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Ep. 82- Tongue Ties, Lip Ties, and More: an Interview with Michelle Emanuel, Pediatric OT and creator of the Tummy Time Method

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This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

Maureen: Welcome to the Milk Minute podcast everybody.

Heather: Yes. Welcome. It’s been an interesting past week or so. And I don’t know about you guys, but maybe it’s this whole mercury in retrograde slash all the planets in retro grade slash everything’s upside down, weird, exciting opportunities being thrown our way out of nowhere that you can’t turn down, but then all of a sudden they’re stacking up and you realize all these little yeses have turned into one giant yes. And then you’re like this isn’t actually possible to do all of these things, but we’re figuring it out.

Maureen: Did your estrogen cycle get ahead of your progesterone cycle? Cause that’s what happens to me when I, yeah.

Heather: Well weird that you say that because I did go off the pill, not because I’m trying for another child, but because I need to. I’m now in a different place physically and mentally and emotionally than I was when I went on the pill in the first place. And I just wanted to see what was going on. And so I just finished my first real period. And my estrogen is pumping.

Maureen: And you’re like, yes, yes, yes I can.

Heather: Yes. All the things. Sign me up, put them on the calendar. Oh, there’s no spot on the calendar? Put them on there anyway.

Maureen: And in two weeks you’re going to be like, oh, no.

Heather: Hello, progesterone.

Maureen: Anyway, anyway, we’re here today and we have a great interview coming up with a pediatric occupational therapist and I’m psyched for it. But first, before we get into that, let’s do a listener question.

Heather: Yes. This is actually a really good question. And I haven’t heard anyone in our group talk about this yet, but this is a question from Kelly DeGere. I hope it’s to gear. It might be de jury, but we’re just going to say it wrong as usual. Kelly D. Say it with confidence, Kelly D she says, does anyone else’s hands hurt near thumbs after massaging the last bit of milk out of your breast when pumping?

Maureen: The answers is yes.

Heather: And almost all the comments were, oh yeah. Carpal tunnel, carpal tunnel, carpal tunnel. But guess what? It’s probably DeQuervain’s Teno synovitis,

Maureen: which we clearly need to do an episode on.

Heather: Yes. It’s actually a very common issue with nursing and pumping parents. And what it actually is by definition, is a common and painful condition that affects the tendons, tissue that connects muscles to bones, of the wrist.

And it’s the tendon sheath, which is the protective covering that wraps around the tendons so they can slide easily when doing those movements, that gets inflamed and it hurts. And it’s pinchy and it feels weak. And it usually resolves when you’re done doing those kind of repetitive motions.

Maureen: It’s caused by repetitive motions. And it’s not just triggered by thumb motion, but by all your wrist movements.

Heather: Yes. But you can actually treat this early. So of course we need to figure out what’s causing it. So if you’re getting this when you’re holding your own flanges, like I used to for some dumb reason. Instead of wearing the bras, why didn’t I get a bra?

I don’t know. Like I just was so busy. I just got stuck in the same thing over and over again. So, you know, call one of us or reach out and figure out which motion it is that’s causing this inflammation. We’ll fix that. And then you get together with an OT maybe. And because you want to do it soon because if you treat it early, it’s much more successful to have a full recovery.

Maureen: Okay, well, good luck to you, Kelly, and to like probably 50% of our listeners who are also experiencing this and we’re going to put on the list of episodes to do.

Heather: Yeah, for sure. Because we can talk all about how we should probably be positioning ourselves and what it should feel like, and please stop doing things that aren’t serving you physically.

Yeah. If it’s hurting you. Okay. Yep. All right, Kelly. Well, thank you for your question.

Have you ever been diapering your baby and just imagine all the diapers from that day alone being in the landfill? Doesn’t it make you feel a little bit guilty? Like actually every day.

Yeah. And also, I just want to mention, I remember standing in the diaper aisle at the grocery store, wondering which diaper I should switch to next for my child’s persistent diaper rash.

Maureen: Absolutely. And you guys know that I am really passionate about environmentally friendly products. We have a solution for all of this.

Heather: The company DYPER, D Y P E R was started to solve three problems. First problem was running out of diapers because who hasn’t been there? So they’ve created a subscription model.

The second problem was not wanting to use harmful chemicals on your baby’s delicate skin. And the third problem was a desire to leave a better planet behind for babies everywhere.

Maureen: So they created eco-friendly diapers made out of bamboo fibers that are soft and absorbent.

Heather: You don’t have to feel guilty about it because DYPER has carbon offset the entire diapering journey from manufacturing to shipping.

Maureen: You can also get a free diaper bag with your subscription through our promo link. What’s not to love?

Heather: Get your DYPER subscription today and your free diaper bag by clicking the link in our show notes, happy diapering.

Maureen: Today’s episode is about oral ties, tongue ties, lip ties. And before we get into anything, I want to read a firsthand account from the wonderful Lydia Johnson Grady. Lydia tells us, “I always knew that if I had children, I would breastfeed. When I was pregnant with my first baby breastfeeding was one of the few parts of motherhood that caused me no anticipatory anxiety whatsoever.

I had never heard of tongue ties or lip ties. So I didn’t know to look for that issue when my son was born and always seemed hungry despite being on the breast for hours at a time. I was in agony and he was starving. A few weeks in, Gabriel was diagnosed as failure to thrive. At five weeks old, he’d still not gotten back up to his birth weight.

By then, we’d identified that he had a pretty severe tongue tie and upper lip tie. He couldn’t latch properly on the breast or bottle. I was advised to start triple feeding him, meaning I was nursing him then pumping then giving him a bottle with either donor milk or formula. By the time that process was complete, I’d sterilized the pump parts and it was time to do it all over again.

We did this around the clock for four months. I honestly don’t know how we survived the stress and exhaustion. Living in a rural area I’d called every ENT I could find within two hours of our home and the earliest available appointment was three and a half months away. I knew we couldn’t wait that long.

Luckily in my frantic search for help, I learned about a group of providers in Virginia who would see children with feeding issues. They were able to see him two days later. And the doctor there revised the tongue tie with scissors and advise me that the lip would tear on its own when he was older. He still didn’t have a great latch, but we did continue to supplement to migrate disappointment. But having the tie revised improved his latch enough for me not to be in excruciating pain while breastfeeding.

And I continued to nurse him until I found out I was pregnant again when Gabriel was 14 months old. In all the hours I spent trying to find information about tongue ties and what to do about them I was confused and overwhelmed by the contradictory advice I had both read and received directly from various medical professionals.

I still don’t know whether the route we took was the best one, or if we might’ve seen better results and had Gabriel’s tongue tie been revised with a laser, for example, or something else. All I knew at the time was for sure that I was desperate and we had to take action.”

Heather: I mean, listen, But of course, you know, all of that and everyone that has ever had somebody mention that your baby might have a tongue tie or does have a tongue tie pretty much experiences that same sequence, the events, right?

Maureen: Yep. So I think that leads us very well into our episode today. And I can’t wait to get to it. And Lydia, I thank you very much for telling us your story and I hope you enjoy this episode.

Heather: And if you’re listening to this and it sounds very familiar to you, know that you’re not alone and we’re about to give you some really, really helpful information.

Maureen: So all right today I’m excited to introduce Michelle Emanuel. Michelle is a neonatal and pediatric occupational therapist with over 20 years of experience. She’s a craniosacral therapist, infant massage instructor, as well as being certified in yoga and reflexology. She combines her knowledge to create the Tummy Time Method, which is designed specifically to support connection, health and development of the infant, promoting natural reflexes and optimal breastfeeding relationships, which we love. Yeah. We do love that. She specializes in babies with oral restrictions, helping them achieve proper latch and breastfeeding skills, airway development, and autonomic nervous system regulation.

Heather: Yeah. So what you thought you were getting was an episode about tongue ties. To clip or not to clip? But what you’re actually getting is so much more.

Maureen: And without further ado, here we go.

Michelle Emanuel: Hi, I’m Michelle Emanuel and I’m an occupational therapist. I’m delighted to be here today to talk all things, OT and tongue tie, et cetera.

Heather: Hi, Michelle. Hello. Thank you so much for coming today.

Michelle Emanuel: Thank you for having me.

Maureen: Awesome. We are delighted to have you. We get questions, you know, literally constantly about this. So I want to be able to have like some real answers. But first, before we hop into tongue ties, can you explain what an occupational therapist is a little bit?

Michelle Emanuel: Yeah, that’s a, that’s a great lead in, because we joke in the occupational therapy field that no one knows what we do, and they think we get people jobs and they don’t understand that. And there is an aspect and an element to OT that is about, you know, workers comp and Voke rehab. And there’s this element of getting an occupation, but it’s also looking at what is our daily occupations, what are our daily activity living?

And this is things like eating and pooping and sleeping and bonding and attaching and playing and connecting for babies. And you know, that changes as we grow and mature. So an occupational therapist will address or an allied health professional that will address activities and daily living that are hindered in some way.

We also are big into sensory processing and integration, and that was really thankfully, we were cross-pollinating across a lot of different disciplines about sensory integration, but this was born out of the occupational therapy profession and blossomed and our understanding of how sensory input as modulated or, or moved and worked in our brain in order to evoke or ask for an optimal output.

And that looks like development. It looks like behavior. It looks like having fun. It looks like playing, it looks like eating. It looks like having self-satisfaction. So there’s also this element to OT that we can be hand rehab therapists or specialize in one little thing. And there’s even occupational therapists that are now getting into pelvic floor health and moving into lactation and just, you know, spreading out a little bit.

Yeah. I love this cross pollinating of disciplines. And it adds such a rich perspective for the families to have things to look at in a different way, because I remember one of the things about, you know, I, I focused mainly on pre crawling babies and have most of my career, but I did spend a period of time doing outpatient with older children and really enjoyed the aspect there, of how to regulate even emotions and how to interpret, play and challenges as positive and something that you want to do.

And I think we can relate that along to the tongue tie world, because there’s a lot of challenges to overcome. And so we can, we can help people, babies, families become more regulated or resilient. So regulated means that you can endure what’s going on. So you can be able to make the challenge and meet it and maybe even exceed it.

And resiliency is endurance or the ability to bounce back. And it’s also to go the long-term. And so we help find those skills and people, and that helps them be self-motivated and then transitionally motivated for development.

Maureen: That is the best explanation I’ve ever heard about what OT is.

Heather: Yeah. And honestly, I want to speak to something that you alluded to, which is this constellation of providers that are specialized in different things that work together in more of this mapped out way and not a pyramid way, which is how I think we are trying to move towards this working together thing.

Previously it was doctors at the top and then when they think there’s a problem, they send you down the line until when you get to the bottom of the pyramid, you’re all better. And I don’t think that all of us that work at this level with human beings that are dynamic, that don’t just have one problem.

You know, 28 problems and there’s not one person that can fix it, but it’s great when we have these interdisciplinary relationships where we can call up our friend Michelle, and be like, Hey, I figured out the first 17 issues, but I’m suspecting that this is more your lane. Like mind if I send them your way, or is this like a quick, easy thing I can do?

And I think that patients really want that. And this is born out of patients being so sick and tired of being like, yep. I had one problem, but it took me four providers and two years to figure it out because no one works together. So thank you for doing what you do and for becoming specialized in lactation and tongue ties and tummy time.

And this really, really important area of people’s lives when they’re also having many other issues, like maybe birth trauma, you know. Who knows the plethora of issues that they could have? So thank you. And thank you for explaining that. And if you’re a person listening right now who has run the gamut in the healthcare system, know that there are people like Michelle and Maureen and I who really do try to work together to make it easier for you all.

Michelle Emanuel: Yeah. Yeah. I agree with everything and totally echo all of that.

Maureen: Nice. Yeah. So what made you gravitate toward pre crawling babies and specializing in breastfeeding relationships and tongue tie and oral mobility and all of that?

Michelle Emanuel: Ooh, that’s a good one. Well, I was working as an occupational therapist in a NICU at Cincinnati Children’s Hospital Medical Center. So I saw a lot of babies over a long period of time. So I got very good at babies and that was kind of my jam. And it just because I did it a lot, but when you’re in the NICU, it’s just such a different environment. And what I had access to at the time was heart rate, respiratory rate, oxygen saturation, blood pressure, these physiologic parameters.

See what was going on when I was doing different therapy things, different positions or alignment or touch areas and see the physiologic response. So I got really good at being an observer. It’s always a quiet environment, usually in the NICU as quiet as possible. And I just really open myself up to learning a lot and I got good at mouths and I saw a lot of what we would consider sub-optimal or really dysfunctional or really structural anomalous.

I mean, almost everything you would see. I was at children’s for 17 and a half years, half of that, in the NICU and half of that in outpatient. And it was at that time when, like almost every baby in the NICU has some sort of feeding problem. And that’s where I realized too, that I was learning as a young OT from the OT mentors that I had, that our neurophysiological systems organize around the mouth.

Where I was at, in the NICU, there was also a lot of full-term babies. So kids that babies that needed surgery or had, you know, high acuity. So there’s a lot of tongue dysfunction. So I got really good at that assessment. So I moved over to outpatient. They were already ready for someone with good feeding experience to move in.

So I just started seeing a lot of feeding and both bottle and I had been, I would follow the lactation consultants around in the NICU, but I wasn’t into lactation. I was just nursing my own babies along the way, but once I got into outpatient and you know, a baby would come in, they would have bottle feeding problems.

I knew how to do that, you know, pretty well when they would come with breastfeeding, I just wasn’t sure, even though I like breastfed two and then three kids. Wasn’t really sure how to support that. And obviously referring to lactation consultants, but this was in the medical facility where often not even thinking about that.

So I started learning about tongue tie then when my second baby was born and she’s 20 now. And I think that’s what, that was my introduction. And I had a lot of problems nursing. It turns out all three of my kids do have ties, but some babies with restrictions can nurse better and can hide their symptomatology or don’t seem as overt.

But she came out and was very intense. I had a lot of nipple damage and you know what I know now to be vasospasm and et cetera, but we just were pumping through, because I was, you know, an oral motor feeding expert. I was going to feed these babies. It was a little bit of an ego thing, I think, but just started learning about tongue ties then.

And she had one of those really deep posterior ties and really hard to identify. And so it was confusing even then, it was more confusing then to the providers. I did take her and say, Hey, does, does she have, you know, they’re like, no, she doesn’t have a tongue tie. And I kept like, we would get through a symptomatology, something she would do.

And we would work through it because I’m a therapist and then she would get a little bit better. And then we worked through something else. And then finally, I remember she went through this really messy eating phase and we figured that out and she learned a lot of compensation and then she couldn’t lick an ice cream cone, and then she just got the, you know, a spoon and some, you know, something.

But then when she was five, she had this lymph node on her neck that just really didn’t drain well. And I was like, I’m done with this. And there is something, you know, that feeling, last straw. Right? So I took her and everybody like, oh yes, we agree. You know, she’s tied and this is at the time there weren’t laser options.

And so they said, well, we’re really worried about, cause she’s got a lot of blood vessels around here bleeding, blah, blah, blah. So they took her to the OR and put her under general anesthesia. And I had one of the world’s most famous ENT surgeons, Robin Cotton release her tie. And obviously I would do this a little bit differently now, knowing what I know, but she was five by this time and she’s had it since released you know, a couple more times and she probably will again.

And the reason is because her jaw and her face and her palate and her tongue keep changing and growing. And so she keeps needing a little bit, you know, more, but she was so tight and she had five years of practice with it. Right. So that was a lot. So it was a personal journey that I was seeing it professionally.

And then I, you know, I was friends, I, oh, I went to grand rounds and I went mainly for the free lunch and just good talks. Now I do like research and I like, you know, stimulating my mind. I still learn every single day, even though I’ve been doing this for 25 years. And this we were having, you know, there’s always guest lectures and this woman stood up and started talking and I was like captivated and, you know, fell in love with her.

I was like, I got to be friends with this woman. And it was Alison Hazelbaker. I don’t know if you know who she is. She’s an IBCLC who really put tongue tie on the map for the, the professional community and really kind of started the ball rolling. She did her master’s degree in lactation and developed the ATLFF, which is the Assessment Tool for Lingual Frenulum Function.

And it looks at both function and structure as a guideline, and it is validated whether to release or not. And it has been a helpful tool for me. I use it for many, many years now. It’s just ingrained in what I do. But tongue tie a little bit has become polarizing. Yes, because people have such big opinions.

But the other reason is because when we’re talking about tongue tie, it’s so complex and it’s so individualized that this is why some babies respond well to release and other babies don’t. Now I do think I’ve been doing this a while, that I’ve seen enough patterns along the way to make some good clinical statements about readiness for release, because that’s really what I’ve learned over sending babies for release and doing therapy is that optimal timing is what helps the best outcomes.

And what that means is that the baby is ready for the release and it’s put at, we want to do it as soon as we can, right? Because we want to capitalize on brain development and body function, but we take as long as we need in order to do that. Because if we take a baby and put them through a surgical procedure that changes the whole game plan in the mouth and they’re not ready for all of this change, and they’re not able to use the change, then the mouth, because of the way the tongue tie heals, the tongue was supposed to be happening in the body, as it thinks it wants to bring those edges back together. You know, they’ve been cut apart, but we’re trying to prevent that and we want it to heal open and that, so that’s kind of going against the grain already.

And so when we’re at such a disadvantage, we need the situation to be optimized. And that way the body doesn’t have sort of a panic and reattach really quickly. Cause we hear that happen a lot.

Maureen: Right. That makes a lot of sense.

Heather: So people that clicked on this episode to listen to it probably clicked things in mind that they wanted to get immediately because it’s probably people that either just had a, a revision done and they’re wondering, you know, did I make the right move? Or why didn’t it work? Why didn’t it work? Or it’s people that are on the fence. They’re like, do I do it or do I not do it? So when you have those two types of people sitting in your office, where do you start with those people? Like, how do you make them feel good about what’s happening, positive about what’s happening and help them on the path to a good decision?

Michelle Emanuel: I would like to take hours and hours, right, to be able to do that. But unfortunately we have to try to pack all that in even sometimes at first or a second or a second, third session, even into how do we impart all of this information. And one is creating a cozy environment where people feel safe and open. And that is what does our nervous system, if you feel safe and you look around and there’s pleasing and you’re feel supported then it’s also how we, you know, show ourselves and our facial expressions, that type of thing to signal, Hey, I’m here for you.

And because this is hard stuff, okay. This is really hard stuff. It’s stressful. So that’s the first thing. The second thing is to listen to what the real concerns are, because if I have done a good enough job listening, then I know what their main concerns are and that I’m going to keep that right here.

Number one, number two in my mind, so that I can bring everything back to them. So I, I, listen, I try to stay on point and then I’ll do my own assessment because I’m an occupational therapist. And part of it is we’re gonna look at posture. We’re gonna look at movement. We’re going to look at all of the motor skills in general.

We’re going to look at oral motor. We’re going to look at how their reflexes are responding and how they are managing the sensory processing. So I do that and then as we go along, I point out functional things and then, you know, this would be like helping them understand and educating them. Then we’ll look at the tissues and we’ll look at the structures and ask questions.

And then I, a lot of times too, if I, you know, if it’s parent on the fence and I think that this baby is, would be ready for release, I would have them put a glove on their finger and put the hand in and guide and let them feel the restriction themselves. And I think that helps a lot. If it was someone who you asked me had already gotten one and there wasn’t a lot of functional changes.

I would still be really reassuring because I work with the nervous system and it is the most robust ecstatically changing, wonderful neuroplastic thing we have. It changes easily more easily than anything. So I know, Hey, we can still make a lot of changes and let’s focus on, and this is where the tummy time therapy would come into play.

And remember you guys that tummy time therapy is a lot more than just doing tummy time. It’s what’s done in tummy time and it’s how it’s done. So doing tummy time is super great, but what I’m talking about, you know, therapeutic tummy time is it’s a little bit, you know, you got to figure out how much challenge the baby needs.

Cause we don’t want to be overwhelming. If you ask too much of someone, they will not be able to stay in the zone where you want them to be. And if you don’t ask enough and that’s what sometimes happening when we don’t have changes, but we’re not really sure what do we do to make it enough without going overwhelming?

So that’s what therapeutic tummy time is about. So I say, listen, and feel safe and stay focused on what the functional problems are in the here and now. And what you see as a variation or a deviation from ideal or typical or optimal or functional. Getting maybe some hands on and trying to find the right intensity of exercise that will help motivate and change.

Maureen: Yeah, I like that you brought up the different factors of assessment because I mean, actually every day, somebody on one of our Facebook groups or whatever posts a picture of their baby’s mouth, while they’re crying, saying, is this a tongue tie? And I, I actually have a response that I copy and paste every time that says, Hey, you know, I understand you’re concerned, but this cannot be assessed through a photo because this is a functional oral assessment.

So you need to see somebody in person to assess all of the facets of this, because I could look at that and say, yeah, that frenulum looks tight and you might have no feeding trouble whatsoever. You know, versus a baby who maybe can stick their tongue all the way out and yet still can’t breastfeed. It’s so much more than just a tiny piece of skin as, as you’ve been alluding to.

And, you know, it makes me think then what’s your opinion about how routine an oral function assessment should be? Should we do that for every baby at birth? Just babies with trouble? Like what do you think?

Michelle Emanuel: Great question. And there’s not a linear answer. Why? Because individuality is so important and that’s why the classifications of ties is a little bit meaningless in the functional sense. You can take five babies that how have a class three tongue tie, and they all have completely different symptomatology. So that is a little bit of a complication and it makes, it muddies the water and that right there, necessitates individualized evaluation.

Now whether that should happen at birth, which that’s a really good idea on some level. It’s a really good idea for the frontline for catching the anterior ties that are to the tip are very much on the blade of the tongue that are severely restricting the blade of the tongue range of motion. That can be a really good time to assess that and to not delay and helpful at birth.

What isn’t helpful and we would miss at birth is the submucosal or the posterior tongue tie that may be still buried in the muscle tissue. Because remember a tie, we actually are all tied when we’re an embryo, because we’re one kind of piece of material. And through cell death, the tongue separates from the floor of the mouth and the tissues come along to open up.

And that’s also what grows the jaw, but also that’s why there’s a lot of associated small jaw with the tongue tie. All right. So that the tissue it gets buried and the muscles are kind of bulbous and big and surrounds it. Now that doesn’t do well because you wouldn’t find that at birth, it’s not that easy to do unless we get in there and lift the tissues and do what we call a push-back maneuver, which is to push back that muscle on either side of the front, let me get it to pop out a little bit, but difficult to release.

So I think there should be some sweep initially of the overt ones that have to the tip or on significantly the blade of the tongue. And those could be done very easily like they do now in many different areas. But it’s so funny just within Cincinnati, it depends on where they’re born, whether they’re going to get a decent scissors release on that tip of the tongue. I’m always like where where’d you have the baby?

Maureen: We find that also. We’re like, oh, wait that was, okay. That’s why nobody checked their…

Heather: It’s regional. Everyone up here gets a laser release. Everyone down here gets a scissor release and everyone over here gets shame. Gets nothing.

One thing I just want to add from one of my lactation pet peeves with tongue tie, is that when the baby is born, whoever is doing the initial assessment before even asking the lactating parent how it’s going, they look in the baby’s mouth and say, Hmm, might be a little bit of a tongue tie. What does that mean?

You know, with the M shape, that’s obvious. You know, when they try to stick the tongue out, they can’t, the tongue becomes an M like you were saying, the overt tongue tie. But if you are just looking in the baby’s mouth casually, and you would like to mention to this now anxiety ridden lactating parent, that they might have a tongue tie, no big deal.

Now that lactating parent has it buried in the back of their head, that they’re not going to be successful at this, that and now they’re demanding a release. Why aren’t they giving me one? I’m going to fail. My nipples are going to bleed and fall off. And, and then we’re like in this trap, and then I get consults with people who are already crying and I’m like, wait, but how has the baby’s weight?

And they’re like, great. And I’m like, how are your nipples? And they’re like, fine, but no one will release this tongue tie. And I’m like, yeah, because it’s not a functional problem for you at this moment, but let’s note it and keep an eye on it.

Michelle Emanuel: Right. But I would, I love to throw just a little devil’s advocate on there. I would say that if you do have oral restriction that you do have functional deficit, and if it’s not something obvious, it’s more of the subtle developmental things such as pallet shape. The effect of an open mouth on over time on, as the TMJ is developing. Interesting, the paucity or the lack of tongue palate contact.

And we have nerves that actually exit down into our pallet that are waiting for the tongue to match that like two magnets that come together. And that’s what typical development is. And sometimes you’ll even say, oh no, no, there’s the tongue. The baby’s got the tongue up, but you’ll notice it’s this really steep slope or the tip of the tongue is up, but you can see the tongue looks like it’s almost straight up and down.

And what we want to continue to remember is that there’s three parts to the tongue, the front, the middle and the back. And the tongue is unique because it’s an organ that’s made of several muscles, intrinsic muscles or muscles that are just unique to the tongue part that moves around. And muscles that come from the jaw and the palette and the skull that support and move the tongue around in space.

So when we talk about tongue tie, it’s not just the string, it’s the whole, how it’s affected everything outside of that. So we might be just needing, and that’s why we have us as professionals to be able to find the subtle, developmental, functional things and see if it matters or not. Because a lot of it is working on oral rest posture, getting the tongue up and getting the lips sealed because that will strengthen the tongue. And it will also be a good way to see whether there are going to be problems coming up or not.

Heather: Can you explain the TMJ development that you had mentioned?

Michelle Emanuel: Well, I know that there’s a lot of people know that babies I’ve heard it say that having a small jaw is normal for a baby, but it’s actually not. And it’s certainly not optimal.

What a small jaw means is that it has been hindered in some way. Okay. And every baby that’s born actually should have good alignment of the upper part of the mustache area, the jaw and the lower jaw. So what happens is that the, the T in the bone is called the mandibles is our jaw. It’s a single bone.

But it has a part on the right and the left. So if you just touch right in front of your TMJ or right in front of your ear, this is two joints with one bone. Now, if you bring your fingers down, along your jaw and meet at the chin right there in babies, this is very much still a cartilaginous really open section.

So their jaw is really in two pieces still. So the TMJ is the joint where the jaw attaches to our ear bone. Okay. I don’t think we think about that a lot. How our jaw is actually part our ear bone and our jawbone. The TMJ. And babies are developing their joints and their ligaments and their tendons. And they’re also growing very fast.

So you’re not born with this sophisticated adult joint. You develop it through not time passing, not getting older, but through movement. Or not. So if you don’t move it enough, I like to move it, move. If you don’t move enough, it won’t grow enough.

Maureen: Yeah. You know, I liked that you mentioned that as part of the assessment, but also just like, as part of normal functioning that has, that movement has to happen because that has to happen for breastfeeding.

Like we, you know, constantly as like that might be the most common thing I correct people for when they have a latch that’s hurting them is they’re not either allowing their baby’s head to fully go back because of their own hand placement or baby has some kind of muscular skeleton thing going on that isn’t allowing their head to go back all the way.

And it is just so tied into normal oral functioning, you know, and we know if baby can’t eat, that is like the number one problem we have to address because if they can’t eat, they can’t grow. They’re, you know, they’re in a health deficit, they’re back in the NICU. It’s, you know, it’s a disaster. If we can’t have a baby who can eat.

Michelle Emanuel: And it is important to work with babies that have obviously the feeding problems. But what about that, baby you mentioned a little bit ago whose nursing fine, gaining fine. And we want to not just gloss over the ones that don’t have feeding problems, but look, are they really generating the seals?

Cause baby that I worked with this morning is fully nursing, but just chomping. Just going to town and just using the lips, like a straw on the nipple. And you know, there’s not a complaint of feeding problems, but we know that after if you practice that. And that’s the one thing about our brand too. If we practice something, we get better at it and that’s not going to get better necessarily. You just, it, this gets more dysfunctional as you go along.

Heather: So how would you fix that one if they’re, if they’re chomping and really heavy on relying on lips to nurse, how do you, how would you correct that?

Michelle Emanuel: I already know, and I’ve never met the baby that they have tongue weakness. There’s no doubt. And probably jaw weakness too. It’s really hard to understand how we can have good jaw strength with suboptimal tongue function, given the tongue and the jaw and there’s symbiotic relationship. So when we have both areas have trouble supporting each other, it makes it even more challenging. So I’m going to go in with some tongue strengthening things, and that’s going to be thinking about doing obviously modifications and a little bit of strategy to help the latch, but also what can we do outside of feeding that’s going to help support that and generalize the skills for the latch.

So I would, you know, first of all, I would do and see which tongue function is working the best. I like to look at what we’re doing really well first. And I think that is a little bit of, one of my secrets of working is that I work with what you do well first.

And then we go into areas of concern or constriction or barrier because at that point, you know, is there’s a lot more willingness to open up if we’ve been able to do something easily first, and then I would just do some tongue strengthening things and it was, it would obviously also be therapeutic tummy time.

I’m kind of boring when it comes to that, because it, but that I developed it specifically, right. It’s an eight-phase movement and connects in sequence and I develop it specifically after seeing the babies roll in with all of these problems just after I was just making notes like, okay, we gotta work on this.

We’re gonna work on that. We’re gonna work on this. And how can I put this together in a way that parents and babies can do this together and have major therapeutic gains? Because I knew that coming to me once or even twice a week was not going to cut it, that we had to equip and empower and make sure that the home was having the kind of fun therapy and finding that right intensity.

Again, those parents are nice people and they just want their babies to be happy. So we’re not, we’re not maybe the best at challenging them appropriately with our oral motor skills.

Maureen: I like that you mentioned that this has to be something that is accessible to parents. You know, I, I love your Instagram feeds, @TongueTieBabies, because, you know, I just see you over and over go over the same accessible things, like closing your baby’s mouth while they sleep. Doing more tummy time, engaging their feet and movement and development.

And there, those are, I feel like we need to change the way that we talk to parents about how they engage their children physically, in the first, you know, three to six months so that these are just normal things that they do, you know. And, you know, everybody knows, okay, you should do tummy time and that’s it, you know?

So. I understand this is your passion and you probably have eight hours of, of information on it, but what’s the short five-minute version of how do we do tummy time wrong and how do we do tummy time right?

Michelle Emanuel: Really, no tummy time is wrong unless the baby is crying and dysregulated. Okay. It’s not torture time. It’s not a time, it’s a no cries zone. Right? That’s another thing. This is like, can you spoil a baby? Yes. By not holding him enough. By not kissing him enough by not moving around with her enough, because they’re in this trust, this isn’t versus mistrust period of time psychologically. So that’s how we spoil a baby.

But so you can’t really do it wrong unless it’s torture. So anything we’re doing can be really helpful, but there are ways to make it more therapeutic and ways to make it so that we get enlisted and utilize and really work with the natural innate neurodevelopmental biological imperatives that are happening.

That sounds like a lot of blah, blah, blah, blah, blah. What it means is that we’re born with all of this potential and intrinsically motivating things. We just need the right stimulation to get it to come out. And that’s true for even babies who are tied. Like we see a baby and do an assessment. And in my mind, I kind of say, is this mild, moderate or significant.

And if they’re mild, usually that means they have little bit of symptoms. There’s not a lot going on. There’s just like this kind of cut and dried thing. And that baby is one that you hear a lot on social media or from parent reports that the release went really well. And there were changes that were noted and the baby was different and they had a different baby.

So we know that that baby had less sort of symptomatology, less functional deficits. Whereas if you go into moderate, when you’re getting a little bit more characteristics, you have both a really strong head-turning preference and maybe the babies, you know, like a lot of babies like to extend and they push back or get really stiff and straight, or their shoulders are really tense.

You know, when we do a release with, with a baby, who’s got a little bit more tension, it makes them a lot of times tense up more if they’re not really ready. Now, getting back to tummy time, do you can do a lot of it on the body. And that’s a fun thing to do. The contact tummy time. But when we have moderate or significant symptomatology and things are sky high, wrong with feeding. Or we’ve got pain and this and that. And we’ve got a need for getting ready to go get a release. We want to do some therapeutic tummy time on a firm, flat surface on the floor. Doesn’t mean don’t do it on your body, do. But we do need to make time just because we need to be able to hit the right intensity.

And also it gives parents their two hands available to be able to do some massage or some gentle body work that can help them really relax. Because the biggest thing about bodywork is if you can just get the baby’s nervous system relaxed, the tissues will follow. You know, very rarely when I meet a baby, who’s really, really tense at the shoulders there’s nothing wrong with their shoulders. There’s nothing wrong with their muscles or anything else it’s that they’re contracted and tense out of. It’s a protective response, whether it’s to hold themselves up or to hold their airway open. And so when we work with relaxation, you notice, oh, it feels completely different.

And the shoulders, those same tense shoulders that felt tense and really hard before now feel soft and squishy. So there’s a little bit of an emphasis too off of like how can you do tummy time right or wrong is exactly just like, okay, we’re doing it and check that off. We did it. Okay. I got to do tummy time cause I know it helps the tongue and we just did it.

More so, did the baby enjoy it? Did we get some interaction? Did we work on head-turning? Cause head turning is a big part of tongue tie problems. If you guys have noticed a lot of babies, most babies that have tongue ties also have it’s called torticollis. Now I don’t believe in torticollis and never have, but the reason is because what torticollis is, is its tongue dysfunction and oral restrictions.

Maureen: Interesting. I feel like over the last few minutes you just did a really good job of describing my oldest child who now, you know, that I’ve been doing lactation work and midwifery for years, you know, I now know, yes. He had severe or restrictions. He was extremely tense and, you know, he basically just needed all the help and I didn’t have any resources to give it to him. And we called tummy time, torture time. And he hated it all the time, you know, so we did end up doing it mostly in the baby carrier and all of that, you know, and now he.

He is six and he has speech problems, you know, and from what I’ve heard and read from some people is that, that we should get these tongue ties clipped to prevent speech problems later. You know, I never got his clipped because frankly I would’ve, if somebody would have done it, but nobody had any idea about that anyway.

And they were like, it’s fine. You know? So do you know if they’re like how much truth is behind, you know, does this clipping these prevent speech impediments later and whatever?

Heather: Or is that like the least of our worries? You know, like speech, but like, meanwhile, is there some bigger underlying thing that is a better reason to clip it than preventing speech issues later on?

Michelle Emanuel: I love that question. I’m so geeked about it because we have just compartmentalized everything in medicine and that’s including the symptomatology. So we need to really look at this as a cranio, facial, respiratory development. How do you grow your face and your sinuses and how do we grow our upper airway to help us breathe really well?

How do we develop a tongue and a mouth and a jaw and lips that are quite competent to, at first we’re on a liquid diet, and then we move to mix blend the textures, and then we get, you know, more and more elaborate with our oral motor skills? And we know now that chewing quality actually affects cognition.

And so the whole, when I really got into the tongue tie, I was telling you about how, you know, I kind of like dwindled off, but then tongue-tied conferences started happening and a lot more awareness happened. And then there was this blending of tongue tie with the mild functional world and mild functional therapy is very important and maybe can’t be separated completely from tongue tie. But also has been around itself, not as a distinct profession, but as sort of a modality or a way in a viewpoint and the lens with which to see people with.

But it’s been around for about a hundred years and it wasn’t developed for tongue tie. We just noticed that what myofunctional therapy is, is the exercise of the lips and the cheeks and the tongue and good swallowing and oral rest posture, and, you know, not drooling and having saliva management problem.

But using this mouth area well, and so that coalesces with tongue tie, because when you have an oral restriction or more, it reduces function, it can change strength. It can change tone; it can change range. It can go all the way down to your toes. As a matter of fact, when I’m assessing a baby, that’s what I’m going to look at first is, was the effect all the way down to the feet.

And I know we’ve all heard or seen that picture maybe of the tongue to the toes connection. And that’s still a very rudimentary map of the body. It’s actually way more elaborate than that. And it’s interdigitated and interconnected with the tongue as the epicenter, meaning everything’s going to stem from here. And we know this to be true for babies because we develop in a head-to-toe fashion. Babies and their sophistication is here, the mouth and the face and the neck and making eye gaze and cooing and orienting and opening your mouth and swallowing and coordinating, breathing with sucking and swallowing, which is really how our nervous system stays calm as a baby. That all lays down the foundation for our entire sensory system and our entire nervous system.

So how you and I, the three of us that here as adults is influenced by that period of time in our life where we’re developing our autonomic regulation, and this is all unconscious, obviously, and part of our physiology. How we breathe, how we feel inside. There’s worse as you’ve, if you’re out of breath and you feel like you can’t really get a breath, you can’t be friendly.

Right. Unless you’re intentionally exercising. Okay. That’s a little bit of a different thing, but even then you need a little recovery. Yeah.

Heather: But you know what too, like what you said. Respiratory, the only thing that I kept thinking was taking voice lessons and them teaching you the lips, the teeth, the tip of the tongue ha, and how to like sing with your whole body. And I was like, oh my gosh, that just throw that in the mix.

Maureen: Thinking about that too. Cause one of my voice teachers as a child was probably like the first person who really made me aware of the interaction of the jaw and the ear. Cause I guess I hold a lot of tension here and she was always like, before we start do your TMJ massage.

Heather: But it’s the same for a baby, right? Like however you as an adult would take a voice lesson and think about your diaphragm and your posture and your ear and the connection of your ear to your jaw and being conscious about it for just 30 minutes a day. That’s basically adult tummy time.

Michelle Emanuel: Well, for your six-year-old son, to get back to tummy time. Yeah. And go back and lay down and get the head to the right and the head to the left and pick up the head and see how much you know, elongation. Can he maintain it in the middle? Can he go to the left? This is looking up. Can he go to the right? Can the arms come under? Are the arms equal? Can he push up? Can he go up and down?

And you will find maybe some of these areas where not as much efficacy and it can make a big difference because if you were to go and try to get a release and to fix a speech or whatever, it would really need to be someone who could do some myofunctional therapy with them. And that’s along with the speech therapy. It’s like someone who could blend the speech with myofunctional therapy. Yeah.

Maureen: Maybe I’ll have to like change up our daily yoga routine just to do more of that and tell him it’s because the baby needs to do it. And then cause he will do anything for his, like I have a six-month-old. He’ll do anything for her.

And actually, you know, she had some oral restrictions. I think partially because I know more, but also I think functionally, they were just not as severe. So she’s doing much better with it. You know, she’s got a great resting posture now that we’ve worked on it and all of that, but like, yeah, it’d be great if I’m like, Hey, Hey buddy. Like, we need to do tummy time with yoga with your sister. So how about you do it? And she can copy you.

Heather: For you. She’s fine.

Michelle Emanuel: And then him copy her.

Maureen: Yeah, that’s a good idea because she’s, she is great at tummy time. She loves it. She doesn’t scream like he did.

Michelle Emanuel: That’s interesting. Well, and that’s the thing too, that throws a lot of people off because one of the things I wanted to talk about, I had it in my mind.

I thought, what, you know, what am I thinking about for today? And I was thinking a lot of it is that I’m just, I have a lot of empathy for parents who, because they hear different things from different professionals. And that just is so it’s confusing and there is no greater suffering than confusion. And it’s really hard because many of us have been culturized to look up to our pediatricians and our healthcare providers.

And so it’s ingrained in us to believe what they say, and we should for, you know, for the most part, but they’re not the ones who are advancing the field of oral function and really ferreting out and say, Hey, what do we need to deal with? And what don’t we need to deal with? That’s us, that’s the therapist.

That’s the lactation support. That’s all of us. And so, you know, the parents are hearing one thing from their lactation support person who they love and trust and have this amazing connection with hearing something else from the pediatrician. And then the pediatrician, if they will, they’ll send them maybe to an ENT, might give a completely different answer.

And I think that’s the hardest part.

Maureen: I know, you, and we probably deal with this equally in our fields where someone comes to us and they’re like, I’ve seen six different people. Here’s what they all told me. And we’re like, okay, I’m listening. Gosh. I hate to tell you something different from all of them, but like I have to, because, you know, and sometimes I. Sometimes I’m like, so who were they? Cause like, maybe I can have a conversation with that person if we’re all in the same community.

And just at least be like, Hey, you know, if this problem comes up again, maybe just call me first. But I think our biggest challenge here is we don’t even know the people to send them to, you know, I can’t think of a single pediatric occupational therapist that I could send somebody to as an outpatient.

I can’t, I don’t know a single ENT or whomever that I can easily refer to that’s close to our area that would do a revision. You know, it’s like such, we let you know, I live really rurally. I mean, you live in a city, but even still you have like, she lives in Morgantown. It’s like we have, you know, the WVU conglomerate and all the best providers even still. It’s like finding someone to refer to for that is next to impossible.

Heather: And the right amount of time, because they’re so booked. I mean, even our pelvic floor PT she’ll see you in six months and by then,

Maureen: We’re going to pee her pants for six months? No, thank you.

Heather: You know, or we’re not, or we’re divorced by then, but these babies it’s like you said, it’s a timing issue.

And so, you know, if, if they can’t be released at the right time, you know, then it’s like no guarantees, which is what leads to this perpetual ENT shoulder shrug. Well, you’re here, might as well snip it cause it’s no big deal, not a really huge procedure. We’ll snip it and see what happens and follow up in a, you know, a while.

Michelle Emanuel: You brought up so many important things. One that stuck out to me a lot is that we are working on having resources and all the different areas. Thankfully we’re coming out of the woodworks or people everywhere that want to learn.

Heather: Absolutely. And with this, you know, a lack of resources and you know, this polarizing experience of tongue release and the method of like, it’s very complicated. So with all of that, how do parents know say they’ve been cleared to have a release, how do they know if their baby is ready?

Michelle Emanuel: It would take a little bit of collaboration with the professional to really know. Okay. But other ways to know something about positively is that the baby can handle when you practice the wound care.

So we have to lift up the tongue and we have to do it so many times a day and for so many weeks. And if you know, you can practice that and the baby’s like why they get mad, they do. And then they can calm down. That is a decent ish sign because if they certainly can’t, it’s certainly an idea to slow down because if they can’t even handle the practice for the wound. It’s not going to magically happen, that they can handle the wound care.

Maureen: That makes so much sense. And usually people go in and get the revision and like on the way out the door. And they’re like, oh, here’s the handout that you have to follow for the next six weeks. And they’re like, wait, what?

Michelle Emanuel: That’s my biggest pet peeve.

Maureen: Oh, oh yeah. I bet. So. Yeah. So I think, you know, for everybody listening, who’s considering a revision, call the doctor who’s going to do the surgery, ask for that handout now in the two weeks or six weeks or four weeks until your appointment and do it every day and ease your baby into it.

Michelle Emanuel: So much sense. Another indicator that baby is ready is that they made a little bit of functional change because every baby, no matter when I meet them can get a little bit better before their release.

Unless they’re mild, you teach them the wound care and you give them a little bit of this and that, and you set them on, but every baby can get a little bit better. And what that does is it closes the gap and the functional deficit. So then when we go to do the release, you can jump off that board and you, you get catapulted into more function instead of trying to make up this, you know, the slack area where you could have already been making big change happen.

And a lot of times during this time, it’s not waiting for release. We’re actively doing stuff and getting better function.

Maureen: Right. Or working toward it, not waiting for it.

Michelle Emanuel: That’s exactly right. And feedings actually improving, or something’s improving. Things are improving. And I always give really, you know, strong parameters, what the watch, what we’re looking for.

And when you come back and like, so what do you notice a change? That’d be the first thing I asked you. And sometimes the parents will say, I don’t think anything changed. And I’m like, okay, Michelle, you didn’t do a very good job listening. But that can also be a good indication for you if you saw them and nothing changed that baby’s not ready for release.

Heather: Well, and this all seems like common sense of course, but no one knows it. So thank you for sharing.

Maureen: Amazing when you spend a bunch of money on a course, like a continuing education course. And you’re like, I feel like that just duh, that was easy.

Heather: But it’s not. It’s like sometimes I, you know it’s blowing my mind to look around and the more I learn in this medical field, this new innovative stuff that we’re doing is actually shit that we did 200 years ago, just naturally.

So it’s like, you know, this, this new, innovative technology is actually something nature already figured out for you if you would just get out of the way.

Michelle Emanuel: Yeah. It is so it’s restrictive to our mindset too, because we do want to get back, but we have changed so much and so much has like where even, you know, we’ve advanced in many different ways, but what’s happened to our jaws and our teeth is that they’ve gotten smaller even over time.

So just anthropologically, the smart people are looking and they’ve traced this back that we’ve actually changed over the past thousand years. We’ve lost 10% of our brain volume and our jaws are small and our airways are smaller. Our teeth are smaller. So these are changes that are a little bit are happening to us in general.

But what is so great is I think we’re given; this is partly why I think we have the fourth trimester. This is just my theory. Just hear me out for a second. That we’re still gestating and it’s still very much a period of gestation the first 12 weeks after birth, that we actually need to gestate and help our babies gestate into optimal oral function.

And this is what we can spend our time doing. Of working with the tongue and the lips and the mouth. And it just so happens that we eat a lot when we’re babies, but we’re also very good at social engagement and interaction. And that is our sophistication. And so we can work with eye gaze and facial expressions and cooing at each other and orienting to one another and using our Bogle prosody to cue the other one that I’m happy.

Are you happy? I’m happy, you’re happy. And those things actually build into our nervous system and make us better and make changes and make improved tongue function and help them tolerate a higher level of intensity. But the problem that, that makes me so sad with tongue tie babies is we don’t spend a lot of time sometimes doing that because there’s so much symptomatology to try to mask around.

And they have problems with these muscles and this ability, so they may not do it as well. And so we’re, we could focus on, you know, Hey, if we can get the baby to smile and raise their eyebrows and kind of go together, they’re ready for release.

Heather: Yeah, I was going to ask you this question 30 minutes ago, but then I thought it was too soon and I also didn’t want to make any listeners upset, but I learned later on that my maternal stress did affect my son in our fourth trimester and his eating and his foundation for his nervous system.

And, and, and so without shaming or guilting people, I think it is important for them to know that your maternal stress is in many ways, not able to be separated from your baby. And if you are feeling that way, you should reach out for help and it can look like a lot of different things. And if that means stepping back from a job for a while or if that means getting therapy or if that, whatever that looks like for you. Phone a friend, because I’m sorry, even though the baby is not connected with the cord, you’re still connected and this is very important time, right?

Maureen: Yeah. I mean, we talk about that a lot with latch problems when people can’t get their baby to latch, you know, everybody’s upset and we’re like, well, are you starting upset?

You know, or the second it doesn’t work. You’re, you’re upset. Of course. And your baby’s upset. Just stop right there because nobody’s getting anywhere, just creating stress around the problem that you’re trying to solve. Like you have to figure out a way to be calm and keep your baby calm and happy while you solve problems and while you grow.

Heather: Think about this as an adult, do you learn anything really, really well the first time when you’re stressed? Do it, do it now. Okay. I challenge you to go learn calculus while someone is screaming at you from every direction. It’s very difficult. So, you know, as you guys are learning these new things, that lovely Michelle has been teaching us today. If it becomes stressful for you or baby, take a break, have a cup of tea.

It’s supposed to be fun. Like your baby isn’t broken. Your baby is your baby. And it’s not like if you get the tongue clipped now they’re perfect. No, right. Like how do you explain this to your patients to make them feel better about like this isn’t this unattainable goal that we’re trying to achieve to get your baby to be the best baby there ever was?

You know, how do you tell your patients that and make them feel good?

Michelle Emanuel: I talk about optimizing them, but also really recognizing the stress levels that we’re under. And these are abnormal stress levels because we already know in the tummy time method, we talk a lot about the primary maternal preoccupation, if this slightly elevated anxiety that every parent goes through after they’ve given birth.

And we’re, we’re a little bit more worried about everything because we have to take care and it’s a lot, it takes a lot of our energy and effort. And then when things go off kilter and there are real things to worry about, it makes our stress level go sky high, and we’re already elevated a little bit, and we’re already primed to be anxious or upset or nervous or constricted.

And then something really is going on. And it’s something that you don’t understand. And it’s something you’re getting confusing information about. So there’s never worse, you know, scenario, but it’s the same sort of thing coming back to listening, using therapeutic presence, giving the space and the cushion and having, you know, helping the person find the “ah ha” themselves in somehow.

And that’s, I’m always the detective trying to figure that out. And I don’t say I always succeed necessarily, but it’s not a fail, succeed thing. We’re working with people. I’m a person there’s a lot going on here, but I do like, and I think I do a lot of study with psychology and one of the things and actually parent mental health and infant mental health is one of my top priorities and tummy time method in this.

Cause we do it and it’s, bi-directional the tummy time method. So it’s the same in the sense of we’re both doing it. So if you get a benefit, I get a benefit. When I get a benefit, you get a benefit. Really? You know, what I have to do most of the time is just really like the hammer down on do the skin to skin cause a lot go yeah, that sounds really great. And then like, how’s it going? We haven’t done it today. We did it once yesterday. Rip those clothes off. All right. Let’s get skin to skin because there’s the like, and it’s just hard and it’s because we’re stressed and it’s because we think, and we get all up in here when we get stressed.

Give yourself permission to do the skin to skin, because that’s where I say the skin is the way in, and then it changes the physiology. And then the stress level goes down rather than trying to manage the stress, manage the nervous system, which then manages the stress. You know, I always do the movement medicine and we can go over this as we end. Where you hold the baby up in sort of seated position, we go up and down and up and down.

We’re just moving the baby very gently and rhythmically in this up and down in a seated position. That will help calm almost every single baby. And it feels better, less stressful when, you know, you have a plan for that. Because a lot of the stress too, is the confusion. I don’t know what to do.

Maureen: And then like the stress of every parent ever, when their baby gets upset, what do I do? I tell, I often tell people I’m like, make the list and put it on your fridge of soothing tactics. Like, okay, first you’re going to try the boob. Then you’re going to try, you know, skin to skin in a baby wrap. Then you’re going to go outside. Yeah. I mean like, you know, because I know at least with my first kid, he would start to cry. My brain was like, boom, we’re frozen.

Michelle Emanuel: And think about it from the baby’s perspective, that the primary way a baby is built to regulate their nervous system and calm down is through sucking. We don’t quite have the social engagement thing yet.

So if you have trouble with your primary regulator, the primary way you get calm, the primary way you cope and you regulate, and that’s your biggest deficit, it’s just tough.

Heather: That’s a really good way to think about that. And you know what you do that reminds me of one of my favorite motivational speakers, Simon Sinek. He says, when you ask 10 people, what’s the opposite of winning? Nine of them say losing, but there’s always one person that say playing, yes. And that’s what you’re doing. You are that one out of 10, that’s like, oh no, we’re not losing. We’re playing. It’s an infinite game.

Michelle Emanuel: Thank you. That’s an honor. Thank you.

Heather: Yeah. So thank you for, for embodying the very favorite thing that I try to keep in mind all the time in business, in life and parenting and just all of that.

And thank you so much for just imparting all of this wisdom. I have learned so much today and oh yeah.

Maureen: In like one hour. It’s amazing. But I want to give you the opportunity to tell us how we can learn more from you, how parents can learn, how professionals, you know, plug your stuff for a minute here so that we can keep following up and learning.

Michelle Emanuel: So I teach tummy time method and that’s a professional training. And there are people, You can go to find a provider. If you’re a parent who wants to get therapeutic tummy time, we’ve got people who’ve trained. The website is going through a big update. We’re going to be adding a bunch of people, but there’s a whole bunch of people listed there.

I am going to be actually coming up well, I’m coming out with some parent training videos that are going to be short snippets of sub training and facial massage and a positioning one. So that’ll all be on tongue tie babies though. And it’ll be really obvious when that’s happening. I love for people to get interested in that because I agree.

Like we got to equip people to do this work and let them take ownership of it and use us to gauge the changes and what’s next. And how do we go? And we’re like the guide and they’re the doers and the beers and the connectors. You can’t do anything to a baby, has to be with a baby. And I think shifting from that perspective makes us realize a lot of things that need to happen.

Thank you guys for your time.

Maureen: Thank you. You know, I was going to ask you, like, what should you send parents home with thinking about, but I think that’s it. I think that’s what we need to send them home thinking about today is that you can’t do this to your baby. You have to do it with them and you have to grow and change with them.


Heather: I’m signing up for the provider training. We’re just, that’s our next thing. I want to be on your list of people. And I’m opening my new office soon and I want to be able to help people in that way. So thank you. And everybody join me if you’re a professional. Come do it with me.

Michelle Emanuel: Thank you guys. Thank you so much.

Heather: Hey guys, Heather here with a very special message for you. I wanted to let you know that if you’ve attempted to breastfeed your baby, even once or began pumping after an unexpected postpartum complication, you’ve taken the first step to a beautiful journey. I also want to let you know that you can breastfeed no matter what kind of labor you had, no matter what kind of baby you have, no matter what kind of job you have. There is a way to breastfeed that can work for you.

The thing that I really want to get across here is that the fear of what if I don’t have what it takes to breastfeed? What if people think I can’t do this? What if I fail? What if I can’t do my job? What if I’m not enough? Here’s the truth. Everyone has those thoughts, but some people push through and succeed at breastfeeding anyway.

So what’s the difference? Consistent support. Yeah. Consistent support is the linchpin in the breastfeeding plan. Having support available to help you through the natural hiccups of feeding your baby is essential to decreasing that anxiety and making those doubtful voices in your head disappear.

Throughout the pandemic I’ve been accepting virtual, private lactation clients to meet people where they are, despite the crazy circumstances with COVID. At first, I honestly wasn’t sure how it would go. But as it turns out, it was better than ever. I’ve decided to continue doing virtual consults and help people all over the world.

As an IBCLC, I hold an international certification and breastfeeding is a universal language. If you find yourself needing that personal support and would like to work with me, one-on-one you can schedule at your convenience at my link in the show notes, or by going to

Let’s get you to where you want to be with breastfeeding and start asking new questions. What if I succeed? What if I can breastfeed and do my job? What if you are. What if it works, we got this.

Heather: Okay. First of all, I am just mind blown. That was amazing. And listen to this. My TMJ is lit. Okay. It is the worst. I can’t open my mouth beyond here or it will get stuck open. You can’t see that, but it’s not very wide. You’re like, look at this, everybody. If you join our Patreon, you can see how not wide my mouth can open. But when I was, I don’t know, in elementary school, at some point they took me to the dentist who was not an orthodontist.

She was a, some kind of device specialist. You know, she got some kind of certification on making weird retainers. And she told me that I swallowed wrong. And I never could figure out what that means. And I wanted to ask Michelle selfishly. I’m like, first of all, I can’t swallow with my mouth open. So how do you know that?

And so she created this retainer for me, that was hollow that had two, like sword poker, things that came down from the roof of the device, that when I swallowed the way I wanted to swallow, it would stab me. And it was a literal torture device.

Maureen: This sounds like we shouldn’t do this children.

Heather: Yeah. But we did.

And I had scars on my tongue forever from it, and also it kept my jaw together. So I didn’t actually, I could, I had to talk like this because it was one piece. It wasn’t two pieces. It was one piece.

Maureen: I feel like that’s going to increase the muscle tension.

It did.

Heather: In your TMJ and it moved my jaw forward. And now it does not sit right back here.

So I have problems with oral sex. I have problems with talking for long periods of time, which might shock all of you who listen to me talk for a living, but yeah. And just my tongue movement, like sometimes I get weird lisps out of nowhere and I’m just like, well, what the hell?

Maureen: Yeah. Yeah. And a lot of people who have lived with oral ties you know, as adults now, who, who get them revised and do exercises are like, oh my gosh, I like kissing. And I can eat things that I didn’t like to eat before. And, you know wait, I enjoy giving my partner oral sex now. Oh my gosh.

Heather: And I just thought it was normal. I didn’t like to eat before.

Maureen: But you know, it’s just like, when you have those changes, you’re like, holy crap. I thought that was normal. And it’s not.

Heather: I mean, we’re just thinking about this as a baby issue. Like, is, does my baby have a tongue tie or not? It’s like, okay, well, first of all, your baby’s a person and let’s look at your whole person, does their mouth work? And does their mouth work? What are the other symptoms down to their toes?

And then what kind of adult are they going to be? And if they have issues, we’re not done yet. Like we’re always in process. We’re always growing and learning. And the good news is that she gave us hope that our neuro-plasticity makes it changeable. So don’t give up. And if you’re sitting there right now with your tongue, not on the roof of your mouth, listening, where it should be, where it should just, yeah.

Maybe you should think about it and think about how your body is functioning and how your tongue functions as the central part of your body. I am nerding out and I am signing up for her class.

Maureen: Anyway. Yeah. So we’re going to run and do that right after we give this award.

Heather: Yeah. We have a very special award today for our lovely friend Chrissy Rodeheaver. Yes.

Maureen: Chrissy had her much-awaited baby in October, and we are so proud of her for advocating for herself. She worked really, really hard for every bit of breast milk in the first few days and getting babies latch perfect, pumping to get baby’s bilirubin levels down. It was a really difficult process and she was a total badass.

Heather: Yep. Chrissy says every drop counts and I’m working hard for every bit of it. Her latch is great, but now I’m pumping to get her Billy levels down. I’m determined with breastfeeding emoji and a prayer.

Maureen: And we love you so much Chrissy. And we just hope by the time this episode airs that things have changed and progressed and you guys are doing super well.

Heather: I’m going to give you the Determined Dame Award.

Maureen: Yeah, let’s do it. We love you. Love ya. All right, guys. Let’s sign off here.

Heather: All right guys. Well, thanks so much for listening to another episode of The Milk Minute Podcast and educating yourself on breastfeeding.

Maureen: The way that we change this big system that isn’t set up for lactating parents is by educating ourselves and sharing with our children and our friends.

Heather: If you found some value in today’s episode we produced for you, please go to, and show us your support with a small donation,

Maureen: which grants you access to cool members, only

Heather: stuff. Okay. Everybody kiss your babies for us, bye.


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