Heather Johnston (@cradlednz) Medical Doctor on Unsettled Babies: Busting Myths on Reflux, Colic, Tongue Ties, Alcohol & Breastfeeding and more
This chat with Dr Heather is so juicy and full of wisdom!
We chat about: - What is reflux and does it need to be medicated?- Is there such a thing as a 'happy chucker?'- How much crying is normal in babies?- What is colic?- How seriously do we need to consider food allergies? Elimination diets? CMPI? - What's the deal with breastfeeding and drinking alcohol? What about in pregnancy?- Should we continue to avoid sushi and soft cheeses in pregnancy?
Dr Heather Johnston is a medical doctor with a background in obstetrics, gynaecology, and general practice. She is now working entirely in the perinatal space through her business, Cradled, supporting families with infant feeding and breastfeeding, responsive and holistic approaches to sleep, as well as perinatal and infant mental health. Alongside medicine, she is an International Board Certified Lactation Consultant, an accredited Holistic Sleep Coach through Lyndsey Hookway's program, accredited in Neuroprotective Developmental Care through Possums, and is a Circle of Security Parenting Facilitator. Heather's passion is empowering parents, especially those who go against the mainstream narrative and find themselves adrift, and busting myths and misinformation that do harm or steal the joy out of parenting. She prioritises normalising normal infant behaviours and patterns, and troubleshooting when things fall outside that normal realm, to find workable and family-centred solutions that promote attachment and relational health. She is based in Palmerston North in the lower North Island of New Zealand, and sees families all over New Zealand via virtual consultations. She's also a mum of three little ones aged 1 to 6, a fur-mum of a curly-tailed cat, and a lover of hot pink and hot coffee.
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xx
TRANSCRIPT
Fiona Weaver 00:05
Hello love and welcome to the mama chatters podcast. If you're keen to ditch all of the parenting shoulds and want to uncomplicate sleep and parenting, you are in the right place. I'm your host Fiona Weaver, founder of mama matters and through honest chats with experts and each other will help you to cut through all of the noise and to love the heck out of your imperfect and authentic parenting. Wherever and whoever you are. You belong here. Now, let's have a chat
Fiona Weaver 00:37
Hello, my love's I hope you're having a wonderful week I had a chat today with Dr. Heather Johnston. You might know her from cradled in Zed On Instagram, she is a bloody legend. She is a medical doctor with a background in obstetrics gynecology and general practice. And she is now working entirely in the perinatal space through her business cradled supporting families with infant feeding and breastfeeding, responsive and holistic approaches to sleep as well as perinatal and infant mental health. She is talking our language alongside medicine. She is an international board certified lactation consultant and accredited holistic sleep coach through Lindsey hook ways program. She's accredited in neuro protective developmental care through possums and is a circle of security parenting facilitator. Find me a better fit. Heather's passion is empowering parents especially those who go against the mainstream narrative and find themselves adrift. And busting myths and misinformation that do harm will steal the joy out of parenting. She prioritizes normalizing normal infant behaviors and patterns and troubleshooting when things fall outside that normal realm to find workable and family centered solutions that promote attachment and relational health. She is based in Palmerston North in the lower North Island of New Zealand and sees families all over New Zealand via virtual consoles. She's also a mum of three little ones aged one to six, a fair mom of a curly tailed cat and a lover of hot pink and a hot coffee. This is such a good chat because we talk about all of the sticky things, all of the things so I asked her all of the hairy questions like reflux scored, spewing colic, alcohol and breastfeeding, alcohol and pregnancy, cow's milk protein intolerance,
Fiona Weaver 02:20
tongue ties and why so many GPS give us behavioral sleep interventions. You are going to love this chat. It's a doozy. And she would be very grateful to hear from you if you have any further questions or anything. You can find her at cradled in Zed on Instagram. Enjoy this chat. Good morning, Heather. Welcome to the potty. I am so happy to have you here.
Dr. Heather 02:44
Hi. It's really lovely to be here. Thank you.
Fiona Weaver 02:47
No worries. Thank you. So we are going to be busting all the myths and asking lots of contentious questions today. You are a well I'll let you introduce yourself. So tell the listeners who you are where you're from and hoping to do this work.
Dr. Heather 03:02
Lovely. Thank you. Yeah, we I can get into all the really good sticky contentious bits and pieces that will raise some hackles and make some people excited. So
Dr. Heather 03:12
I'm here I am ordinary Dr. Heather Johnston if you want to be really fancy about it. So I'm a medical doctor working in in New Zealand and the perinatal space predominantly at the moment. I've got a bit of background and GP land a bit of background and obstetrics. But at the moment I'm working mainly through my own business cradled which you may have spotted on social media is great audience it
Dr. Heather 03:39
I do a lot of work with normal sleep feeding and lactation consultant as well just to add in something else there. And, and support for families really, as my as my main staff. Love it. You are you've trained with possums as well, haven't you? Yeah, yeah. So I'm, I'm a neuroprotective developmental care accredited practitioner and I've also done Lindsay Healthways holistic sleep coaching program as well. So I'm a sleep coach tau. So how much training have you done, we were just talking, and you are enrolled in another parent infant mental health course. And you've just done your circle of security facilitator training. Yeah, I like to tell people that I'm a bit of a bit of a junkie for the courses and the continuing education. I just have gotten to the point now where this I've started to realize all the gaps that your traditional kind of Medical Teaching has left me in this kind of space. And I've now got the hunger and the passion for really knowing about you know, attachment driven approaches to things that what is normal for for babies and for families. And that stuff all comes with heaps of extra education that you need to go chasing and lots of unlearning of some of the things that you knew you knew before. So yeah, done lots and lots of training and it'll be finished.
Dr. Heather 05:00
Even
Fiona Weaver 05:01
though you'll never be finished, as this passion or drive come from your experience having your own children. Yeah, so that's absolutely how it started. So I've got, I've got three kids, my eldest is nearly seven, and I've got a four and a half year old and a nearly two year old as well. So, three kids, this all kind of started from my journey with my first child,
Dr. Heather 05:23
you know, seven years ago now, which is blows my mind.
Dr. Heather 05:28
Essentially, with him, I was, you know, in hindsight, kind of let down by the the medical system when it came to things like breastfeeding predominantly. So a lot of that really intensive kind of intervention with feeding for him and his early days. So lots of extra top ups, he had jaundice. So there was a lot of separation and all of that kind of stuff that just kind of snowballed against me to make my breastfeeding journey really hard for him.
Dr. Heather 05:55
And instead of kind of, you're putting that aside, and you're writing that off as a, as a really hard time, that lit a fire underneath me basically to try and improve that for for myself and for people going forward. So I ended up breastfeeding him till he was over to where the supply line the whole way through. So it was Oh, wow.
Dr. Heather 06:15
Yes, I had like every feed every face with every face, oh, my goodness, but at the same time, I was facing feeds for him. And I was not responding to every cue because people told me that I shouldn't. And so my journey with him was very different to my, my journey with my most recent child, where we've been bit sharing from day.he is he's been exclusively breastfeed from, you know, from his earliest, earliest illness moments when he was, you know, he's born by cesarean section, but he had skin to skin in theater, which I missed out on with my first child, because I didn't understand the importance of it then. And so it's been a, it's been a really different, different journey. But it has, you know, it's made me really aware of all the messages that I was exposed to, through my training, as well as just through, you know, being a parent and a mom and kind of current social situation in our current culture. So, it's been a, it's been a long a long journey, but it's, you know, it's been a good one. And, you know, started down the process of becoming a lactation consultant, after my journey with with my firstborn, and then realized as I was doing that training that you can't disentangle feeding from sleep. And you can't disentangle that from parenting and responsiveness and cues and attachment and just kind of snowballed into all the other things that have become interesting to me as well. So, yeah, oh, amazing. I can't believe you kept up a supply line for over two years.
Dr. Heather 07:47
Thank you. It was yeah, it was, it was really hard. It was a big learning, big learning curve at the start. But ultimately, for us, it was the thing that that saved our breastfeeding journey. Because that was really important to me. But at the same time, I wish someone had said to me, it's okay to feed him to sleep. You don't have to space your your feeds from sleep, you don't have to, you know, only offer him one side because all of that stuff was working against me when it came to my milk production, and kind of potentially avoided feeding the supply line for two years. If someone else had kind of said to me actually, this is what normal babies are like, this is what happens. How can we optimize that for you instead of adding the other layers to you needed you? And then it may
Dr. Heather 08:29
it may NAS but I'm here I'm here for the maze of today, which is
Dr. Heather 08:34
your validating and empowering part of this work?
Fiona Weaver 08:37
For me. It means so much more when there's a there's a story attached isn't an experience that lights a fire. So we have lots of questions to go through today. I put it to Instagram and it's it's all the same sort of themes, isn't it that comes up for mums and babies. So
Fiona Weaver 08:57
let's just get stuck into them. But let's start on a sticky one. And let's talk about reflux.
Dr. Heather 09:04
Sounds good.
Fiona Weaver 09:05
We mentioned that reflux, colic, those sorts of things might be entwine. So I'm really keen to hear your your perspective, whole Sounds good. All right.
Dr. Heather 09:17
There's so much to talk about, and I don't think we're gonna be able to talk about all of the things that there are to talk about, but we'll just have a have a good crack at it. And I kind of want to start this with a bit of a caveat and a bit of a disclaimer that there is so much conflicting advice and information out there for parents. And when it comes to this kind of stuff, that's often you know, the way you see it the most is when you kind of go to your GP or your pediatrician, your midwife, you know, and then you have your, you know, social supports as well and everyone's giving you different advice or different bits to try and make things easier for you. And that can be really confronting and some of the things that I may say today may be really confronting for people if they have heard something different. So I just want to kind of put
Dr. Heather 10:00
Get out there right at the start to take, take what I say kind of lightly if and hold it lightly, if that doesn't feel like the right thing for you, but also kind of at the same time, it's your, it's coming, coming from a good place for me as well. But also it is coming from the place from the other people that are giving you advice to people are generally trying to help people are generally trying to do the right thing. And sometimes that does translate into into conflicting advice, which is really hard for parents. So, reflex reflexes is tricky. So it's one of those things that does get, it seems to be really kind of, I don't wanna say popular, but it seems to be more visible and kind of social media spaces and health practice at the moment that it really has ever been before. And I think we can get kind of tangled up in the difference between reflux as a kind of normal physiological process, as opposed to a disease process, which happens for some babies. So you know, this is the kind of difference between reflex with which is something which basically means contents kind of moving the wrong way, basically. So in the case of babies, that's milk moving from the stomach, up the esophagus, into the mouth, sometimes sometimes out of the mouth, sometimes all over the walls and all over year. As opposed to gastro esophageal reflux disease, or good or good depending on which part of the world you're from, which is a disease process, which involves the esophagus getting irritated, which involves pain, and often a lot of other symptoms as well. So, trouble with feeds, they can be things like cough and wheeze, and choking, they can be weight gain problems. And those two things, you know, they they link for some babies that most babies will have reflex and that they'll know they'll spit up, they'll pass it as one of the other words, you hear us they'll vomit, they'll spill, most babies will do that. But very few babies actually have reflux disease.
Fiona Weaver 12:07
So how would a baby with like gourd reflux disease? How would they present they are generally more unsettled more unwell, aren't they?
Dr. Heather 12:15
Yeah, yeah. So with those babies, it's, it's not just about the silliness. So you can kind of get you know, the concept of a happy checker. So baby that will, that will spill a lot and will seem to be fine with it, that it will kind of just be an effortless, you know, if it was stream of milk that will come out. And you know, those babies, they're, they're, well, they're generally content, they may still cry, and they may still cry a lot, because a lot of babies do cry a lot. But they will be generally well, whereas your babies with reflux disease, there'll be other layers of symptoms on top of that they may not be thriving, and it may be really, really, really had the appearance of those babies as well.
Fiona Weaver 12:58
What happened, like how was actual Gord diagnosed is that a scope thing.
Dr. Heather 13:06
So some, some babies do end up having scopes, sometimes it's more a matter of kind of working your way through trying some different things to see if it is more that kind of normal physiological pattern or something else contributing to crying. So often, you kind of end up with a baby that gets diagnosed with gorge really early on in the process, like from the first kind of interaction with a healthcare professional, which is probably not the appropriate thing to do, it's probably more that you need to kind of work your way through trying some different things, seeing if there's ways to get relief for that family, as well as for that baby, and normalizing the parts that are normal for those kids. So yeah, some babies do have scope some babies up for the kind of presence of an acid in their throats. You know, it's, it's not usually invasively tested for it's more of a kind of a process to get there.
Fiona Weaver 14:00
Yeah, okay. I do hear of a lot of people going to GPS and lowsec, or something like that being given really freely, whatever is on them.
Dr. Heather 14:11
Yeah, it's part of as part of a lot of protocols, actually, to not do that. But it still seems to be the thing that gets done. And it's the thing that I hear about a lot as well as that your parents will go to go to their GP with a baby that cries with a baby that spells and that will kind of land them with this diagnosis of reflux, and they will be given a mixed result, although sick to kind of manage that. And the evidence that we've got about those kinds of drugs is that they're not any more effective than a placebo medication and treating and treating this for most babies, because reflux disease is really you're really a cause of, of crying and babies. The placebo effect is very, very strong, which is important and I think a lot of that is from pair Feeling listened to and parents feeling validated and their concerns about what's happening with their baby and you're changing something. And yeah, this has come comes back to doctors not not wanting to you're wanting to be able to offer something, having not a lot of time to offer, you know, a lot of wraparound supports, and wanting to do the right thing and wanting to come from a good place and try and help. But you know, there's not not a lot of good evidence that these drugs are the right thing to do, they can be for the for some babies, once you've tried a few other things, which might be you know, a lot of kind of education of parents letting them know that a lot of babies do have reflux or spilling, because babies have an entirely liquid diet. And so if you've got a baby that's only taking in liquid, and they've got the combination of kind of low tone of some of their muscles, including those sphincter muscles, and there's been a long timeline down, there is going to be a lot of spilling. And so that's, that's part of that kind of process. You know, reassuring parents around crying, and how common crying is crying is really awful, and really hard and activates something in all of us that is completely overwhelming a lot of the time. But it's also really, really common, and crying and itself increases that kind of physiological reflex pattern because it activates the sympathetic nervous system, which activates the gut. So you know, like, if you're nervous about something, you've kind of feel like your tummy is tight, or you might kind of get a bit nauseated, the same thing happens for our babies. And so they spell if they're, if they're crying, which something that that people don't necessarily kind of put that part of the picture together. And so a lot of these babies that cry end up being diagnosed with reflux because they cry and they spill and so that combination of symptoms are kind of stuck together. Yeah, which then kind of results in the, in the medications, being prescribed, so that, you know, so that something is tried and something that we're trying to help.
Fiona Weaver 16:59
So happy chugger is a thing, it's not necessarily a cause for concern if you have a particularly spui baby, if they're not bothered by spewing.
Dr. Heather 17:07
Yeah, if they're not bothered, if they're gaining weight, if they don't kind of have any other symptoms that are concerning you, then you're it's what I kind of refer to patients as being you know, it's a laundry problem, not a medical problem. And
Fiona Weaver 17:20
I love that it really isn't a carpet cleaning problem. And
Dr. Heather 17:25
yeah, it's and it's really hard. And it's really overwhelming, sometimes being a parent of a, of a smelly baby or a speedy baby, because you feel like you can't go anywhere, a lot of the time, you're covered in vomit, you having to kind of carry extra cloths and stuff around with you lots of changes of clothes. And it's really kind of sensory experience for parents, as well as a lot of added layers that can make parents feel really dialed up in themselves. But you know, if then if your baby's okay, then then it's probably not a disease process, it's probably just this is part of their normal physiology that will improve over time. Yeah, the thing to kind of think about and those babies as well as the crying babies is, is there a feeding challenge that's actually going on here that is contributing to, to, you know, all the little pieces of the puzzle, which is something that GPS aren't generally trained in managing, breastfeeding is not a big part of Doctor education, which still blows my mind. But as
Fiona Weaver 18:27
much as a part of it, I'm sure. Very little, really very little.
Dr. Heather 18:31
Yeah, very little. And the parts that are included are more of the kind of public health parts of it. So you know, breastfeeding is really good for the state and the other rather than, here's how you identify a feeding problem and a parent and baby, here's how you can kind of optimize feeding a little bit for them. Or even if you're out of your debt, get a lactation consultant involved with this, a lot of those pieces are missing,
Fiona Weaver 18:55
really shine my current, you know, educate on at least identifying or helping to identify a feeding problem, so then they can refer on
Dr. Heather 19:05
Yeah, because I think one of the things that people will contribute to reflux is stuff like my baby arches, their back and they don't like feeding and they kind of thrash around when they're, they're breastfeeding. And the majority of the time, those kind of signals from babies are that something is not working for them with the feeds rather than they're actually in pain. That might be that they, you know, if you're able to kind of watch a feed and have a bit of knowledge around feeds, it might be that, you know, they're they're latching on but they're not kind of facing their period, and they kind of feeling a bit unstable, the whole time, their heads kind of turned slightly more than their body or Something's just not quite right there that could be optimized that would then kind of settle down a lot of those behaviors, which will then settle down or that crying and fussing which will settle down the reflexing. So it's yeah, lots of
Fiona Weaver 19:53
cycle as well when parents start to get stressed about every feed because the feeds have been so unpleasant and stressful and then the baby is feeling that Stress and getting stressed about feeds and then it's stressing the parent. And, yeah, overall effect isn't?
Dr. Heather 20:07
Absolutely, absolutely, yeah, it has a snowball effect with
Fiona Weaver 20:10
if you do have a chalky Baby, what age range can we start to expect that to sort itself out.
Dr. Heather 20:19
So it's variable depending on on your baby, but it starts to kind of be when they can, when they normally naturally kind of develop more tone and more kind of, they're able to kind of sit up a little bit and, and that kind of stuff starts to happen. So that's often a commute between that kind of four to six, eight month mark. So often, you'll notice that a lot of the kind of crying behaviors of babies will start to settle down around that kind of four month mark, there's kind of a peak of crying, that seems to happen in those early months, and then that starts to settle down again. But the actual kind of, you're spilling and vomiting, Pat usually does tend to stop settle down around that mark as well. So there is light at the end of the tunnel, some babies will spill for longer than that. And but it starts to become less, less dramatic and less kind of compensate. And you'll realize that you haven't actually needed to wash as many outfits one week. Yeah, it's just starting to kind of settle down away. But yeah,
Fiona Weaver 21:17
I remember my first was a happy jacket. And he just, I was just constantly covered in vomit, I could never feel put together or nice, there's just vomit on everything. Every time I'd walk around the house on my I didn't even see him, you know, vomit over my shoulder there and they'd be wet patches everywhere on the carpet, that slip up on them.
Dr. Heather 21:37
Yeah, and you kind of laugh about it later. But at the time, I think it's really overwhelming for a lot of parents to be in that kind of space. Even if you've kind of got a happy baby that's that's spilling a lot. It's it's still a really kind of intensive thing to go through like to kind of, you know, have a feel kind of put together you never kind of feel like you've got some baggy? Oh, you feel kind of gross. And yeah, yeah. And it's, it's a tough part. So you know, we've kind of overlook that part as well, that these, even if these things are normal, they're still actually really tough. Giving parents that kind of validation and support around that there's an important part of the picture that I think sometimes gets missed, if we kind of go straight to, let's just kind of prescribe a medication and see what happens to medications is not going to stop them checking out, it's going to change the acidity, but it's not going to stop the actual vomiting part of the picture.
Fiona Weaver 22:30
Okay, okay, so let's move on. Now let's talk about crying how much crying is normal for a baby?
Dr. Heather 22:38
Oh, it's it's variable.
Fiona Weaver 22:40
It's really, really big. They're all going to be variable, aren't they?
Dr. Heather 22:46
And it's, it's so much down to kind of temperament into, you know, what kind of little baby you've landed with. How that kind of impacts the parent as well, and what's happening in the home. Actually a big part of the crime picture too. So you'll get babies that, you know, that cry a lot. And parents are really distressed by that crying. And it's really important to kind of step back a bit and be like, Well, what's what's the bigger context around the crying? And, you know, are they crying a lot, because they're being put down a lot, or their parents are trying to space their feeds out? Because they have heard that's what they need to do, you know, is the crying kind of a, you're a result of the wider societal strap structure that we're living in? Or is this that your baby is really, really difficult to soothe, and there is something kind of bigger going on there. The kind of the old, old definition of colic would be more than three hours a day, more than three days a week for more than three weeks. It's outdated. Some babies cry, no more than that some babies cry much less. But that kind of amount of crying is still really distressing for parents. So I think it's yeah, it's a it's a tricky one to answer with an exact number.
Fiona Weaver 23:56
It is but it's an it's an important one to to flag that colic is not a diagnosis in itself. It's a it's an amount of crying. Yes. You know. Yeah, I think it's a really misunderstood term.
Dr. Heather 24:10
Absolutely. And it's applied in a really funny way because all kinds of field call it in any other setting and it's not a baby refers to kind of the sensation or the pain associated with you know, the squeezing, all sudden passing through like a hollow organ so that kind of colicky pain in your tummy would be you know, this sensation of pain of stuff going through your your gaps, and you can get renal colic, which is that kind of sin, you're associated with kidney stones with that sensation of the pain of the stone moving down the the ureters from the kidney and to the bladder. So colic is kind of more as a slightly different definition and this kind of environment but it's interesting to kind of say that, that's the word that people have chosen to use, because it has been traditionally associated with my baby is in pain. That is why they are crying. A lot For time, that's, that's not what's happening most of the time, it's not pain. Even though that's, that's what people are mostly worried about.
Fiona Weaver 25:09
Because when babies are crying, they often pull their legs up, don't they, and they often arch their back. And that's where we think they are having tummy problems, or then they'll fight or then they'll birth and it's, it's not usually, it's not always an indicator that they are in discomfort, is it exactly, it's not,
Dr. Heather 25:25
it's not always an indicator, sometimes it can be that it's most of the time, it won't be. And so a lot of those behaviors that you'll see like the legs pulling out, or the, you know, the grunting and the straining, there's a there's a process what we call infant dyskinesia. And what that basically means is that babies aren't coordinated enough to be able to kind of relax their pelvic floor and strain to order an auditor, you do a fat or have a poo. So they need to kind of bring your bring up that intra abdominal pressure by crying, and during those kind of movements, in order to be able to do that process themselves. So
Fiona Weaver 26:00
they can't actually got manually. Yeah, they've got to kind
Dr. Heather 26:03
of do it in a way that they know how which is, which is crying. And so sometimes you will notice that, that that you're, that kind of leads into your particularly dramatic nappy, or, you know, some something kind of goes on there. And it's also that kind of gut activation with with dialing up with that sympathetic nervous system starting to ramp up as well. There's that there's a big feedback loop there that happens between years that the gap that started and all the crying that started, it probably doesn't matter which but they do seem to Lincoln
Fiona Weaver 26:34
each other. It's so fascinating to hear this stuff, like how clever our babies are. They have a little ways of working all of this stuff out if we just trust them. Yet they do. They really do. We don't need to diagnose everything.
Dr. Heather 26:47
We don't and but I think I think that's a really normal thing for parents to to want to do with FSA in their baby industry. So they want to know if there's something that's going on that is causing distress, and you're and it's worth getting, getting an opinion on that if you are concerned. So even though I kind of come to a lot of this with saying this is probably normal, this is quite common. It's probably nothing to worry about. If you are worried always go and get someone to have a look at your baby. Have a look today.
Fiona Weaver 27:16
Yeah, yeah, exactly. Okay, so what about cow's milk, protein intolerance, ENPI and other allergies and things?
Dr. Heather 27:27
It's another kind of Hot Topic thing that seems to be popping up everywhere at the moment. It's not very common, I think is probably one of the first things to look at is that actually, it's an increasing part of our kind of social context, or something that we'll hear about from a lot of people, you know, just just stopped dairy and the crane will stop or the reflux will start. That actually, if you've got to breastfeed, baby, the incidence is about half a percent of breastfeed babies. Oh, wow, really accounts for protein allergy, much more common formula feed babies, somewhere between kind of two and 7% of a formula feed babies. But it's not as common as I think we
Fiona Weaver 28:05
might any formula or fully formula. And, yeah, any additional formula? Yeah, yeah.
Dr. Heather 28:13
But yeah, actually, it's common and exclusively breastfeed babies, if you've got a family history, or that baby has a history of HIV. So things like x more or Esma or hay fever than that, you that relative risk increases a little bit. So those would be the kind of more of the babies that I'd be more interested in, do they have a family history? Or do they have other symptoms that could be suggestive of that. So a lot of people, a lot of people will kind of go to that as being the logical next step. If you've got a baby that's got a sleep disturbance, or you've got a baby that's got a sleep disturbance with reflux, or that kind of stuff together. There are some symptoms that are much more likely to be a cow's milk protein intolerance or allergy, which is stuff like blood in the stall. Sometimes eczema can be a bit of a signpost towards it. Sometimes if you've got kind of significant allergy symptoms, like kind of your, a lot of those really, really bad ones that you'll get with your rashes and dish carrier, whoa, hives and you know, the significant kind of stuff but a lot of the symptoms are really nonspecific, as well. So there's that kind of reflux picture or an unsettled tummy or an irritable baby or baby that's a little bit Raschi. And so, it's can be really hard one to unpick.
Fiona Weaver 29:34
It's another thing that if parents are dealing with an unsettled baby and they don't know whether they're in pain or not, it's it's one that parents can feel that they can have potentially some influence over if they just stopped every Yeah, yeah, everybody just wants to help their baby.
Dr. Heather 29:50
Yeah. 100% And I think that you know, sometimes trying and eliminate an elimination diet is not, you know, not always a bad tend to give a go. And it's something that I would always do with a bit of support and supervision from someone that knows what they're what they're talking about when it comes to this kind of stuff. Because some babies do have food allergies. And in those babies that only, only kind of management for that food allergy, it's to avoid the trigger. And so it makes sense for filming, hey, yeah, makes sense to give it a go sometimes, and this is, you know, part of what month part of the reflex picture for me is if I've got a baby that is your is potentially got reflux disease, or you're really significant kind of crying and, and vomiting, I'd probably try something like a two to four week elimination of dairy before I'd go down the route of of medication for reflux, because that may be maybe what's going on. And but there's always a plan to make this very much a trial, try, you're withdrawing the dairy, do it pretty intensively for a couple of weeks, see if that makes a difference. If you seem to notice that the symptoms are better, try reintroducing the dairy again, if the symptoms get worse and come back in, that's usually pretty conclusive for most families. But also known that that it that is really, really hard to do an elimination diet for a lot of parents, sometimes you can end up in a situation where you're trying to eliminate heaps of different foods to try and make something better. And nothing's really seeming to work. And then you're ending up with an extremely restricted diet that not good. Not good for you as a breastfeeding parent. And not probably helping your child as well. So doing it with a dietitian, with your GP, with your your children's specialists, if you need them as with you know, that's that's important, I think,
Fiona Weaver 31:48
yeah, I think allergies more common these days in babies,
Dr. Heather 31:54
I don't think they're truly more more common than they have been, as far as I'm aware, I haven't kind of seen really good, good evidence to kind of suggest that they're, you're increasing a lot in, in how common they are. We are often kind of introducing solid foods to our babies really early. You know, the recommendation is still to kind of wait till around that six month mark, a lot of parents will be doing it earlier than that kind of the four to five month mark. And is not not great evidence that that that helps for food allergies. But I think that's one of the messages that people hear is that early introduction of allergens is something that helps reduce allergies. But what that really means is to make sure that you're introducing stuff from when you're kind of introducing your solids around six months, and that you're continuing to do that through that first year, rather than you really need to get ahead of it and start introducing solids early to try and prevent allergy. So it's a complicated kind of tangle one I think
Fiona Weaver 32:57
it is, isn't it? Okay, this is everybody's favorite topic. Do you know what I'm gonna say?
Dr. Heather 33:05
And talk about alcohol and you.
Fiona Weaver 33:09
You became quite well known for it recently on Instagram. Let's talk about alcohol and breastfeeding.
Dr. Heather 33:17
It's still. So this is a this is one that I've kind of been into for a little while I started talking about this back. And when it was a, I mean, 2019 actually that I first started talking about this. And that was before I launched cradled around that kind of stuff. So I was just kind of, you know, working away in the background. And basically, my interest in this stuff kind of came about from a coroner's case here in New Zealand, which was looking at a baby that they passed away with significant alcohol levels on board, basically. And the conclusion that was made in that coroner's case was that the baby had those alcohol levels because of breastfeeding. And that blew my mind because that went against everything that I knew about breastfeeding. And the case was a lot more complicated than that. You know, there was a lot involved, including your a lot of unsafe sleep stuff that went on. And the numbers didn't make sense to me. I couldn't I did a lot of looking through the maths and trying to figure out how on earth this baby could have such high levels through breastfeeding. It didn't make sense. That still doesn't make sense. And I wrote a letter to the coroner with the backing of over 700 other doctors to say this doesn't make sense. Can we please not make this recommendation based on this one case because this is probably the wrong thing to be focusing on here. I think oh, that's awful. It was a it was a completely awful case and it doesn't Am I lifted and change the coroner's recommendation and that kind of seating but it brought a lot of attention to the thought process around some of these recommendations. And so I've been kind of an interesting with a little a little While always with this is that I, you know, I'm not recommending or encouraging alcohol use in and of itself, because it's not an innocuous drug, it does have harms associated with it for us as a society on your bigger levels. But my kind of my beef with it is that I don't think the breastfeeding population is the right place to focus our attention. So my, my take on it is that our, our breast milk is made from our blood, basically, it's, it's, it's clear, but like that, so if we drink alcohol, we absorb the alcohol, we metabolize it, it goes into our blood, and then it goes into our milk. And the levels stay roughly kind of roughly the same roughly parallel between our milk and our blood. And so they rise in parallel, and they fall in parallel, and alcohol doesn't accumulate in the in the milk. Which means that, you know, if you, if you express your milk, you can't kind of get rid of the alcohol clear and any faster it just gonna go, it's gonna go up and down with with your blood levels, basically. And in a New Zealand, I'm not sure about Australia, what the driving limiters, but this is kind of my, the way that I work things out and kind of reassure people really, is that our driving limit is about point zero 5% blood alcohol concentration, which means your 50 milligrams of alcohol per 100 mils of blood, which if you had been breastfeeding parent and had enough alcohol to get to that driving limit, you'd have 50 milligrams of alcohol, and 100 mils of breast milk, which is half not even half 0.05. So alcohol,
Fiona Weaver 36:37
that's half of
Dr. Heather 36:39
100 0.05 mils of alcohol is 0.050 point 0.05 less than a half a million, which is one drop basically in the ocean, that drop, literally one drop of alcohol and 100 mils of breast milk if you've had enough to drink that you're at the driving limit, okay? Okay. So to me that is a it's a really small amount. And if we will look at things like you know, if you were going to buy a alcoholic, you know, an alcohol free wine from the supermarket, it's got to be less than 0.5% in terms of its alcohol, how much alcohol was in it, which is, you know, 10 times higher than what's in your, your milk, if you've had enough drinks to get to the standard, you're driving a ripe banana or 0.2 to 0.4%, as opposed to 0.05% than your milk. So it's, it's considerably different. So you're right, banana is multiple times more alcoholic than your breast milk is if you've had a couple of drinks, essentially. So I think we kind of space Yeah, focusing on the wrong things, I think, yeah, because breastfeeding parents, we know that a lot of them will drink alcohol. And we know that those parents will usually take steps to kind of minimize any transfer of alcohol to their babies. So they'll know they'll space fading from from drinking, or they'll have less to drink. What and we also have evidence that that lactating women, they absorb alcohol more slowly, and so they end up with lower levels on their body regardless. It's all very clever. And and the other thing that we can find from the research is that your low level alcohol consumption, so there's kind of a couple of drinks during breastfeeding isn't associated with any adverse outcomes and babies under a year old. We don't have evidence for your over that. But I'd be really surprised if there was anything else that will be applicable to those older age groups.
Fiona Weaver 38:46
So I can enjoy my glass of red wine with dinner after I have my baby after you've had
Dr. Heather 38:51
your baby. Yeah, exactly. Exactly. Yeah, it's a really it's yeah, it's one of these spaces that I think we focus in on the wrong problem area, the wrong problem group. I don't think we need to police this as much as it has been in breastfeeding parents and I think, yeah, yeah, it's a tricky one.
Fiona Weaver 39:09
I get the the risk averse, you know, stance that public health often has, because they have to talk to everyone. But what are the problems with this approach? Is it that it makes breastfeeding feel really hard for people and it makes them stop earlier? Like, what is it?
Dr. Heather 39:26
Yeah, I think I think it is one of those kind of those situations actually, that you feel as kind of what you don't Dr. Sophie Brock talks about with the perfect mother math, you have to be so bad to be a perfect mother. And that kind of patriarchal society essentially. So our society has no problem with telling breastfeeding parents what to do, essentially. Society has no problem telling us that we're feeding too much in public or for too long or all kinds of things. or, you know, what kind of things we should be doing with our body. While we're feeding. You know, there's a lot of a lot of patriarchal stuff that fits in here and a lot of paternalism as the other word that I use it, which basically means through a perception of, you know, of us as breastfeeding parents that we can't understand or process the kind of nuance or complexity that's associated with this kind of stuff to make our own informed choices. So just take the choice away, basically. So if you think the group can't make a choice that's safe and informed, take the choice away have a zero have an abstinence kind of approach to it and remove the choice entirely. So I think that's kind of a lot of it is that actually, it's a societal kind of a thing. And part of it as well will be that there is that kind of connection or conflation between pregnancy and breastfeeding, which happens a lot. There's a lot of a lot of thought that the two states are kind of continuous or the same. And so you have these recommendations not to have alcohol and pregnancy, which I which I do still agree with. I think that that's I know, that's been something that has been contentious as well. And but you know, there is there's no safe limit of alcohol and pregnancy. The placental fetal circulation is really different to what happens with with breastfeeding and production of milk. So basically, it's a direct line through the baby when they're when they're still on board, as opposed to kind of filtering and reducing through milk. And so there is evidence of harm with breast with pregnancy and, and alcohol, which there isn't with with pregnancy. Yep. So, yeah, I think
Fiona Weaver 41:40
I had no. What's the word? I had no to recommending any alcohol in pregnancy, it's just best to just avoid completely, I would
Dr. Heather 41:53
still, I would still hold that position that it's, you know, the, the harm is too great. If, if you're the potential case that takes this on board and says, Oh, this is actually fine. Let's just, let's just do it, it's probably okay. The potential risk of hammers is too great. And it is evidence of harm. But we just don't know where the safe limit is with with pregnancy. So this is one of those situations that actually, you know, both parents should be not drinking during the day trying to conceive process. person should know, ideally, not drink during pregnancy. But then you can make some more informed decisions. If you're breastfeeding, after baby's born. A lot of a lot of my favorite position on it is what other risks can we minimize if you are drinking while you're breastfeeding. So that's things like, you're never sharing a bed with your baby, if you're thin, if you've been drinking, making sure that you've got someone sober around that can parent your baby, if you're your hip if you're intoxicated, so that you've actually got someone safe there that can look after your little person. And you may still just want to reduce any potential exposure to alcohol. And that's absolutely fine. And is absolutely your informed choice. Which means things like you can you manage your own intake, choosing your lower percentage drinks, having fewer of them, having them more slowly having them with food? You can you express some milk for your next feed so that you don't have to feed at the peak of of alcohol on your body? Or can you feed your baby while you're drinking so that you feed them just before you hit that peak level? And then they might have a little bit of time before they need the next feed. So you can do to minimize any potential exposure. But I think most people can be pretty reassured that there is no there's no. no association between any adverse outcomes and infants and this kind of low level alcohol consumption and, and breastfeeding.
Fiona Weaver 43:48
Yeah. Because that's a bigger concern, isn't it? If you are drinking to the point of feeling intoxicated, then you potentially might not be caring for your baby as Yeah, baby. So it's more that than the breastfeeding to the babies. Exactly. Yeah, exactly.
Dr. Heather 44:06
The ability to make those decisions and to handle a baby safely. And that kind of stuff that is as much more important to focus on I think, than the actual alcohol consumption part of the picture. And I was
Fiona Weaver 44:19
really lucky with with my firstborn, my midwife said, if you're safe to drive, you're safe to breastfeed. So that was my mantra all along, too. And it just took the pressure off. Like I enjoy a glass of wine. And then I don't think I felt intoxicated for years after I had my first because I didn't want to ever get to a point where I felt like I couldn't, you know, be on my A game, but I enjoyed a glass or two all the time. And it was really nice to just not feel stifled by those rules, like now pregnant. Yeah. And
Dr. Heather 44:51
I think that it's important to kind of not feel trapped by societal roles, which I think is you know, a big part of the work that both of us Both you and I do and in a wider kind of context as you're trying to lift some of that pressure and that shame and that guilt that gets kind of piled on us as parents. From day dot really?
Fiona Weaver 45:13
Yeah, yeah. Lots of good mom's stuff in there. Isn't there and powerless responsibility that Dr. Sophy talks about. I can't remember who's responsible for that term, Adrienne Rich, maybe. But the idea that mothers have all of the responsibility, but none of the power, and that's sort of that approach with breastfeeding. And you know, just don't breastfeed and drink.
Dr. Heather 45:37
You should be able to do this. Why can't you just Yeah, yeah,
Fiona Weaver 45:40
yeah. But you are entirely responsible. And we will, we will shame you and judge you. But yeah, yeah, yeah. Yeah, absolutely. So pumping and dumping, not overly necessary, like the next day, or if people go out and not with their baby, and they drink. Like more? Yeah, should they pump it up the next day, or pump and dump that night?
Dr. Heather 46:04
I don't think really, anyone truly needs to pump and dump most of the time for most situations. So it's one of my other kind of big things. But when it comes to alcohol, when you express your milk, it's essentially it's going to stay at the same level of alcohol concentration as the moment that you removed it. So if you're expressing it, when you are, you're at the peak of your kind of intoxication, it's going to stay at the higher percentage of alcohol. Whereas if you wait a little bit, and let your body metabolize a bit more, more of the alcohol move out, and your levels will be a little bit lower and the express milk. So that's potentially something to think about, if that's manageable. I mean, at the same time, if you've been here, even if you've had more drinks, then that kind of driving limit, you're still kind of tucking in your drops of alcohol per 100 mils of milk. So even if you've had twice as much, you're talking two drops of alcohol, as opposed to one. So the amount is really, really low still, even if you've had quite a lot to drink. So you probably still can feed that to your baby, or you can save it and you can dilute it with other non alcoholic
Fiona Weaver 47:09
milk. Oh, yeah,
Dr. Heather 47:12
you can just kind of dilute it out a little bit reduced the reduced the concentration. Yeah, I don't think you really need to pump it up, you always can, if that's what feels best to you. But I think that it's not something that you need to really strongly worried about doing.
Fiona Weaver 47:30
It must hurt you when you go on Instagram, and see people pumping and then dumping their milk out and saying how much it's hurting them to do it.
Dr. Heather 47:39
And it's part of that is around that kind of alcohol stuff, but also just partly around so many other things, too, there's a lot of pumping and dumping advice out there that generally is just not necessary. So a lot of a lot of medications will be you know, there'll be good advice from from doctors again, or from other health professionals around you have, you're taking this antibiotic or this, you're on an antidepressant or that kind of stuff. So you need to not be feeding or you need to pump and dump until you're finished your course or whatever, depending on what the drug is. So there's often a lot of that that comes in, sometimes things like, like scans. So you know, if you're having a CT scan, or an MRI scan or something like that, often, you'll be given advice to pump and dump, which for most of the time doesn't actually isn't actually what needs to happen most. Most of the time, you don't need to pump it up. So if you're given advice from anyone to pump and dump your milk, she get asked you twice ask
Fiona Weaver 48:46
me, I have so many people in the DMS.
Dr. Heather 48:50
Like there's just so there's a lot of good resources out there. And for doctors as well. If there are doctors listening to this, maybe there will be I don't know. But your resources like infant risk, or Dr. Hale and his his book, he's got a book called medication and mother's milk that's really helpful for making these kind of decisions if you're a health professional, because the information that you get from the standard kind of a prescribing information will be excessively conservative and it will say your interruption to breastfeeding suggested or avoid when breastfeeding, all that kind of stuff that actually, if you really get into the nitty gritty bits of how the drugs work and how breastfeeding works. Almost all of the time, that's excessively conservative and actually not relevant. So
Fiona Weaver 49:35
yeah, everyone's just trying to cover their bones a lot
Dr. Heather 49:39
of the time and a lot of that comes out of out of America and that kind of lets it just kind of society and you're, that's that's fine, but actually it can be really damaging to a breastfeeding relationship and really, really hard for a lot of parents particularly if you're a parent that uses feeding as a way to settle or waiter help you baby sleep to just sign I've had feed for however long because I had to I had my tooth pulled and the local anesthetic and the dentist said I needed to go and pump and dump which is just boards, all rubbish. It's all
Fiona Weaver 50:15
I can imagine ever just not being able to breastfeed my firstborn, especially he was such a baby monster. Like that would have caused so much stress. Yeah, I remember going out one night, I didn't go out much because he needed me so much in that first, you know, 18 months or so. But I remember coming home, it was about 10 o'clock or something, I'd been out for dinner with the girls. And my husband was sitting on the bed trying to soothe him and he was crying. And then I took him sat in the football with him. He was crying, and I was trying to soothe him for so long. And in the end, I'm like, Oh, just get on the boob. And I felt like, oh, well, he's drunk now. Knowing this, I could have just learned into that and had such an easier time and not felt such shame about that one time where I would have not been safe to drive. But I breastfed.
Dr. Heather 51:06
Yeah. And it was probably fine.
Fiona Weaver 51:10
We're fine. I mean, he's got his he's got his stuff. Don't we all? Okay, so breastfeeding, and have it is this is something else we hear that you can't feed during the night, you can't feed to sleep because your baby, if they have teeth will get cavities.
Dr. Heather 51:30
Oh, man. And that's fine, as is the realm of the dentists, I think, more than the doctors but it's still kind of one of those bits of misinformation that is used as kind of a you shouldn't be extended breastfeeding because of this kind of situation. So some kids do develop cavities. And that's, you know, that's just, that's just life, some kids do develop cavities. But that's not from breastfeeding at night. Okay. So if you kind of go back hundreds of years and you look at skeletons of our ancestors, you'll, you'll see signs that extended breastfeeding was the norm for the men, obviously, it had to be because they didn't have access to formula, and they may have had some access to other animal milks. But extending breastfeeding was the norm. And these kids didn't have cavities. And so if if we kind of had, you know, if we if there was a link that you probably would have seen it back, and those kind of old bits of evidence. But if you use a bit of a bit of common sense, and a bit of that evidence, you're breastfeeding as protective against dental disease, at least for the first year of life, we know that that's that's the case, we've got good evidence about that. Evidence is a bit more murky beyond that, but that's probably less about the breastfeeding and more about everything else that changes in a child's diet and a child's life. After that kind of stage. We know that the mechanics of breastfeeding are different to bottle feedings. So the breast when it when your baby is feeding, the risk is drawn all the way into the back of the mouth and the back of the throat. And so the milk doesn't pull around the teeth as it does with with bottle feeding, it goes it goes down the throat basically, and it doesn't kind of sit around the teeth with the your potential ability to contribute to cavities. We also know that the kind of immune factors and breast milk have been shown to be specifically protective against the particular bacteria that cause cavities. So you're putting all these pieces together. It's it's not feasible that is breastfeeding at night that causes the causes cavities. What causes cavities is dietary sugar and bacteria that's in your mouth. So if you're brushing your kid's teeth twice a day, you can still feed them to sleep, you can still feed them at night, that's okay. You're not going to be causing them cavities and you can kind of you know, either smile and nod when your dentist tells you that that's what you need to be doing or you can push back against that depending on how much fire you feel like you have a new that day. But you don't need to be fearful of breastfeeding at night causing cavities because that's not what you know the science and the way that breastfeeding works tells us all right,
Fiona Weaver 54:09
love it. Okay, one more. Dr. E question. What can we eat in pregnancy? And what do we actually need to avoid? I'm talking soft cheeses, sushi, that sort of thing.
Dr. Heather 54:25
So this is kind of the realm of more more kind of direct this to you the dietitians and the room then in May but there is you want to basically be avoiding stuff like listeria, so that is exactly as you just said near the soft cheeses, the the sushi, you know things like hummus, or homeless depending on how you want to pronounce it. So the tahini and that can sometimes be associated with increased risk of contracting diseases like listeria. Yeah, so that was that was a tricky one. Oh, If you're things like salads that have been sitting in a deli or cafe for a lot of a lot of time and potentially not handled well, that kind of thing. Yeah, most most things are probably still okay.
Fiona Weaver 55:17
But every now and then then, baby now and then they're not
Dr. Heather 55:20
exactly. The tricky thing isn't it is that sometimes you just, you don't know what's going to be safe and what's not going to be safe. Your levels are kind of immunity to things are lower when you're pregnant. So you're more at risk of disease and your baby obviously has that kind of direct line throw to you when you're pregnant. So
Fiona Weaver 55:41
is it listeria? So if somebody had listeria they would have food poisoning? Yeah, yeah. Yeah. It's just like, sushi and things like that. I think. Yeah, people get sick from that. Pretty often. Yeah, yeah, that's soft cheeses. I've never heard of anyone getting food poisoning from cheese.
Dr. Heather 56:00
Yeah. And I think that's yeah, there must be must be evidence for it. Because it's one of those things that just kind of keeps coming back. But you can cook that kind of stuff. So you can bake bread or something in the in the oven would be a nice way to kind of get around that one of you really unto yourself cheeses, pizza with mozzarella on it instead of kind of having it raw. That kind of stuff. But yeah, it's, it's just kind of you avoiding those high risk foods when you're pregnant is it's really hard. And it's particularly hard for people that are in your I know, it was really hard for me when I was a hospital worker, and I was trying to get lunch from the hospital cafeteria and you just kind of meet with do I eat the salad bar and kind of brisket or do I eat hot chips for lunch? Because that seems to be the only other thing that's available. And sometimes it's kind of choosing the you're choosing the lesser of two
Fiona Weaver 56:53
evils. Yeah, I sort of have and I'm not saying that this is right, but I will go on order some fresh sushi that's not not Euro fish, like I have tuna and avocado or something. Would that be okay, or is that just still the lesser of two evils? If I'm getting it made
Dr. Heather 57:13
for I mean, it's it's mostly the kind of the roar seafood element of it and sometimes it's also around the you know, how long has the sushi been sitting there in the in the shop for if it's kind of just been prepared? And you can you're pretty confident that it's been well handled? It's again, probably okay. That you're if it's been in the in the cabinet for most of the day, and you're kind of picking up the cheap stuff that's lifted, then it's probably less good.
Fiona Weaver 57:43
To sushi snobby to do that, anyway. Yeah. Okay, tongue ties. Should we go there?
Dr. Heather 57:50
Oh, let's go there. Yeah, go there. This is again, a really, really contentious one and
Fiona Weaver 57:55
contentious. I don't even really talk about it at all. Hey,
Dr. Heather 57:59
yeah, it's, it's hard. It's one of those things that polarizes people immediately, I think. And part of that is your own lived experience as a parent or a provider, and what your what your own kind of perspective is on that. And so parents of children that have had a tongue tied division, and seem to have improved and that kind of symptoms, after that, we'll strongly stick to the opinion that that is the right thing. And that was the right thing for them. And that's okay. That's right. Yeah. But if we kind of look at it, on a population kind of level, it's probably one of those things where something that, you know, a normal piece of anatomy has been kind of pathologized and made into a problem. So almost 100% of babies, you'll see what's called the lingual frenulum. So the the bed near that bit of tissue underneath the tongue, if you are looking in the mouth, and if you do the same with adults, you almost always see it and but we have kind of only recently kind of come to understand that that piece of tissue isn't, it's not a discrete structure, it's not something that's kind of extra stuck in there. It's, you know, it's a fold of the connective tissue that kind of starts in the floor of the mouth and kind of comes up to the tongue. So everyone has it. It's not, you're an extra bit that's not supposed to be there. It's a spectrum. You know, some, some kids will have really thin fine one, some kids will have quite thick ones. And there's everything in between. And we're it kind of becomes a tongue tie is, is it functionally impairing something? Is it causing a feeding difficulty? And is it causing in later life? Is it causing problems with with solid food, all that kind of stuff? So if you've just kind of seen someone who's looked in your child's mouth and said, Oh, yeah, they've got a tongue tie, you need to get it divided. That's not really enough for me, I would want to have had a feed observed had a really good kind of check of what the symptoms are that are bothering you and actually done a really good examination inside that baby's mouth. How does their tongue move it? Can it kind of lift up and come down kind of curl around? Is it actually able to move freely? Or is it impaired? And so I think that's where where we get tricky is some kids really do have have a tongue tie or have a lingual frenulum that is impairing that function and that movement. But most linguaphone your limbs are normal and are not causing a problem. Yeah, you get into really tricky parts when it comes to division of tongue ties and diagnosis of tongue ties. So a lactation consultant is not supposed to diagnose a tongue tie, that's not your their diagnosis is not part of their scope of practice. So you need to be seeing someone that has those extra levels of, of your ability to make those diagnoses and ideally, able to kind of cut those as well, if that's what's appropriate, because you need to know your cataract. And before you cut something, basically, you need to be here for a really good look. And really understanding what you're getting into.
Fiona Weaver 1:01:00
Is that a is that a pediatric dentist? So sometimes
Dr. Heather 1:01:03
it could be a dentist at the same time, I don't know how often dentists are doing examinations of feeding and have no function of the tongue as opposed to just kind of looking at, is there a presence of a lingual frenulum? Or not? Is it a thick or thin? Where does it where does it sit, because a lot of the management of those is things like lasers. And things like going into the mouth quite, you're quite deep, and going into the back of the tongue quite deep, which is we can talking about posterior tongue ties, or submucosal, tongue ties and the kind of complicated extra levels of stuff. And that is what I would, what I've heard one of my colleagues refer to was, you know, you're going backwards. And lo and into the kind of deep structures of the mouth, you're getting into Tiger country. So yeah, there's nerves there, there's blood vessels, there's a lot of stuff going on there, you really need to be really confident that what you're cutting or what you're going into with your laser is, is worth cutting and that that is safe. So that's, it's a tricky spot, because I think it probably is over called by some people in some places, it is the kind of the thing that a lot of kind of normal child behavior gets gets blamed on again, and your trouble with sleep and trouble with crying and that kind of thing. It may be that there is a feeding problem that can be managed without surgery. And we can kind of get into your lip ties and buckle ties, so cheap tires, as well, there's no evidence that those are actually problems or that they will benefit at all from being cut. So I stay well away from those, I'd kind of really only be looking to divide an anterior tongue tie. So that kind of classic tongue tie that's connecting the front of the tongue to the floor of the mouth and impacting on feeding and impacting on function, I wouldn't even look to do it. It's kind of prophylactic kind of thing. So maybe it will help with speech down the line. If you don't do it. Maybe your child will have problems with speech or problems with this. We don't do that really, for any other kind of surgery. We don't kind of say, well, maybe there'll be a problem with this thing, possibly in the future. So let's do an operation on your baby without anesthetic to prevent that potential thing. Like that doesn't fly with me. Yeah, that's a tough one. And again, there'll be parents listening to this going, but it really helps my baby. And that's really cool. And really, really, we support you and support you and they're absolutely on a bigger population level. I think it's a it's a potentially dangerous thing for some people. What are we getting into? And there's a lot of lot of reasons why people were getting into into that stuff. But again, it's probably a big part of it is just your what can we outsource the trickiness to what can we blame the the hard parts on what can we try and fix and that is weird people trying to help, but maybe just not focusing it into the right space?
Fiona Weaver 1:03:59
Yeah. In my experience, my firstborn was a harder baby. He was you know, he breastfed often. I wonder if there was maybe some feeding stuff that I could have had some help with. He was Chucky. He was, you know, watered down the cat nap and sleep on me and all of that sort of stuff of just being a high needs kind of baby. And then at three or four months, I took him to an osteo that osteo said, yeah, we've got great for tongue ties everywhere. And then I decided not to do anything about it for him that I'm so grateful that I didn't because he even in his later years, he is fine. His teeth are beautiful. He has no speech issues. He you know, took on solids, okay? Okay, because he's still fussy. But he doesn't have any mechanical issues. Yeah, eating. And then my daughter. She had the enlarged tonsils and adenoids. She had the surgery at 20 Something months she has crowded bottom teeth. I've been told that she has a tongue tie. And I believe has more. She has speech stuff, but I, that one person did take her to was a cranial sacral, something like that. She said, Tanya is restricted, but it doesn't mean that you have to go and do something about that. Now you can see how things go. And then you can come back later as a four or five year old and she sits in the chair and gets the needle and an ASA ties and do it that way. It doesn't have to be this laser thing when they're little babies because it's easier for us to do because they're babies and they can't
Dr. Heather 1:05:32
agree. Yeah, absolutely. I think that it does come back to it a lot as that kind of idea of kind of behavior or kind of behaviors kind of view of children as well as babies while they list a list people list of lists of people than then. Yeah. Well, they weren't explicitly remember. Yeah, yeah, exactly. Which is a whole other conversation of itself. But yes, that's the whole idea of doing something that doesn't have a really strong evidence base behind it that may potentially be dangerous or damaging. To try and prevent something that may occur in the future, it doesn't feel robust enough to me to want to be operating on on a baby for that reason. So yeah, it's, it's, it's a hard one.
Fiona Weaver 1:06:17
It's, it's really hard. And I yeah, I have experienced that firsthand how confusing and overwhelming the conflicting information was, and just feeling like, am I not doing enough? Am I? And yeah, and then you would feel the same way, if you had done something about it, whether there's any regrets about doing it, or you know, that it's just, it's a really complicated place to be.
Dr. Heather 1:06:39
It is, yeah, it is so funny finding a provider that you, you have a good relationship with that you trust that you know, that you value, their opinion, I think is really important, because there are a lot of a lot of people out there that are, you know, quote unquote, kind of tongue tie providers or that kind of thing. So for some people, that's who they need to see. And that's who will feel best for them. But there's also kind of more of a bias and that kind of group of people towards intervention and tongue tie, as opposed to, as opposed to not so
Fiona Weaver 1:07:11
who are we looking for? Is it more like a medical professional who has training in ties,
Dr. Heather 1:07:16
I think I think that's probably a good place to start, a lactation consultant is often a really good place to start. Someone that has that extra, extra level of knowledge, and you actually get along with because it doesn't matter how, how clever they are unnecessarily as if they are telling me things that you don't feel good about hearing. But yeah, medical professionals can be helpful. It just depends on if they're actually got the got the knowledge or not in that space.
Fiona Weaver 1:07:44
So you'd hope that the lactation consultant would be a place to start, you mentioned that they're not usually able to diagnose but they can.
Dr. Heather 1:07:52
They can raise envelope. Yeah, they can have a look, they can give you some ideas, they can work with you on the other things that may improve feeding, if that's feeding, that is the the tricky part. And yeah, just give you guidance, and that kind of space as well. And then when you come to if you are wanting to look at someone to divide someone to divide a tongue tie, then really just kind of feeling good about who you're going with there. Because I think there is, you know, there's an element of commercial interest for some, some people, you know, often I'll hear of people that go to get a tongue tie divided, and they're kind of told in the chair, there's a lip tie and buckle ties as well, why don't we do those two for the price of why? That kind of stuff, but it just, it just doesn't feel feel good to me. And
Fiona Weaver 1:08:38
this is what happened with Sally, right? So I called the pediatric dentist and I said, I want to come in for an assessment because I was just gathering information. And they said, What are her symptoms? And I said, what her symptoms are? And I said, Yeah, okay, well book her in. And then they booked me in and then I said, what, what am I booked for? And they said, the release, right? So I never when it completely turned me off, like not coming in for a release. So I'm coming in for an assessment and to have a release on the same day, you have to be pretty confident. And you know, if you are having a really bad day, you feeling vulnerable, caring for babies really hard, or they're unsettled or something and they just offer you this quick fix right there. And then before you've had time to walk away and think about it and do your research and stuff, it just doesn't feel right to me.
Dr. Heather 1:09:29
Yeah, yeah, absolutely. There's I should signpost people actually towards the breastfeeding medicine network of Australia and New Zealand. So they were kind of the the medical doctors that specialize in breastfeeding medicine essentially, which is that you know, those extra levels of breastfeeding knowledge and a lot of a lot of the doctors in their space will be able to do the feeding assessment, do the oral examination, diagnose the tongue tie if there is one and divide it so there are good places to start and you can find them I think breastfeeding meetup.com.au For that,
Fiona Weaver 1:10:05
that's helpful. Okay, I'm gonna ask you one more question. Why do we get so much sleep training advice from GP? What? What training? Do you have, as I know you're not practicing as a general practitioner, but medical doctors, what training do you guys have in sleep? Why is that so pervasive? Like you go in and you say, it's really hard my baby's unsettled, blah, blah, blah. And they say, All right, I'll refer you to a sleep school. Yeah.
Dr. Heather 1:10:31
Yep. Well, you're finishing with a hard one. I know.
Fiona Weaver 1:10:36
Interesting with a bang.
Dr. Heather 1:10:37
Yeah, fisherman bank. So this is really common. This is a story that I hear a lot from a lot of families is, you know, I went to my doctor, and this is what they told me. And they told me, I just wanted to let them cry, because that's the only thing that they could offer me. And oh. Oh, does it does. So as doctors, we get very little in the way of infant sleep education, and even less about normal infant sleep education. So I, before I came on, I kind of googled the the College of GPS in Australia and your control crying is kind of a couple of key words. And it comes up with you know, this is how you talk to your patients about doing control crying, as a GP. So this is the education that you get, as you are looking for here, how can I help my patients with their baby sleep, and you get behavioral sleep interventions that is near point A to point B, that's how it works. Which is hard for people like me who are like, Oh, since there's so much more to it, then then it and part of it comes down to that little education and this kind of specialized space, we have so much to learn, as doctors, there are so much content and GPS, they know so much about so many things. And sleep and children is a very small part of their overall workload. And maybe if it's not something that their attention has been brought to, with any other kind of options, they might just actually not know that they're people too, they're exposed to the same kind of mainstream narratives and same kind of ideas that everyone else is exposed to. They may not know that there are other options. They know if you're a young GP and you're being mentored and observing your GP and the generations before you as you're learning. If they're sharing the information about behavioral sleep interventions, and they're saying this is you know, safe and effective as we keep hearing effective in that's the message you're going to take on board unless you look further than that, which requires you to kind of have the insight that actually maybe there is something else out there. Or maybe this is not the whole picture, or maybe this doesn't fit for families.
Fiona Weaver 1:12:50
And the interest as well. I can imagine that GPs are treating so many things, they're all going to have really different varying interests. Yeah, deep dive into.
Dr. Heather 1:13:00
Absolutely, absolutely. So the, it's usually again, kind of comes back to that desire to help them and if you are a doctor that's heard the that your behavioral sleep interventions are safe and are effective, then you're going to kind of say, well, this is the thing that I've heard about, and here it is as an option. Whereas if you're someone like me, and you kind of go into it deeper, and you go what is safe mean, actually, what is effective mean, actually, and what are the other options out there, then you're I don't recommend sleep training or behavioral sleep interventions to my patients, either. Because there are a whole lot of reasons. But for me, part of it comes back to first do no harm, which is part of our training as medical professionals, and the more that I've learned about behavioral sleep interventions, and that kind of side of things, the more I can't convince myself that it would be harmless for every family and every child to offer this, you know, blanket recommendation. For some families, that's what what they choose to do. That's their informed decision. And that's what they what feels good to them. But for a lot of families, it will do harm it will make things more difficult for their family in the short or long term, it will feel really stressful for parents there'll be more crying. A lot of that stuff is is harm in and of itself, even if it's not measured and the kind of binary variables that you get from from the studies which is you know, does my parent perceive there's an attachment problem yes, no. handless like yeah, what what is what is safe mean and those kinds of different things talking about that forever, but for me, it comes down to you know, I can't guarantee that this will be the right option for people I can't guarantee that it will do no harm, so I'm not gonna suggest it I'm gonna look more widely at all the other stuff. You know, and as parents, it's, it's very hard when you go to your GP and you say I'm your He's struggling and my baby's not sleeping to then be told, well just do sleep training, because that's the thing that we're going to give you. But actually, if that doesn't feel good to you, as a parent, you can question that you can say, actually, I don't want to do that, what else have you got? And if they go to you, oh, well, I didn't really have anything else, then the new look somewhere else, or you look for a possums accredited practitioner, or you come to someone that has a different lens, if that kind of approach is not what sits well with you, and doesn't feel like that's going to be the right option for your family and your baby. You're I'm aware that I'm a doctor. And I've said lots of things. But just because the doctor has said, it doesn't mean that it is the thing that you need to follow. And you're that it's going to be right for every family. So
Fiona Weaver 1:15:49
yeah, and we don't we don't need to ask our doctor if we, you know, if we're going to see a doctor for a script, or something we've never met with them before. We don't need to get parenting advice from
Dr. Heather 1:16:01
No, absolutely not, absolutely not. And you can, you can shut those conversations down, if you don't want to have them, it can be very hard. And it can be emotional as well, especially if you're tired, and especially if you're kind of going into those situations already feeling quite vulnerable. But sometimes it is just about kind of smiling and nodding and just not letting that stuff kind of soak in and really undo you. If that's what you're hearing. I think, you know, hopefully changes kind of slowly coming. But I think you know, those kind of behavioral but sleep advice are going to be around for a lot longer yet before they start moving out more. It's more villages around for people now that are interested in that. So when I had my first baby, you know, things like that, beyond sleep training projects weren't weren't up here went around. And now that's huge. And there's hundreds of 1000s of people that are in that kind of space. And that's really, really cool. So it might be just actually taking that piece of advice from your doctor, letting it set holding it lightly. Putting it down and and moving somewhere else with someone else that you feel better about.
Fiona Weaver 1:17:07
Yeah, it's that language that that upsets me when a mother goes to a doctor and says, I'm struggling, my baby's not sleeping. I'm really tired and I'm not coping. And they say, Well, it's, they imply it's your fault. If you're not going to do anything about it. 100% Yeah. There's nothing more unsupportive to me.
Dr. Heather 1:17:29
Absolutely. I completely, completely agree with you. And in those kind of cases, yeah, that person may not be the right person to talk to. These might be great
Fiona Weaver 1:17:38
for your rashes and new things, but not your parenting and your sleep advice.
Dr. Heather 1:17:43
Exactly. Exactly. Which also comes
Fiona Weaver 1:17:46
with confidence as a as a mother will acquire throughout the years of parenting as well to know when you can trust yourself. And when you can, you know, shut things down. Because sometimes that feels really hard at first.
Dr. Heather 1:18:01
It really does. Yeah, it really does feel like you didn't listen. Yeah. And if you don't know what you don't know, at that point in your are trying to outsource the information gathering all that kind of perspectives from other people. If Yeah, if you kind of meet with stuff that isn't helpful for you, then you can't kind of shut it down. Because you just don't know at that point.
Fiona Weaver 1:18:21
Yes, sometimes you have to go through it. Sometimes you might have to try a behavioral sleep intervention to know that that doesn't feel right.
Dr. Heather 1:18:27
And that's okay, too. Yeah, yeah, exactly. Exactly.
Fiona Weaver 1:18:31
And some people, it's what they need to hear they need permission to try a behavioral sleep intervention, and it works for them. And they are feeling happy with that. And that's okay, too.
Dr. Heather 1:18:41
Exactly. All about informed choice.
Fiona Weaver 1:18:43
All about informed choice. Okay. Is there anything you want to mention before we finish up?
Dr. Heather 1:18:49
No, I don't think so. I think we've covered lots of juicy,
Fiona Weaver 1:18:53
lots. I've never had the opportunity to sit down with a doctor for so long and get all of the juicy information from somebody I wholeheartedly trust.
Dr. Heather 1:19:06
Yeah, this is what I do with with my work through cradled as well as I can I have your one hour slots to talk to people. It's just not a luxury that people have and kind of normal, normal doctor practice. And that's part of the reason as well that some of the recommendations happen the way that they do is because actually you've got 10 or 15 minutes to figure out what's going on and suggest something and then move on to the next person, which is very tough for patients as the person on the room. But yeah, the reality for the doctors at the moment. Oh,
Fiona Weaver 1:19:38
absolutely. And it requires sitting with a level of discomfort to be able to sit with someone else's discomfort and not offer a solution like that. That's a that's a lot of
Dr. Heather 1:19:48
work. Yes, very much so and I think a lot of that is your again that kind of learning and unlearning and relearning of, of big parts of it and holding your own bias So in your own perspectives on things, so there's there's evidence out there that doctors will talk about breastfeeding more if they're breastfeed your child themselves, or they've seen a child being breastfeed in their house, and but that that experience and how it was for them, impacts what they say. I said, yeah. Yeah, if you've got a good experience as a doctor, then you're going to be more positive about breastfeeding. It's probably the same with sleep as well. And if you've had a good experience with sleep training, then you're probably going to be more positive about it if you haven't,
Fiona Weaver 1:20:32
exactly if they had an experience with breastfeeding, where they just needed permission to stop breastfeeding. And then somebody comes in and says, I'm struggling with breastfeeding, and they think they just need to give them permission to stop but that's really not what the patient needed, because they've only got 15 minutes. Totally.
Dr. Heather 1:20:47
Yeah, totally is is Oh, so many layers, it's very tough. That is why we have people that specialize and all this fun parenting stuff because we can go deeper and we can talk about all the things and we can consider all of the parts that that work together or the feeding and the sleep and the mental health and all of the bits that fit together
Fiona Weaver 1:21:06
pieces. Okay, so where can people find you I know people are gonna want to find you.
Dr. Heather 1:21:11
So you can find me on Instagram most of the time. I'm not very good at posting at the moment because I'm just too busy but Instagram on at cradled in Zed and or you can find me on my website@cradled.co.nz and email me through there if you want to get in touch.
Fiona Weaver 1:21:29
Amazing. Thank you so much for your time today. We are so grateful for all of your wisdom and sharing all of your wisdom nuggets today. You're welcome. You're
Dr. Heather 1:21:40
welcome for the wisdom nuggets. Thank you anytime I have so many more things I'm sure I could talk about but
Fiona Weaver 1:21:47
we can do part two. All right. Thank you so much for listening to mama chatters if you enjoyed this episode, let's continue the conversation on Instagram at MAMA matters.au. Be sure to share this app with your family and friends. And don't forget if you liked it, please leave a rating and review wherever you get your podcasts. Thank you again and I will see you next time.
