Hi Jennifer

If you or your collegues have any contacts in the Pittsburgh PA area, I
would be more than happy to refer and give parents another option.
Little breaks my heart more than being involved with a treatment plan
that tells the mother that putting the baby to breast is not safe due to
aspiration risk or very severe reflux.  The feeding specialty programs
and specialists that I know of in the Pittsburgh area do not work with
structural issues with reflux.  Does anyone have recommendations for CST
in the Pgh area?  I can address that in local meetings as well.  I have
to say that the patients with tracheomalacia that I work with, only a
very few have had tongue tie.  Probably most end up having a swallow
study done that would show a tongue tie.  A speech pathologist is
performing the study with the radiologist and would most likely see a
tongue tie at that point if missed clinially.  I am confident with the
multidiscipline assessment that we have in regards to tongue tie,
especially when the babies are seen inpatient, and outpt aerodigestive
clinic.  I have certainly found several tongue ties myself and refer as
needed.  Those are not issues that require thickening.  Now, if patients
go directly to other disciplines, I cant speak for them. The children
(and babies) that have oral motor issues are followed by occupational
therapists that specialize in feedings, so there are many that they see
that I am not involved in and cannot speak for their treatment plans. I
think it also may come down to the population that I see.  By the time I
am consulted, the family and PCP have already tried standard/benign
treatments for a while.  Pittsburgh tends to be behind mainstream
lactation so I am not very optimistic that many families would choose
chiropractic/CST options but would love to be able to give names.  I
have provided that as an option but without referal sources.  Do you
have any names of organizations for CST/chiropractic feeding specialites
to have referral lists, references/pamphets or info sheets for oral
motor exercises for parents that are interested?  What is very
interesting, is that we are expanding our outpatient feeding program as
we speak.  So, that means that when an infant have feeding problems,
they will be scheduled at the main hospital outpatient office so that
they will be evaluated by OT, Speech and myself.  So families that are
breastfeeding will have board certified lactation support for input to
their feeding plan.  Hopefully will start in July.  

Angie Kirkwood RN, BSN, IBCLC

Nurse Feeding Specialist and Certified Lactation Consultant
Children's Hospital of Pittsburgh

Office  412-692-5036



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