Episode 12: Why Babies Need Bodywork with Dr. Giselle Tadros

Jacqueline Kincer  00:43

Welcome to the podcast, Dr. Giselle Tadros. We have Dr. Gigi, as she’s known here. She is a tongue tie oral motor specialist, a bodyworker, and a baby development expert. And we are so blessed to have her on the podcast today. And we’re going to be talking a lot about tongue ties, and how they affect not only the ability of a baby to breastfeed, but how they can impact their development, their temperament, their sleep, and so much more. So welcome to the podcast.

 

Gisele Tadros  01:12

Thank you, Jacqueline.

 

Jacqueline Kincer  01:14

you’re welcome. I would actually love for our listeners to hear and I’m curious as to how you got into the world of tongue ties, and a little bit more about your professional backgrounds.

 

Gisele Tadros  01:28

Yes, thank you so much for having me. I’m so excited to be here.

 

So with the tongue tie world, I had been working as a PT for about 20 years. Now it’s been 20 years, but around. And then I was doing just regular Pediatric Physical Therapy. I was working in the schools, and I was working with babies in preemies in the NICU and all that kind of stuff. And then I had a friend who was an IBCLC. And she came to me one day, and she said, I know that you’re so great with all the babies, and I really need somebody. Do you think that you could maybe help out with doing some of this bodywork that we need and retraining? So some of these babies can feed correctly. And so I’d actually never heard of it. But once I started taking courses, I agreed that I would look into it.

 

And it took me two or three years to get all my certifications done. And I just found it so rewarding. Every time I went to a course, I realized that all this stuff was right up my alley, in terms of physical therapy, we know how to turn on muscles, how to turn off muscles, how to stretch muscles, how to lengthen the spine, how to do all these kinds of things. And I was just surprised that there weren’t more physical therapists doing this.

 

And we just hit the ground running and there’s no turning back. Interestingly enough, I feel like it was like a dripping faucet. Like, once people hear that you’re doing this, you just get calls and calls and calls because it’s just such a need for this work. And there are so many IBCLCs that just call me out of the blue, because they’re so interested in the work that I’m doing, and it’s just so necessary for all the babies.

 

Jacqueline Kincer  03:20

I love that. I absolutely love that.

 

And I know, I’ve definitely done that with some of the bodyworkers in my area and invited them to come to appointments with me so they could learn more and collaborate to help these babies. And I love what you said because one of the things that I always look at when I work with the babies is I’m watching how their muscles are moving their posture, their coordination of their suck, and their swallowing and their breathing and all of that.

 

And I can tell what’s going wrong. I just don’t know how to fix it. And that’s where you come in. But I know what muscles are supposed to be firing in what ways and what that should look like and what that should feel like.

 

So when I can even tell from a video often I can have a mom send me a little video clip of baby nursing and I know the system is wrong, which helps you right? Because you may not know exactly everything about breastfeeding, I know and then we work as a team. So I’d love for you to talk about why that team approach is needed. And what you see when the team isn’t collaborating and caring. Like are there some downsides if you know the family only gets the bodywork or only gets lactation support or only gets the frenectomy.

 

Gisele Tadros  04:36

Yeah, that’s such an important point.

 

And I find and I’m sure you find as well that the kids that do the best and see the best results are the ones that really have a team approach. And so when I first got into the field, it was Michelle Emanuel that I trained with. She said Now go out and find your team. You know you have to have an IBCLC, you have to have a good provider that’s gonna release the oral tissue and release that tension. And of course, you have to have the oral motor piece as well as the bodyworker piece. Because just stretching the tissue isn’t going to help them figure out how to suck correctly.

 

And also, sometimes there’s a lot of underlying tightness there. But if you’re just addressing the oral motor part, the rest of it also is going to suffer. So as a PT, I can address both.

 

But I do also like to call on the IBCLC. And they’ll sometimes come to my office, and we’ll do a joint appointment. So I will do all the muscle reeducation and the neuromuscular piece and stretch the babies a little bit, do some tummy time. And then an IBCLC comes in and works her magic. Like you said, I’m not an IBCLC. What I know, I just learned from observation, but you guys are the ones that can magically put it all together.

 

IBCLCs will call me and say we’ve tried everything we can, and it’s just not working. So you know, when I look at the baby very quickly, again, I could see that the muscles aren’t functioning correctly. They’re not using them the timing and all that thing like that you were saying about sequencing and sex well breed. And then we can actually go in and change that.

 

Jacqueline Kincer  06:24

Yes, that’s so true. And, you know, I always try to be really upfront with my clients. Sometimes we get to a point in the appointment when I go, Hey, I’ve done everything I could do. Yes, the latch is better, but it’s still not quite there. Here’s why. Here’s what I’m seeing.

 

And this is why we need to have you continue with bodywork, and then continue working with me until we see the full resolution of things. Because there’s only so much each one of us can do. And we do really need an approach that works collaboratively. And I love having open communication. And I know my clients do too.

 

Because if you’re a new mom, and you’ve got this little baby that you’re holding in your arms, you know, 80% of the day or whatever the last thing you want to do is be on the phone all the time, sending emails back and forth, and this and that. So I always try to just say, hey, here’s what I saw, and the body workers I work with, it sounds like you do the same, those joint appointments, that can be so beneficial. And I know we’re not the only ones out there that are doing work like that.

 

Gisele Tadros  07:26

That’s right.

 

And I wanted to say that there’s some babies that are so resilient, that once they get that tongue release, they can just figure it out on their own. But there are kids that, sometimes they’re so stiff and tight and they’ve had a rough delivery or whatever the case is, they really need a lot of help and support even before they do the frenectomy.

 

And that’s where having a team approach really comes in. Because I think the timing of the release is really just as important as the release itself. So that we can get the baby, we don’t want to create this oral aversion and then have them do it and fully resist the breasts altogether.

 

So there’s so much that goes into it. And it really needs all of us to put our heads together to come up with all the different things that work best for each individual baby, because they are each different.

 

Jacqueline Kincer  08:16

I love that you said that I am a huge supporter of obviously not just going straight for the frenectomy work with your IBCLC. But then also get a body worker involved.

 

What would you say? Like obviously every baby is different. I probably answered the question similarly to you. But in terms of a baby, just generally a tongue-tied baby, maybe nothing crazy with birth trauma going on in general? Like how often or how far ahead of that frenectomy procedure should they see someone like you?

 

Gisele Tadros  08:52

Definitely, it really depends on a lot of different things in terms of medical history, birth history, and feeding if the baby’s actually even eating at all.

 

But I would say a lot of the benefit of going in there before, there’s a lot of different benefits, but when it gets the parent comfortable in the baby’s mouth, just having them go in and move their fingers around in there, having the baby get used to fingers in their mouth. Because as you know, most dentists have a pretty lengthy post-op protocol that they have to follow for weeks at a time several times a day.

 

So you want the baby to just be getting used to that as well. And just a lot of education to prepare the parents for what’s about to happen, what to expect, the side effects, and timelines. Yes,

 

Jacqueline Kincer  09:42

Absolutely! I agree.

 

I always encourage parents, that the first experience the baby has with fingers in the mouth should be an enjoyable pleasurable one. We don’t want to be adding to the trauma or discomfort that they’re experiencing and all of a sudden, those parents are telling me my baby screams when I tried to go to exercise post-op, or they’re biting down, getting them to be relaxed and used to it ahead of time goes a long way. And I definitely do this as well, where there are some oral motor exercises that we can be doing ahead of time to optimize function, but then may reduce tension or set some good neuromuscular pathways, they’re gonna help that baby feed even better post-op. And I’m sure like you said, there are a lot of things to take into effect.

 

But if there’s a tongue tie, chances are, there’s maybe other things going on as well, like you mentioned, it could have been the circumstances of the birth or a lot of other things. And if we don’t address those, and we just addressed the tongue-tie, it sounds like we’re not treating the whole picture.

 

Gisele Tadros  10:48

That’s right.

 

And actually, one of the greatest things about me getting in and seeing these babies so early is that it’s allowed me to catch so many conditions that may be a mom might not know to even look for, but I’m seeing these babies in their first month of life. And as you know, babies just learn so much quicker, then their neuro system is this, like a clean slate where I can go in and teach them when I need to teach them, I can change the tone of the muscle that I see.

 

So when I get in there early, there’s so much more I could do. And it just takes so much less time. And a baby, that’s only days old, I can switch things so quickly, where in like two, three visits, everything is good. Whereas when I see kids that are much older, that have more poor habits, it takes longer to reverse their compensations and those kinds of things.

 

Jacqueline Kincer  11:45

Hmm, that’s such a good point, too.

 

Everything you’re saying is just magic.

 

And I wanted to bring in a question that I got asked on Instagram the other day. And the question blew my mind because to me, I just like I know the answer.

 

And it’s so obvious, but not everybody does, especially probably the listeners, and you just don’t know what you don’t know unless you’re someone who treats this stuff.

 

But how can birth impact breastfeeding? So if birth does not go as physiologically designed and planned, what are some of the things there that actually hinder a baby’s ability to breastfeed?

 

Gisele Tadros  12:20

Well right, that’s definitely a loaded question.

 

And so, a lot of times, I mean, first of all, I don’t think we will ever know the full story, because we don’t see these babies during their pre-partum period.

 

But I would say that generally, baby’s do have a rough delivery. Sometimes in utero, they are in a specific position that maybe doesn’t allow them to just magically come out of the canal the way that it should in a utopian world. And so, if there, one shoulder is jammed up against their ear, and they’re tucked under mom’s ribs, and sometimes it’s harder for them to slide out. So, there’s a lot of pressure with every push, and whatever.

 

So when the babies come out, it’s been a long journey, it’s rough. Their neck is a little stiff, their shoulders a little stiff, and their chin is tucked into their chest. And when they’ve been sucking in utero, they’re more chomping rather than having a nice suck where the tongue is sort of the main mover, and they’re using their jaw. So all this ends up playing into how they’re going to breastfeed.

 

Sometimes if the tongue is really stuck to the bottom of the mouth, they end up using their jaw. And then you’ll see other muscles tighten and stiffen when they’re feeding.

 

And I’m sure you see this over and over again, to where if the system isn’t working, the way it was designed, the baby is going to kick in all these other muscles to try and get this food. And so you’ll see a lot of compensation going on.

 

Jacqueline Kincer  14:05

Yes, yes, absolutely.

 

And, I think it’s been a phrase that I know has been tossed around in our communities, that compensation is not the same as competency. And we’re not just looking for any breastfeeding.

 

That’s obviously better than no breastfeeding. But if breastfeeding is happening in a dysfunctional way, it ends up creating dysfunction down the road. And since you’re such an expert in infant development and things like that, I’d love for you to talk about some of the developmental implications when we don’t address these things early on in the baby’s life.

 

Gisele Tadros  14:43

So one of the big major things that I see over and over when I first started this in my practice, is torticollis.

 

And the protocol is basically I mean, in its purest definition, it’s when the sternocleidomastoid muscle which is one so on the side of the neck is shorter than the other side.

 

So the baby will tilt the head to one side has trouble turning its head to one side. But I find that almost, when I first started this, every single baby I thought had torticollis. And then I realized that it was just really like a body tightness issue where that’s what it looked like to me. Or sometimes their whole body would be in the shape of a C. And then when we work, all that stiffness and tightness out, everything will sort of figure its way out. And now I forgot what your question was.

 

Jacqueline Kincer  15:39

Well, that’s okay. So if that tension is left in place, though, if we never address that, then what are some of the implications for them down the road, especially when it comes to their development?

 

Gisele Tadros  15:52

So development actually happens in a series of ways. So initially, a baby has reflexive movements, and then as the upper parts of the brain develop and kick in, they have more voluntary movement. And so when they’re not able to move voluntarily, like looking right and left, then they start to have trouble with their developmental milestones.

 

So if they’re unable to look right and left, and their shoulders and their spine won’t rotate, well, then they might not roll on time. And then that just starts leading to a whole bunch of other developmental delays down the road.

 

So I see kids that are sometimes six, or eight months that aren’t rolling. And when I’m doing my evaluation, I’m like, Oh, these guys have a tongue-tied. And nobody ever saw it or caught it early enough. So there really is a big correlation between delays and development because of this deafness and tightness that happens.

 

And so many times I hear moms that have given up on breastfeeding in those initial stages, because it was painful, or because it was too hard, or because they could only get them on one side, and they ran out of milk. There’s so many different reasons that I see these delays, but there’s always a link to feeding in those initial stages.

 

Jacqueline Kincer  17:09

Yes, yes, I see that too. And for the listeners who are hearing this, and they don’t know, what is the normal timeline for these milestones, like rolling over sitting up walking? And I asked that question because I just wanted to meet people in passing, and maybe a new acquaintance, a neighbor or something. And they’re telling me, they’re 18 months old, doesn’t walk yet.

 

And they’re like, Oh, he’s just slow to walk. And now I get it, like, you don’t want to think anything’s wrong with your child. And we’re not here to say anything is “wrong” with your child. But there is sort of an expected timeline of when certain things are going to happen. And I’d love for parents to be empowered with that information. So if you just said, if there’s a six month old, they’re not rolling over yet. That’s a little bit of a warning sign that we need to pay attention to as parents. So if you could just give us a little overview of that timeline, I think that’d be really great.

 

Gisele Tadros  18:08

Sure! I’m right there with you about empowering parents, because I never like to say anything is wrong with the baby, I think a lot of times, we just have to position them a certain way, or encourage them to play a certain way, and then they’ll get it.

 

With kids that have no tightness or stiffness or anything wrong, they will figure all this stuff out on their own, if you’re leaving them on the floor to play. So a lot of times, it’s really just coaching parents, showing them what to do and showing them how to get their kids to meet those milestones.

 

But generally, I would say in terms of like red flags, you want a baby to be rolling between three and five months. You want them to be sitting around for six months. If they’re not sitting by eight months, I would definitely look into it and try to figure out if there’s a reason for it.

 

Jacqueline Kincer  18:58

And when you say sitting, does that mean that you prop your baby up and sit them? Or does that mean that they get into a seated position on their own?

 

Gisele Tadros  19:06

No, I would mean if you were to sit them down, that they would stay sitting, they probably between seven and nine months is where they start to push themselves into sitting or if you know, left them asleep in the crib, when you came back to check on them, they’d be sitting up, okay, on their own.

 

And then also between seven to nine months is when they start to crawl. And then soon after crawling, they’re gonna start to close a stand and crew side to side.

 

Then they’re going to start to squat to pick up objects on up from the floor, and then they start to let go and then they walk. So the general rule of thumb for us is that you want them to be walking by 12 months, but we do give them a little bit of leeway till 15 months and if they’re not walking by 15 months, I think you should definitely get help. And again, that’s not to say that anything is wrong with them. But it’s just a physical therapist can quickly identify where there is a little bit of muscle weakness and address it.

 

Jacqueline Kincer  20:08

Yeah, no, that’s a really great point. And I think, again, as you said, sometimes it’s just a little education. Sometimes it’s just maybe changing up the environment for this particular baby. I have like a wonderful baby, and we actually worked with Michelle Manual with her.

 

And of course, I had great body workers and everything here. And she did not skip the crawling phase. A lot of people get concerned when they hear about early walkers and skipping the crawling phase, but she was walking at eight months, and it was nuts. Like she was walking, holding on to a wall at six months, and it blew my mind. But we just put her on the floor and did tummy time and all these other therapeutic things and worked with our body-workers.

 

Because she had so much tension. And I’m saying that as a point that’s not everybody’s standard. Like please don’t think something is wrong if your baby’s not walking by eight months, and I kind of wish she wasn’t because it was hard.

 

But that to me is just a sign that like because we did all the work though then we got her like we weren’t playing catch up basically, later on in life. And so I really valued that very, very early bodywork also she stayed in the womb a few extra weeks. So she kind of came out maybe a little more insurance in case if we hadn’t done that bodywork I mean, I look at photos of her in her first few weeks of life, and she was oh, incredibly tight and colicky all the time. And I couldn’t imagine if that had been her whole, you know? infancy?

 

Gisele Tadros  21:38

That’s right. One of the beautiful things that I love about…

 

Jacqueline Kincer  22:46

I have no idea what the heck, okay, let’s talk about my baby. It was great to have help for her.

 

 

Gisele Tadros  22:56

Okay. So one of the things that Michelle Emanuelle talks about is that when you treat babies, this young, everything is reversible. So we can get in there and make all these changes and educate parents on the importance of tummy time. And what that independent for time and do for your child. And it really is, like you said, almost like miracle work.

 

And I remember being in school and being so fascinated about child development. And it’s not just something that magically happens, it’s acting muscles that develop, and with the curiosity and the drive move that these children have, it just facilitates all these things for them.

 

So it’s such a beautiful thing to watch babies’ minds develop and their muscles develop at the same time, you get this regular child development. And so you know, some kids take a little bit longer depending on what’s going on. But most of the time and just one visit, a parent will see a big change right away because it’s so easy to change when they do know the recommendations.

 

Jacqueline Kincer  23:59

Yes! I love that. I think that’s just such a great point. And, you know, I get this question a lot. Sometimes I have parents who feel very hesitant about the bodywork, and I feel like one of my jobs sometimes it’s just sort of being a salesperson for you. Which is really funny. So I am for hire. No, I’m just kidding. I only sell it’s needed, but I don’t make money off of it.

 

In fact, I always tell my clients, that referring you for bodywork or to get a tongue-tie treated probably results in weight loss revenue for me because you don’t need my help for much longer when we get a whole team and just get it fixed. But one of the questions I do get from parents is they feel a little hesitant like you know, they’ve heard of PT or chiropractic or other things for adults, but when it comes to babies, they feel really hesitant and I understand that because, you know, you just brought this new child into the world.

 

They’re fragile, you have probably just sworn to protect them right? And to give them into someone else’s hands that you don’t know can feel very scary for a lot of parents.

 

And so for those parents who are listening and going, I don’t know like, Does my baby really need PT? Or do they really need bodywork? And then also, the other question they might have is, well, can I just massage my baby, I do baby massage. What’s the difference there between massage and what you do? And then also just explaining how what you do is different for babies versus adults.

 

Gisele Tadros  25:30

Right. So one of the things I always try to do is ask parents that have already worked with me to go online and write a review. And then I tell the IBCLCs, to go and tell their patients to check out the reviews online because parents are really good at enunciating, and describing how the therapy is good and why it was beneficial, and how it helped them in terms of feeding or whatever the case is.

 

So I let the parents do all the selling, and you guys as well, for me, because sometimes, for sure, parents don’t know exactly what it is that a physical therapist can do. And it doesn’t look like you know, the therapy that they’re used to in a typical physical therapy clinic where there are machines that they put on you. And they make you go into the gym and do a ton of exercises.

 

Jacqueline Kincer  26:20

Right! No 10s units for babies.

 

Gisele Tadros  26:30

But I do have to say that once parents come, they quickly realize the benefit of it. And I think even just the knowledge that they gained from understanding what was going on how they can get them to turn on how they can get the ones that are working wrong to shut off.

 

You know how their jaw is driving the movement instead of the tongue doing the work. And then once we get the tongue moving, the brain realizes, Oh, this is like a big major muscle. And it’s so much easier to move than the jaw. And so parents will quickly see the benefit of it.

 

But I understand that it’s hard. It’s something that I’m sure will you as well. It’s not covered, it’s not in-network. And so there is a lot of resistance to it because it’s a highly specialized field.

 

Jacqueline Kincer  27:23

Yes, that is such a good point. And, I found just for my own personal health, and, of course, my clients as well, that a lot of the best providers, 10, maybe not be covered by insurance, unfortunately.

 

But it is one of those things that if you’re able to invest in it now, it’s going to pay dividends later on in life and save so much more money. And one of the things too, is if anyone’s listening to this podcast, I know, I definitely have a lot of pregnant listeners, if it’s your first baby, or if it’s a subsequent baby, and you’ve had problems in the past, I know a lot of my clients have asked for baby shower type of stuff, sometimes just money for these kinds of expenses that come up. And just to prepare to have a little fun, especially if you’ve had a tongue-tied baby in the past, probably expect that I don’t want to, be pessimistic, but there’s a potential that you’re going to have another one.

 

And so if you have to pay out of pocket, a lot of times you pay a top pocket for the procedure. It’s not a preventive procedure. So if you haven’t met your deductible kind of stuff, PT, chiropractic, all that.

 

And then even lactation consultants, unfortunately, are supposed to be covered by insurance, but insurance companies like to play tricky games. So that doesn’t always work either. And you totally deserve the support and your baby does too. And my question for you doctor GD is like, can we live in the same city? Because I just there’s never enough providers, the ones we have here are amazing, and they’re wonderful, and I love them so much.

 

I’m so glad they’re here. But, you know, for those parents who don’t have someone like you in their area, what do you suggest for them? If they are really struggling? Maybe they live rolly. Like, they have a hard time accessing seeing someone like yourself in person, what are your suggestions for them?

 

So I would definitely say to get connected on Instagram because that’s sort of how I actually found the show Emmanuelle. She puts out so much great information online.

 

Gisele Tadros  29:30

And then I also just started offering some zoom consultations, and I’m trying to keep it as affordable as possible, especially in this time. Um, but just to reach out, I think that moms have a gut instinct, their mommy instinct and it’s strong.

 

And you know, if they feel like something is not right, it’s probably not right. And we’re here to help them and just not to suffer by yourselves or to give up because there are answers And most of us providers, if you send us a question online or send us an email, we’re willing to help. It’s not like, we’re none of us are doing this for the money, we’re doing it to make a living. But so many of us are willing to help.

 

I can only speak for myself that, you know, I’m in my own Instagram account. So if you send me a message, I’m not gonna say, Hey, make an appointment. So we’re always willing to help and give you tips and tricks to see if you can do this on your own. And then if you need a little bit of extra support, then we’re gonna be here for you.

 

Jacqueline Kincer  30:35

Yeah, I love that. And, I try to offer a lot of stuff on my social media in this podcast as well. But I’m also going to be the first person to tell you, hey, sounds like your situation is really unique, and you’ve tried a bunch of things, and we really should set up an appointment. So I always try to tell people, kind of preface that like, I wouldn’t be telling you this unless I really thought it was needed. So there is a lot you know, parents are smart, right? They’re researchers, there’s a lot they can do on their own. But sometimes you need an extra helping hand. And I love that you’re on Instagram like me, where can people find you on Instagram?

 

Gisele Tadros  31:14

I have two different Instagram handles for milk matters. PT is the one specifically devoted just to tongue-tie babies. And I specialize particularly in babies who are under six months, in terms of tongue-tie. Once they’re eating solid foods and whatnot, I refer out that’s not my area of expertise. And then I have in-home pediatric PT, which is just my regular physical therapy business.

 

So I have lots of developmental things on their tips and tricks and lots of ways that parents can play with their baby to help boost their development and encourage that normal development. Oh,

 

Jacqueline Kincer  31:51

That is so amazing. I love it. And I’m so glad that we could have you on the show today. And is there anywhere else on the internet that you’d want to direct anyone listening to find out more information or connect with you?

 

Gisele Tadros  32:05

So definitely, you could send me a DM on any one of those. And I have a website, www.inhomepediatricpt.com.

 

Jacqueline Kincer  32:15

Awesome. Well, thank you so much. Are there any last tips or information or message may be that you wanted to share with our listeners just to wrap this up?

 

Gisele Tadros  32:26

I think I just want to empower parents and tell them they don’t have to go through this alone. I mean, ask for help. We are here to help. We’ve seen it all over the years. And there’s always a solution. There’s no, don’t give up and trust your gut.

 

Jacqueline Kincer  32:42

Oh, I love that. It’s so perfect. Such a great end to this amazing interview with you. I feel like this is one where parents might go back and listen again, just because I feel like what you said was so simple, but also a lot to unpack for those who might be new to this information. So thank you, Dr. Gigi, for being here. I appreciate you so much.

 

Gisele Tadros  33:02

Thank you so much, Jacqueline, and I look forward to talking to you again soon.

 

Jacqueline Kincer  33:06

Thanks, me too.