, once they start to put the pieces together for their baby, they’re like, Wait, oh, is that why, like, my shoulders and my neck are always so tight. Or it’s Wait, you can explain my TMJ. Or like, they kind of put all the pieces together. And usually there’s kind of they’re trying to play the blame game of like, whose genes did this to the baby? I’m like, No, that’s not the blame game. We’re not here to do that. It’s just giving information on things that you could, you know, start to address. And right now we’re gonna focus on baby, but here’s the good number of somebody to call.


Jacqueline Kincer  39:12

I love that. Yeah. And, you know, I didn’t want to miss this either. Because I know you’ve had some recent posts on this over on your Instagram, which will link up here in the bio, or the show notes, but in her bio will be in there too, by the way, so you guys can read that. But, um, pacifiers, you know, we talked a little bit about about bottles, pacifiers, you know, I’m definitely not a purist about these by any means. You know, there’s many completely valid reasons to give one but you know, it’s a question that comes up so much and I feel like you know, as an OT, this is something that you’re really qualified to answer. Pacifier yes or no, if yes, which type for how long? All of the things I’d love for you to give your perspective on that to


Kelsey Baker  39:59

you Have I kind of used pacifiers to diagnose a little bit and as an OT, I cannot officially diagnose, but in my own mind for my own practice and how to proceed with therapy, you know, I always asked, do they use a pacifier? Are they able to keep it in? What does that look like what type of pacifier and a lot of times babies with ties, either don’t take a pacifier, or they will take a pacifier that has like a really bulbous end, like the bibs pacifier or something like that, that basically just hooks on the palate, and then they can give little circles, and they’re still getting that palate stimulation to stimulate their vagus nerve. And it’s calming to them, but it’s not helping their oral function at all. So I’ve also found that using pacifiers is more of a therapeutic tool is a little bit easier for families than sticking their fingers in baby’s mouth all the time. So I kind of use that as a bridge to get them to understand and I really like the ninny pacifier right now, I don’t like it for every baby and every oral issue. But I found that it can be really beneficial for babies that are acabo feeding, and they have to work really hard to use that mini pacifier because it’s so malleable, and so soft. So they have to keep that suction longer than they would on a more standard pacifier like an oven or a bed or something like that, huh?


Jacqueline Kincer  41:29

Yeah, I love that. That’s, that’s a great explanation, because I also see that pacifier to be, you know, pretty good for the reasons that you’re mentioning. Tommee Tippee, has also been kind of a decent one as well, depending on which one you’re getting. But yeah, that section, it sounds like that what it all comes down to is, is the suction, and that we’re not wanting to introduce something that’s going to create some negative motor patterns or, you know, something that’s really going to send us in the other direction of what we’re going for. Right? Right,


Kelsey Baker  42:01

exactly. You know, if it’s the middle of the night, and you’re at your wit’s end, and you just need to use something to help get everyone back to sleep short, do what you have to do. But during the day, or when you have a little bit more bandwidth, you know, really trying to progress those skills rather than just maintain where you’re at. Because if you’re working with me, you’re probably not wanting to stay where you’re at. So to be really helpful.


Jacqueline Kincer  42:27

Yes, such a good point. I also tell people like no one benefits from having a super heightened nervous system. So if your kid hates the car seat, I would much rather them have a pacifier to calm them than to be screaming their lungs out and probably swallowing a ton of air, that’s going to make them reflux later, and they’re just miserable. So I always tell parents, it’s not like, don’t ever get one, but it’s definitely where we’re like, we don’t want you constantly putting it in their mouth, right? Like, that’s not, right, that would just never be the goal anyway, you know, when did they get to suction that tongue up to the palate and go through this? You know, just they should not have something in their mouths at all times? They’re like, a new newborn. They’re pretty much nursing all the time.


Kelsey Baker  43:11

Yes. That’s, that’s true. Yeah, I always say like, use it as a therapeutic tool, use it in conjunction with other exercises that we’ve worked through and introduced. And, you know, it’s on a mute button, especially like, if we are introducing the Ninni, like, use whatever pacifier using to help actually pacify them to help calm them down and regulate that nervous system, or like you’re saying, in the car ride or for more stressful things. And then also, when they are more regulated, you’re introducing something that is going to, you know, up that skill level and increase their strength, increase their endurance, to maintain those, you know, more optimal muscle patterns that we’re looking for, huh?


Jacqueline Kincer  43:57

Yeah, yeah, no, that’s, that’s such a great way to look at it. You know, what I, what I’ve kind of heard as a theme, it from you is that there’s this progression, right? So something you do, or what’s expected of a newborn is different from, you know, a three month old is different from six months. And there’s this progression that we’re ultimately trying to create with all of these various things. And I sometimes see people getting stuck on one thing, right, like, whatever they were at the bottle they used for the 3d old, they’re still using it nine months. And it’s like, whoa, we might want to I want to change it up is Yeah. So I think it’s easy to forget, though to I mean, I get it right. Like you’re immersed in this and you found something that works. And so you’re like, cool, I just keep doing that. Right? Well, not always. So that’s important to remember.


Kelsey Baker  44:46

Yeah, not always for sure. And I also feel like so many times, I’ll get a four or five month old that has been refusing the bottle or just bottle feeds have been really hard or, you know, whatever the case may be, and I’m like, Go Okay, let’s forget about the bottle, let’s work on cup and straw drinking, like, we were kind of past the point of needing to make this work, because obviously, we’ve made it this far they aren’t getting calories, you know, let’s start to add in a new skill that they’re going to be learning in a month or so anyway. So we don’t need to change what their intake is, they can still be getting that breast milk or formula, but we could just give it in a different way that will help progress their oral motor skills rather than stagnate.


Jacqueline Kincer  45:28

Hmm, I love that, you know, I’m a huge fan of that, too. And I’d love for you to explain a little bit more about why we want to transition to cut feeding at that age range. And I think that scares a lot of parents, they tend to not think of that as something that happens until like a year old. So why are we wanting to do it around six months?


Kelsey Baker  45:49

Great question. So PBS usually will integrate their sucking reflex by six months, typically, but it’s still fresher in their mind, and then it would be at a year. So when I present a straw to be between six and nine months, they are usually much more apt to learn how to take that straw and get lip closure on it and create suction to get that liquid from the bottom of the cup up to their mouth. So I really like to use the straw first, I found that that’s really beneficial for families because they can see it working. And they also can be in a little bit more control. Whereas with the cup drinking, again, we’re progressing those oral motor skills, and we’re getting the tongue to retract and bring liquid in, rather than stick out and suckle on something. So there are two very different skills and two needed skills to stabilize the jaw and encourage more tongue movement to better manage solid foods as they go from this six to 12 month progression. So I will usually kind of pick one, like, you get the straw with breakfast, and you get the cup with dinner or something. And then I’ll see which one, they start to take two more at that time. And again, I’m not always even introducing water at this time, depending on the baby, sometimes I am. But usually it’s whatever they’re drinking out of their bottle breast milk formula. And so breakfast will get the straw cup to explore with dinner, they’ll get the Open Cup to explore with and then if they start to progress more with the straw, I’ll use that for a couple of weeks exclusively. So they can kind of master that skill. And then I’ll start to add back in the cup. That’s typically what will happen or vice versa, if they’re doing well with the cup. I’ll push that for a little while so they get more confident with it. And then we’ll start to add in the straw again.


Jacqueline Kincer  47:46

Oh, yeah. Wow, that’s such a cool idea to have both kind of going, you know, on the same day, and then just observing and getting that feedback and then running with it. And I know you said you know, and we’re in the same vein here about straw cup and Open Cup. Why not sippy cup? Because that is you know, parents love to ask which sippy cup and I’m like none more perspective why no sippy cup.


Kelsey Baker  48:16

There’s so many variations of sippy cups and what people interpret to be sippy cups is just very confusing to me to be honest. But typically, they perpetuate more of a cycling pattern. And it’s just a really fast flow bottle at that point. If you’re talking about a soft spout sippy cup, that most people will progress you so and then you’re also kind of making competing priorities. If you are combo feeding, you’re introducing this very fast flow option. And then we’re still at the breast that can be kind of frustrating for babies at this age. But you’re also progressing a skill that they don’t need anymore, that suckling pattern that is just going to lead to a tongue thrust and more malocclusion and challenges with solids and all of those things. So I just see them as kind of a band aid and my biggest thing that I will try to push is that no cup is actually no spill. And if it says it’s no spill, it’s lying to you. So why not just go for the thing that is going to benefit their development and know that you’re going to have spills anyway and it’s going to be fine.


Jacqueline Kincer  49:24

Yeah, that’s so well said I love that and it is true. I’ve gone through many different cups in my children’s times. The best ones that I found were I don’t even know if they make these anymore but they had like a rotating tarp and so when you turn the tarp the straw popped out and then you can turn the tarp back and it would like conceal the straw, which was so great for it like not getting dirty on surfaces and stuff. But if I tipped it over and held it long enough, it still leaked. For sure. Not a lot but you know, I get it. So yeah, that’s such a good point. You know, an Open Cup is obviously going to spell the quickest and fastest but a straw cup, you’ve got some time to pick it up, you know, after a few drops come out. So, yeah, there’s some, there’s some preference there, for sure.


Kelsey Baker  50:10

And these are all things that are, you know, a short lived like, you’re not going to be using these like learning tools for too long like the Honeybear straw cup or the hippopotamus cup. Or, you know, the easy peasy tiny cup. They’re gonna outgrow those pretty quickly. So then you can kind of figure out what is going to be better for on the go. I kind of like the Munchkin Cool Cat strop cup. Any, like, straw cup water bottle that doesn’t have a valve that babies have to kind of, like bite or suck really hard from is a nice transition once you kind of get to that toddler phase.


Jacqueline Kincer  50:49

Hmm, yeah, yeah, absolutely. You know, those are some great recommendations. And I’ll make sure we list those in the show notes for anybody who didn’t catch those. But gosh, there’s so much that goes on in this first year. Right? Healthy? Oh, it moves so fast. It does. Oh, my goodness. And you know, if there’s like a takeaway that you would love for parents to know about, you know, that first year oral development or feeding, what would it be?


Kelsey Baker  51:16

Oh, man, I usually just kind of go back to movement is medicine. As cheesy as that is, we want the tongue moving, we want the head moving, we want the body moving. And we also want babies sleeping with their mouths closed. So those are my two big things right now.


Jacqueline Kincer  51:35

Yeah, no, it’s it’s simple, right? It’s very simple. I tried to tell parents like yes, containers are handy. You know, if you’re the only caregiver around and you didn’t take a shower, absolutely. Make sure that baby’s in a safe split place strapped in. But then when you are available, wear them in a carrier, carry them in your arms and hold them and, you know, get on the ground and do tummy time. Like all of those things are so important. And the more that you can get their body moving, the better off they’re gonna be, the better off you’re going to be. So I know all the tired moms out there, like, Excuse me. It doesn’t have to be constant, right? It’s just that you, you make it a regular thing. You do it multiple times a day, I try to tell people, you know, even 510 15 minutes is, you know, multiple times a day, we would rather you do that, then, you know, one one hour stint, and then never again, Oh, yes. suvmax is important.


Kelsey Baker  52:36

Ideally, this is built into your routine. And one of my like baseline recommendations that I tell every family that I work with is rotisserie baby, like put them on their back, put them on the right side, put them on their left side, put them on their belly, and you even if it’s 30 seconds, and each position, you’re exposing them to a new position, you’re exposing them to new visual input. You know, you’re kind of stretching out their shoulders and their neck and all these different positions. And you’re seeing how they respond. So you might know where to focus a little bit more time when you have it. But that doesn’t mean you have to do it right this second. So you know, every everything is in baby. Oh,


Jacqueline Kincer  53:16

that’s I love that rotisserie baby. I’m totally going to use. It’s great. That is. That’s a great visual


Kelsey Baker  53:24

sticks with parents, because it’s so silly. So they usually remember that one.


Jacqueline Kincer  53:30

Oh, yes, absolutely. Well, if anyone is interested in working with you, Kelsey, where can they find you? How did they get a hold of you? And then we’ll make sure that’s in the show notes for them too.


Kelsey Baker  53:41

Awesome. Thank you. Yeah, my website is B, just the letter B. Well, And then my Instagram is b.well.ot. I’m definitely most active on Instagram. So feel free to shoot me a DM there or fill out the contact form. On my website. I see families local to Philadelphia in person, and I also offer virtual parent coaching. So wherever you are, I can


Jacqueline Kincer  54:08

help you. Awesome. Well, it’s just been a pleasure to learn from you today. Kelsey, thank you so much for answering my questions, which I know are questions of our listeners. And yeah, I would honestly encourage everyone to at least follow her on Instagram because she’s got some great information there. And if you’re local to her definitely connect if you’re having some questions or experiencing some challenges and look into her virtual offerings as well. So thank you, Kelsey, for being a guest on the podcast today. It was an honor to have you and thank you for sharing your expertise with us. Thank you so


Kelsey Baker  54:44

much for having me. I had so much fun. I really appreciate it.


Jacqueline Kincer  54:53

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In this episode, Jacqueline is joined by Kelsey Baker, a Pediatric Occupational Therapist specializing in infant oral development. Jacqueline and Kelsey cover infant feeding, breastfeeding, oral ties, pacifiers and cups, and so much more.

Kelsey is a mom of 2, and uses her personal and professional experience to help families reach their feeding goals and tries to set babies up for lifelong health. This episode explores the first-year milestones from an occupational therapist’s point of view.


In this episode, you’ll hear:

  • Kelsey’s journey, how she got started in occupational therapy and what exactly is an OT
  • What occupational therapists look for when they assess your infant and some things to look out for in development
  • How ties affect the entire body and why you want to get them assessed.
  • Tips on teething and starting solids from an OT view
  • Which cups, pacifiers, and bottles are best and which are not recommended


A glance at this episode:

  • [1:50] Kelsey shares her journey with breastfeeding and how she got started in oral development for infants
  • [5:46] What an occupational therapist is and how they are different from physical therapists
  • [8:36] Some things that Kelsey assesses in an infant as an OT
  • [12:20] How to go about getting support if you start to notice anything off with your infant and some key things to look out for
  • [17:25] How ties affect the rest of the body
  • [20:42] What’s exactly involved in a tie
  • [23:10] Some considerations when teething and starting solids
  • [25:10] Foods that tend to be easier for toddlers
  • [28:06] How babies with ties use bottles and transition to straw cups
  • [30:20] Kelsey’s view on some not so favorite bottles
  • [33:22] How crawling is related to reading
  • [38:32] Parents will sometimes realize through their infant why their ailments have arised, or why a sibling has a certain ailment
  • [39:15] Kelsey’s view on pacifiers
  • [45:34] Why we want to transition to cup feeding as early as 6 months
  • [48:06] Why an OT doesn’t want you using sippy cups
  • [52:38] Kelsey’s advice for the first year and some tips


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