A friend called me recently to tell me how he was doing with his new diagnosis of lymphoma. He told me he felt the big mass in his neck first and then a smaller harder one the next week. The radiologist wanted to fine needle aspirate only the large mass as that would \u201cTell him more\u201d.\u00a0 My friend argued to have them both aspirated and checked for cancer. He was losing the argument.\u00a0 Into the room walked the chief radiologist and asked my friend how things were going. He told the doctor about his strong feeling that both should be biopsied but the younger doctor disagreed. The older, wiser radiologist told the younger one, \u201cIn my years of experience, I have learned to listen to the patient\u2019s concerns because they were usually correct.\u201d Both masses were biopsied and, you guessed it, the smaller one had the cancer. My friend has just finished successful treatment!<\/p>\n
In pediatrics, I have also learned to listen to the parents.\u00a0 Some pediatric care providers feel that most first time parents are too nervous about every little thing.\u00a0 It can be true. I knew a dad so worried about his baby getting enough milk that I taught him to listen for his baby\u2019s swallows so that he would be reassured. He called me the next day to ask, \u201cAre 357 swallows per feeding adequate?\u201d\u00a0 He had made it more difficult by counting them and recording them when I was trying to ease them both into relaxing because baby was doing fine! On the other hand, if a parent says, \u201c I don\u2019t know why,\u00a0 but I am really worried about\u2026\u2026\u201d I take that as a direction to look carefully. If I find nothing, then I move into the reassuring mode, but I have learned to examine and question fully when I hear a sentence begun that way. Sometimes I will ask a parent, \u201cWhat does your gut say?\u201d<\/p>\n
Even more importantly when the child tells his parents to take him to our pediatric office to be seen\u2026. well, we learned that you had better work fast as the child has an inner sense that something IS wrong. The child is most likely right on the money. Children usually don\u2019t like the doctor\u2019s office but they also know it is where you go to get fixed. So when they WANT to go there, we take it seriously.<\/p>\n
So, how does this work in breastfeeding?\u00a0 Moms beginning to breastfeed their first baby are very worried that they won\u2019t do it \u201cright\u201d.\u00a0 This can cause a lot of anxiety as there is a lot of \u201chow to\u201d information out there about different methods of attachment. Moms seem to naturally blame themselves if there is any difficulty.\u00a0 Their nipple doesn’t protrude enough (looks fine to me). Their breast aren’t big enough (looks normal to me).\u00a0 They don’t eat right (diet history normal)\u00a0 They aren’t using the “latch” technique properly (and want me to watch and correct it). \u00a0 I have learned from Tina Smillie, MD to let the baby do it.\u00a0 ( Baby-led Breastfeeding: The Mother-baby Dance<\/i>\u00a0 can be viewed on www.geddesproduction.com<\/a>). \u00a0 When I tried that in my own pediatric practice, the babies all did it and the moms would exclaim, \u201cHe did it! He got there and knew where to go!”\u00a0 “She is so smart! My nipples don\u2019t hurt when she goes on by herself!\u201d \u00a0This went a long way in raising mother’s confidence as mom realizes that she is part<\/strong> of a dyad<\/strong> and not the only one with performance issues. This created a dramatic turnaround in the mother\/baby breastfeeding team.<\/p>\n Now for the mom who comes in with breastfeeding problems. After she tells me why she is here to see us, (sore nipples, baby\u2019s weight is low, etc.) I will ask her. \u201cWhat do YOU think is happening?\u201d\u00a0 Often she will say that she saw someone else for help or all her friends\/family say that she must have \u201clow milk supply\u201d. It is all her fault is what she is internalizing.\u00a0 So I will ask again, \u201cWhat do YOU think is happening?\u201d She will take a considerable pause and then sometimes say, \u201cI don\u2019t think he is feeding right.\u00a0 It seems different than my friend\u2019s baby.\u201d\u00a0 ” She sucks differently than my first baby”\u00a0\u00a0 Bingo.<\/p>\n Moms who come with sore nipples often will say \u201cI was told in the hospital that I was attaching him wrong.\u201d\u00a0 Or \u201cAll my friends say that I should learn to attach him deeper.\u201d\u00a0 Again, \u201cWhat do YOU think is happening?\u201d, I will ask her.\u00a0\u00a0 She will often then describe how it feels such as \u201cIt feels like he is biting.\u201d\u00a0 or “It feels like he is on my breast kinda loosely.” Aha!\u00a0 She KNOWS what is going on. Then it is up to me to discover what is going askew with the dyad. Since I am a pediatric nurse practitioner, I go for the baby. The first thing I do is watch what the baby can do on his own. Can he do it?\u00a0 Or does he get there and not attach. This is very telling. Sometimes he gets there and attaches and problem solved. If not, I usually find that the baby is not suckling well\u2026\u2026..sans the biting feeling, poor weight gain or sore nipples. (See how to asses a newborn\u2019s suckling thoroughly in my distance learning course on DVD www.babysperspective.com<\/a>)<\/p>\n But why is he not suckling well?\u00a0 That is the elephant in the room! In my exam I have found lots of causes. For sore nipples I look for a pain source in the baby: fractured healing clavicle, torticollis, plagiocephally to the point of a misaligned jaw, intestinal discomfort, reflux and so on. I look for mechanical problems such as tongue tie or clefts in the mouth. 36-37 week gestation babies are not known for suckling prowess and yet the mom has begun to internalize that it is HER fault\/problem.\u00a0 However, she intuitively deep down knows what is wrong………….and so she wonders about the baby.<\/p>\n As you can see by my previous blogs, I did not become a nurse practitioner before I became a mom. I remember being a new mom and feeling totally scared even though I was the eldest of six kids and did a LOT of babysitting. It is a very vulnerable time for a woman. The family practice doctor we used had one nurse\/receptionist. She told me at Heather\u2019s one year well baby visit that, \u201cWell Mrs. Frantz, you certainly get the prize for the mother who called our office the most with questions during your baby\u2019s first year.\u201d I realize now that I was calling for \u201cgut reassurance!\u201d.\u00a0 Fight on moms!\u00a0 Follow your gut instinct until you get the right answers.<\/p>\n","protected":false},"excerpt":{"rendered":" A friend called me recently to tell me how he was doing with his new diagnosis of lymphoma. He told me he felt the big mass in his neck first and then a smaller harder one the next week. The radiologist wanted to fine needle aspirate only the large mass as that would \u201cTell him […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-44","post","type-post","status-publish","format-standard","hentry","category-life-as-a-peds-nurse-practitioner"],"_links":{"self":[{"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=\/wp\/v2\/posts\/44","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=44"}],"version-history":[{"count":5,"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=\/wp\/v2\/posts\/44\/revisions"}],"predecessor-version":[{"id":63,"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=\/wp\/v2\/posts\/44\/revisions\/63"}],"wp:attachment":[{"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=44"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=44"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/geddesproduction.com\/Kittie-Blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=44"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}