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Welcome to The NICU Translated Podcast, where we break down the complex world of the NICU into clear, relatable insights for families and the professionals who support them. Hosted by Mary Farrelly—a certified NICU nurse, doula, and educator—this podcast is your go-to resource for navigating the NICU with confidence and compassion.
Whether you’re a doula looking to better support NICU families, a healthcare professional seeking deeper understanding, or a parent preparing for or living through a NICU journey, you’ll find actionable tips, evidence-based guidance, and heartfelt stories to inspire and empower you.
Each week, we’ll explore topics like:
-NICU 101: Terms, diagnoses, and medical equipment explained.
-Preemie care basics and developmental milestones.
-How to advocate for your NICU baby with confidence.
-Emotional and trauma-informed support for NICU families.
-Insights from NICU professionals and families who’ve been there.
With episodes featuring expert advice, list-style guides, and real-life interviews, The NICU Translated Podcast is here to equip you with the tools and knowledge to make the NICU journey less overwhelming and more empowering.
Subscribe now and join our community dedicated to bringing more joy and less trauma to the NICU experience—because the NICU is only the beginning.
Let’s navigate this journey together.
Mary Farrelly (00:00)
Some clinicians don't just treat babies. They study them, listen to them, and teach parents how to understand what their babies are trying to communicate through their bodies. My guest today, Dr. Rachael Carreon is one of those rare practitioners. Rachael is a pediatric physical therapist and infant development expert with over 11 years of experience supporting babies with oral ties, feeding challenges, torticollis, plagiocephaly, body tension, and early motor delays. Her work centers not just on milestones, but on helping parents feel confident and connected through every step of their baby's journey.
In this episode, Rachael breaks down complex concepts into simple, empowering explanations. From why NICU babies are a higher risk for oral motor challenges to how feeding, tension, and development intertwine to what parents and doulas can realistically do to support babies during those crucial first months. If you support NICU families in any capacity, this conversation will give you clarity, language, and practical tools you can use right away.
Mary Farrelly (01:27)
Hi everybody, welcome back to this week's episode of the NICU Translated Podcast. I'm so excited to have Dr. Rachael on today, welcome!
Dr. Rachael Carreon (01:35)
Hi Mary, thank you so much for having me. I'm so excited. I've been looking forward to it ever since we talked about it.
Mary Farrelly (01:40)
So Dr. Rachael and I are internet friends and also we live very close to each other in real life. So both of our stories have kind of online and in-person work have kind of been parallel to each other. So it's been really fun to ⁓ connect and have this like real relationship. So you guys are in for a treat today. We're gonna talk all things development and how to support babies before, during and after discharge. ⁓ So but first let's get to know you a little bit. Tell us your story.
Dr. Rachael Carreon (02:09)
Yes, so I have been a physical therapist for almost 11 years now, which feels bananas to me. But I specialize in pediatrics specifically in infant development, oral motor skills, ⁓ and feeding lactation, that kind of thing. so...
I have been in this realm and in my own business for about three years now, which has been exciting and terrifying at the same time as Mary can attest to. ⁓ But yes, it's just been such an honor to be a part of these families lives and be with them every step of the way, whether they are transitioning from the NICU or they just have a really difficult feeding journey that we need to tease out. I am a mom of two myself, a four year old and a two year old who are adorable and a six year old golden retriever named Atlas.
Mary Farrelly (02:34)
Woo!
Dr. Rachael Carreon (02:55)
who's equally adorable and a wonderful husband who supports and just picks up all the pieces that I drop. yes.
Mary Farrelly (03:03)
Equally adorable.
One of the things that when we first started connecting, I had a community called Life After NICU Community. And we really focused on finding resources for families as they transition to home because a lot of the work that we do as NICU nurses really gets families to that point of discharge. But as we know, the NICU was only the beginning. It's only Chapter 1 and there's so many more milestones and adventures to come. And so sometimes families at that point of discharge can feel like they go from, you know,
Dr. Rachael Carreon (03:31)
Mm-hmm.
Mary Farrelly (03:37)
from 24/7 nursing care, eyes on their baby all the time, support, the ability to ask questions when they want to, just like kind of cut off cold turkey and having a lot of ⁓ kind of fear that they're not, they're missing something or they're not doing the right thing or there's something else that could be going on. know, as moms we tend to have all this like additional mom guilt that we put on ourselves, but this can really come into play around
Dr. Rachael Carreon (03:46)
Mm-hmm.
Mm-hmm.
yes, all the time.
Mary Farrelly (04:03)
both feeding and milestones and motor development, especially with NICU grads. So let's talk a little bit about one of the biggest hurdles that NICU babies have right at both the point of discharge and then in those early days home, which is feeding. What kind of issues do you see most common in NICU graduates, both preemies and those full-term friends who also needed a NICU stay?
Dr. Rachael Carreon (04:07)
Mm-hmm.
Yes.
Yes, one of the biggest things I see is some not only dis-coordination with their feeding skills, but they're just so much more gassy than a lot of my other friends. ⁓ And that's for a variety of reasons. Sometimes it's because they haven't been feeding correctly, perhaps they have been tube fed, or anytime those lines are taped to their face, it restricts their...
muscles from moving and developing and so I see a lot of tightness like in their jaw which can affect their feeding and cause them to have more air while they're eating which causes extra gas. The other piece of that is ⁓ my little friends who were born early didn't get enough time to cook and to develop all of those ⁓ some of those GI reflexes they have slower GI motility and emptying their lower sphincter is not fully developed sometimes depending on when they arrived.
⁓ as well as some of their suck, swallow, breathe reflexes. And so when all of that is kind of working against each other, we tend to see really gassy, gassy babies, ⁓ especially if they did happen to be born via C-section, because they didn't get that nice stretch elongation through the birth canal. So they just kind of pop out. They have beautifully shaped heads, but their ⁓ internal systems seem to be a little bit tighter than some of my other friends.
Mary Farrelly (05:50)
It's so interesting and it's hard sometimes as a NICU parent to think back on their NICU stay and then think, okay, they had all these tape, this tape and wires on their face, like...
Was that causing these issues that I'm seeing today? And I always bring families back to thinking like in the moment, your baby needed those things to survive and thrive in the NICU. So it's not like a what if, it's like now we're at this point, what can we do now to help support babies throughout those next chapters? But tummy trouble is one of the most common issues with most babies, but in...
Dr. Rachael Carreon (06:04)
Mm-hmm.
Mm-hmm. Exactly.
Mm-hmm.
Exactly.
Yes, exactly.
Mary Farrelly (06:28)
especially with NICU friends. And you touched on some of those major
reasons why, like there's real, real reasons why to do that, but it can be hard to kind of...
Dr. Rachael Carreon (06:36)
Mm-hmm.
Mary Farrelly (06:39)
figure out for each baby like what is going on because they can't talk, they can't tell you I'm a baby that's having you know feeding intolerance due to a formula issue, I'm a baby that's having issues because my muscles are tight like why how do you I always support my families and trying to like we need to be a little bit curious and almost like a detective here to figure it out but how do you if you have a family that's saying I'm post-NICU my baby's super gassy what is
Dr. Rachael Carreon (06:46)
Mm-hmm.
Exactly.
Mm-hmm.
Mm-hmm.
Mary Farrelly (07:09)
your first
thing that you either suggest that they explore or what's your first thing that you're looking for?
Dr. Rachael Carreon (07:15)
The number one thing that I look for initially, especially with any kind of like tummy trouble, is tension because that can be a really big facilitating factor to a lot of those issues that we see with babies who are born premature just had a prolonged NICU stay. Even if they were born full term, don't, again, because...
We were doing everything that we needed to to help baby thrive and survive, but they might not be able to get as much movement as they need in those early early weeks. And then on top of that, ⁓ you know, layer on the lines and the tubes and the tape that can kind of cause some restrictions, not only in their ⁓ their face, but in the rest of their little body. ⁓ And so that's the number one thing that I tend to look for and kind of try and tease out.
And so if we address the tension and there's still some issues with gas, then we can kind of go on our decision tree and kind of figure out what the next step might be after we've kind of taken care of all of that.
Mary Farrelly (08:20)
In terms of restoring movement and decreasing tension, what is a typical timeline for a baby to see a difference in their attention? I know this is going to be different. Babies are coming into and they have mild, moderate, more severe. ⁓ But what is generally when a parent is suspecting or someone's told them that tension might be part of their baby's issues, what can they kind of expect as part of their timeline?
Dr. Rachael Carreon (08:24)
Mm-hmm.
Yes.
Mm-hmm. ⁓
Mm-hmm.
Yes, well with anything we love, the earlier the better. So the sooner they get in to see me ⁓ or another bodywork or therapist provider, the...
easier time they're gonna have and the faster their timeline is going to be. ⁓ So I'm gonna, I've said it before and I'll say it again, parents just keep advocating for ⁓ what you know that your child might need. ⁓ And so if I get a baby really early on who's really really little, ⁓ perhaps like fresh out of the NICU or a couple weeks home, then we have a much faster treatment timeline. It can be as little as a couple of weeks.
⁓ if they're seeing me on a weekly basis and then I also give a lot of homework at home to kind of help support baby's development and baby's movement and baby's mobility. And so if parents are diligent with how they are handling baby and some of the activities and movements at home as well as getting the therapy treatments.
then we tend to see a lot of progress really quickly, which is one of the beautiful things about seeing the little babes is because they're so plastic and they just make such much ⁓ faster progress than their stubborn grownup counterparts.
Mary Farrelly (09:50)
with me.
I know, I was just having
a conversation with a NICU doula client. We were doing a pre-Niki consult and talking and she was, she's an adult Niki, adult nurse whose baby is going to be NICU And she has, so we have this framework of how we think an adult patient is going to do. And I was like, you need to erase that. These babies are strong. They're resilient. They are, as you said, they're elastic. They're filled with all these stem cells. They literally just grew a kidney a couple months ago. Like this is...
Dr. Rachael Carreon (10:06)
Mm. Mm-hmm.
Mm-hmm. Yes. Mm-hmm. Yes.
Exactly. They
Mary Farrelly (10:24)
Thank
Dr. Rachael Carreon (10:24)
can do anything.
Mary Farrelly (10:25)
They're so incredible.
I think that ⁓ it can be really hard as a parent to see your baby looking uncomfortable, especially with the potential grief and trauma that's really embedded in a NICU stay, especially for families that have that experience and have maybe see their baby go through painful procedures and be truly uncomfortable than to come home and see them be fussing or squirmy because of their
Dr. Rachael Carreon (10:35)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mary Farrelly (10:55)
gas
or tummy issues too. It can be a different layer of intensity in a family who didn't have the NICU as part of their experience too. So
Dr. Rachael Carreon (10:59)
Mm-hmm.
Mm-hmm, absolutely.
Mary Farrelly (11:06)
Let's talk a little bit. One of the other things that kind of comes up and is always a question mark for some families is does my baby have an oral tie and is that impacting my baby's feeds too? I feel like it's similar in a way to birth education and in the way that social media has made more awareness about like possibilities and people are being able to have more informed questions but it also has that underbelly of people
Dr. Rachael Carreon (11:16)
Mm-hmm.
Mm-hmm.
Mary Farrelly (11:36)
being like, okay, well, I saw it on the internet one time, so therefore it must exist. So let's talk a little bit about maybe the prevalence of oral ties, what are some signs and symptoms of it? Does it connect with NICU stays at all? Is there like an overlap and just maybe a little broad overview about oral ties in general?
Dr. Rachael Carreon (11:40)
Mm-hmm
Yes, one of my favorite hot topics to chat about. ⁓ Never stop surprising me how many different opinions there are about oral ties. ⁓ But even in the feeding community. But I digress. ⁓ So oral ties are ⁓ fairly common. It seems as if, I think it's because we are talking about it more and they are more... ⁓
Mary Farrelly (11:55)
you
Truly.
I mean, no, yeah, no consensus.
Dr. Rachael Carreon (12:21)
you know, more of that hot topic that we are seeing more of them. And so people are thinking like, are there is there a bigger incidence of oral ties? Like what happened? But they were just really not diagnosed, at least in my like when I was ⁓ a little one in my parents ⁓ age group. They just weren't a thing. The appearance would just go straight to bottles because they were in the was in the age where they were like pushing formula. So it seems as it appears as if there are more oral ties, but
In reality, don't think that there is a, I don't think that the incidence is growing. I think it's just that we're noticing them more and we are knowing how to intervene with them more. But when a little one has an oral type, they will typically have a pretty shallow latch either at the bottle or breast. And that can cause some clicking to happen when the tongue can't come out far enough. It's going to lose that suction and they're going, you're going to hear like a
Mary Farrelly (13:19)
Mm-hmm.
Dr. Rachael Carreon (13:19)
when
they are trying to eat because it's literally the tongue losing that seal which can cause increased air intake as well as like milk dribbling which is so hard to see especially if you're ⁓ in general but especially if you're giving breast milk and you're like there it goes. Yep and the other things that we'll tend to see is if baby is breastfeeding there will be a really typically a painful latch with some ties depending on the severity.
Mary Farrelly (13:33)
Yes, right on the floor.
Dr. Rachael Carreon (13:47)
⁓ as well as increased gas and reflex and those kinds of things because of the increased air intake. Baby might fatigue really easily, which we also see with our pre-mies and NICU babies just because their little bodies are working so, so hard already and then we add feeding on top of it, which is a really complex skill.
And we're asking all of those muscles to do this extreme amount of work and they are expending more calories sometimes than they are able to take in, which causes really sleepy feeds, which means they're really inefficient. So baby seems to be feeding like all day long, which is sometimes what they're used to do with the tube feedings depending on the frequency. ⁓ And so it can be a real challenge for babies and parents to kind of navigate.
ties and we think like, it's just the latch, we're going to try different positions or it's just the bottle, we're going to try a different bottle. But in reality, there are sometimes there are some things that need to be addressed internally and not just externally. Obviously, those things do play a part. ⁓ But the tie can play ⁓ a big part in that. The other thing that I see is tension getting misdiagnosed as a tie. Sometimes there is a restriction, but if baby is so, so tight in their tongue, jaw, neck,
then it can present like a tie. We want when baby latches, baby to open their mouth and stick their tongue out ⁓ really attractively before they latch. ⁓ And when there's tightness or a tie, it will present very similarly. And so baby will either open their mouth, but their tongue will kind of retract. And so they can't get a deep latch or they will stick their tongue out.
Mary Farrelly (15:22)
Mm.
Dr. Rachael Carreon (15:26)
but their mouth is not opening. And that's because of that restriction back there. And it can be from tightness or a tie. So sometimes I'll get a referral for a little one who lactation or pediatrician might suspect an oral tie. And it turns out that there was just a lot of tension and compensations at work that kind of presented like a tie. I am on the more conservative side. I try to kind of do all of the more holistic remedies before we go straight to a release. Sometimes it is a helpful tool.
if we've kind of exhausted all of our other options, but it's always one of my last, like, let's prepare, baby, let's see what we can do first, and then if this isn't working, then we're gonna kind of go to a release provider.
Mary Farrelly (16:07)
Yeah, I love that you kind of.
think more holistically in sense. One thing I feel like just in our culture in general is we try to find the quick fix and we're really looking for it. And for so many families that I've worked with, it feels like a quick fix. Like, we just have to do this release and then all of our feeding and gas issues will be resolved. And as you said, like some babies, truly need to have that additional intervention, but it is not a quick fix. Even if you do have that procedure done, there's still a lot of retraining and things that you need to do to be able to
Dr. Rachael Carreon (16:15)
Mm-hmm. Mm-hmm.
Mm-hmm.
Mm-hmm. ⁓
Mm-hmm
Yes.
Mm-hmm.
Mary Farrelly (16:40)
repattern that baby's feeding skills too. I'm gonna put you on the spot here. you know roughly the prevalence or the incidence of oral ties in general? Just curious. No!
Dr. Rachael Carreon (16:43)
Mm-hmm. Yeah.
I do not. I probably should, but...
Mary Farrelly (16:53)
I'm sure that's
one of those numbers that's almost impossible to find because it is so not officially reported anywhere. I'm just curious at something. We'll dig into that at another time. So if a baby does have an oral tie, let's just kind of touch on the fact, say they do have an oral tie and we are doing an intervention like intensive therapy or a release. What are some things that, again, what's the general timeline for that?
Dr. Rachael Carreon (16:58)
Mm-hmm.
Yes. Yeah. Mm-hmm.
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mary Farrelly (17:23)
Is there anything
Dr. Rachael Carreon (17:23)
Mm-hmm.
Mary Farrelly (17:24)
that we can do to support positive feeding skills in that interim period of time, either before or right after a release too?
Dr. Rachael Carreon (17:31)
Mm-hmm.
Yes,
absolutely. So, so many things. You're probably gonna have to cut me off one of these times, Mary, because I could just talk about this forever. ⁓
Mary Farrelly (17:39)
No.
I'm here for it. is
such an important topic for anyone supporting a NICU family, especially those working with babies after discharge. But even more so, I feel like when I was only doing bedside NICU nursing and really did not do a lot of post-NICU support, I did not have a, I was really good about knowing how to support and introduce feeds, cue-based feeding, pace model feeding, supporting preemies in those early sessions. it really, I feel like we do not prepare
Dr. Rachael Carreon (17:50)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mm-hmm
Mary Farrelly (18:12)
for the potential for continuing feeding complications or just changes that we are feeding. It's not a one and done. So I love this topic. So important.
Dr. Rachael Carreon (18:20)
Exactly.
Mm-hmm. Yes.
⁓ I before I get to the the timeline one of the other things that we see with ⁓
with little ones who are having like that feeding struggle and that gas is that they have much more body extension, which proves to be really because they're kind of just trying to arch and get away from any of that tummy discomfort. And ⁓ NICU babies to begin with, especially preemies, tend to have a little bit more of that extension. They haven't had all that time to develop those flexion patterns in utero, and they tend to be kind of more like spread eagle. But we really need to encourage that midline positioning and posture, not only for their motor development, but
Mary Farrelly (18:42)
Bye.
Dr. Rachael Carreon (19:02)
also for their feeding skills because it's so much more organizing for them to be in that flex position, bringing hands to mouth, bringing that chin tuck and that midline position just helps with all of those things. So that's one of the number one things that I suggest to families when they are having feeding issues is to increase that midline play, whether it's having baby on their side, to kind of get them in a more flex position, get those hands towards the middle, just practicing bringing baby's hands to their mouth and doing some holds where baby is kind of like in that scrunchy flex position
that they might not be used to and they might be fighting a little bit because of that extension and that discomfort. So that's one of the first things that I usually ⁓ coach families on because I don't want them to feel so overwhelmed. Their little baby is still developing all these other things, but when we have a feeding issue, it kind of takes like front and center because it's so important. We need baby to be fed ⁓ in any way, or form that we can, ⁓ but we also wanna still support baby's overall development. And so...
Mary Farrelly (19:51)
Have a great
Dr. Rachael Carreon (20:00)
by encouraging those positions, it can make parents feel like, okay, I'm doing something, I am still worrying about my whole baby, and it's not just a feeding issue. Because it's not, it's their whole, they're so tiny, it's their whole little body that's involved with feeding. So we need to, exactly, and their head, yes, is like a third of their body, but still. ⁓
Mary Farrelly (20:10)
Mm-hmm.
Alright. ⁓
And it's so
many hours of their life is either sleeping, feeding or snuggling really. then so it's a tricky part.
Dr. Rachael Carreon (20:23)
Yes.
Exactly. Exactly. So why
not roll it all into one ⁓ and snuggle in that cute little flex position? ⁓ But when I first see a family, so if they have come to me and they have a diagnosed tie, either from a lactation consultant or a dentist, but they haven't pursued a release yet and they're kind of like noodling on that, I will do my evaluation and I look at the baby's function. I do my oral tie assessment like the very last thing. I don't like it to kind of like...
cloud my judgment. So even if someone else has kind of decided that baby has a tie, I save my exam for the end. The other reason I do that is because ⁓ my big joke is if you're assessing for an oral tie correctly, baby will not love it. And so I do it at the end so I can hand them right back to mom.
Mary Farrelly (21:11)
Very strategic,
love it.
Dr. Rachael Carreon (21:13)
Yes, they
don't need to like me anymore. I'm going to do this and then hand them back to you. ⁓ But I'm assessing baby's oral motor reflexes. And again, sometimes if baby has been born early, we don't see those developing in that typical fashion. might be more prevalent than we expect or they might be even less prevalent than we expect because they haven't quite gotten around to being developed yet. But I'm looking at their function.
love to observe a feeding. ⁓ And then I am also assessing their overall body tension. And as I am assessing baby, I'm often working on baby doing some myofascial release, ⁓ some craniosacral releases just to kind of relax and regulate baby ⁓ as I'm working at handling with them. ⁓ I will often give parents some oral motor stretching to do. So even just some like cheek circles getting baby used to having their face.
touched is really good. ⁓ Not only if they are, it's really good if they're going to have a release eventually because there's going to be a lot of stretching and post-care, operative care that is going to be done. So they kind of need to be used to people touching their face and being in their face. So I really love doing like some big cheek circles, like the scream, like jaw opening, ⁓ as well as some like kind of massage around their lips, like doing a little mustache.
Mary Farrelly (22:08)
going home now.
Dr. Rachael Carreon (22:37)
wiggle here and even just like getting in their mouth and doing some some work in there and parents are usually a little bit apprehensive to do this but we we walk them through it ⁓ and make sure that everybody's comfortable with everything the other thing i give them often is to practice those oral motor reflexes so we want baby practicing those good ⁓ coordination that good coordination that they need for feeding so practicing getting them to open their mouth and stick their tongue out practicing that big wide gape that they need for a latch
as well as doing some suck training. ⁓ And those can have some ⁓ different methods, either with a pacifier, we might do suck training on a bottle where we offer different supports ⁓ for them, as well as just like sucking on your pinky finger. The number of parents that I've seen who automatically just like, it's just instinctual, like, baby, it needs something, I don't have a pacifier, I'm just gonna give him my finger. ⁓ But oftentimes we can get a much better.
suck if we offer some cheek support to baby while they're sucking. And you can do that at the bottle or PASSE ⁓ or on your finger, as well as giving them a little help with their tongue elevation. Like I said, those tight muscles are not often strong muscles and babies will often, the number one thing that they have trouble with is elevating their tongue and maintaining that elevation for that seal while they're sucking. And so if we give them a little help, they can practice in that good position without fatiguing as quickly. So it's kind of like an active assist.
⁓ or like a cable machine but for
Mary Farrelly (24:06)
I that. I think that as you're saying this, there's so many things that would have been.
potentially helpful to think through as a part of their NICU journey and some of the things that some of the people listening to this either are working in the NICU or maybe are families that are currently in the trenches of the NICU themselves. ⁓ I have two questions around that specifically. One, what is, you may be touched on one of them, I have an idea of one, but what is like maybe one or two small things if their baby is in the NICU and medically stable.
Dr. Rachael Carreon (24:18)
Mm-hmm.
Mm-hmm. Yes.
Mm-hmm
Mm-hmm.
Mary Farrelly (24:39)
that
families can maybe consider doing to help support their long-term, especially oral, feeding skills. And then I have another follow-up question for the providers too, but let's start with the families.
Dr. Rachael Carreon (24:47)
Mm-hmm. Mm-hmm.
Yes.
I always encourage families, no matter how baby is being fed at that point, but just doing as much oral motor play and stimulation as they can. ⁓ So doing some, like I said, some just practicing some of those oral motor reflexes with your baby, even just kind of gently touching their face, even just like touching your hand on their forehead. ⁓ those ⁓ babies in general, but especially those of the NICU who are just used to kind of being like...
Handled all of the time just like having a calm gentle touch. ⁓ like on their face and on their like closer to their little person ⁓ Up here can be so regulating and so helpful as well as just kind of relaxing and in addition to getting them used to people kind of being in their ⁓ in their space and using some of those muscles a little differently so that can be really helpful the other thing that I love is for parents to just encourage like
bringing those hands to midline, just in any kind of position. Babies are often on their side for various reasons. And so just encouraging that kind of hand over hand or hands to mouth position can be really, really helpful ⁓ in the NICU, ⁓ as you said, when babies are stable and able to be kind of handled like that.
Mary Farrelly (26:08)
And both of those things are kind of instinctive, right? Like families really want to be and touch and connect with their babies and doing it with like a little bit of this extra layer of understanding of like, okay, like it's always going to be good to have this positive touch.
Dr. Rachael Carreon (26:11)
Yes.
Mm-hmm. Exactly.
Mm-hmm.
Mary Farrelly (26:24)
more maybe intentional positive touch too is just another part of being an informed and educated NICU parent. And when I work closely and help to train NICU doulas, and one of the things that we talk about is the importance of balancing negative input, negative environments with positive touch and positive environments and helping families understand their magic and their gift and the power that they have that is equal to modern medicines and that a nurse or a doctor cannot provide.
Dr. Rachael Carreon (26:26)
Mm-hmm. ⁓
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mary Farrelly (26:54)
the same way. Like you just we were seeing babies as a snapshot in time. Families know the ins and outs of their baby's needs and personalities and instincts and so helping build those like moments where you're getting to know, this is what happens when I touch their face in this way. this is what happens. They like this. They don't like this. That is both helping the baby and then also helping families reconnect and bond and build up your own confidence which can be kind of shook up a little bit with a NICU stay for sure.
Dr. Rachael Carreon (27:01)
Mm-hmm.
Mm-hmm.
Absolutely. Yes. Yes. Because what we
don't want to happen is for baby to get so, have these adverse reactions to, ⁓ especially feeding, but like in general to being touched and handled. ⁓ I've seen so many babies who are having either like breast refusal or bottle refusal because they've just built up these associations like feeding is hard, I get gassy and uncomfortable.
Mary Farrelly (27:32)
you
All right.
Dr. Rachael Carreon (27:45)
do not want to do it and they just keep forcing me and I don't want to do it. And so they develop these reactions and their whole little nervous system just kind of goes into this is gonna be really hard, I'm gonna panic and then they can't calm down and regulate themselves enough to feed. so providing as much as you said, kind of balancing those negative experiences with positive experiences is so, so important for so many reasons, but especially when we are feeding, especially when we're transitioning from tube feeding to bottle or breastfeeding, like just making sure that it's as positive as possible.
is going to be a game changer.
Mary Farrelly (28:17)
Yeah, I mean, even as a provider so much, I kind of say this to families, like I bother family. I bother the baby. I, yes, they have to have tape on their face to maintain a feeding tube because they need the nutrition because they're not able to have this ability to grow independently yet, or they need to this IV place or they need to have these stickers so we can make sure they're breathing and all these things. But I don't have as a clinical provider the time bandwidth or really training in certain
Dr. Rachael Carreon (28:23)
Mm-hmm.
Mm-hmm.
Mm-hmm
Mary Farrelly (28:43)
instances to balance that. So I think that's something helpful for families to think through.
Dr. Rachael Carreon (28:46)
Mm-hmm.
Mary Farrelly (30:15)
My counter question to that is as a provider, somebody who's working with babies maybe isn't a PT or OT in the NICU.
Dr. Rachael Carreon (30:18)
Yes.
Mary Farrelly (30:24)
What are some thoughts that maybe you have and maybe you don't have these yet, but I just, do you have opinions about how things are taped?
Dr. Rachael Carreon (30:29)
Hahaha
Mary Farrelly (30:33)
Like, or I was actually, I was just reading an article or maybe I saw, I can't remember where I saw this. Most NICUs with an oral tube will tape down, they'll tape midline. And I'm thinking like that's putting pressure on their tongue. So some people are taping up and over and up into the palate. And I was like, that's interesting. Like I don't have a, you know,
Dr. Rachael Carreon (30:41)
Mm-hmm. Mm-hmm. Mm-hmm.
Mm-hmm
Mary Farrelly (30:54)
skills to think that through, but just curious.
Dr. Rachael Carreon (30:56)
I know I I do not have
opinions because it is not my like the the there is a reason I did not go into like acute PT ⁓ I like seeing them afterwards you guys are amazing I do not know how NICU I know it an odd number of NICU nurses ⁓ and every time I meet one I'm just like you are like God's gift ⁓ to this world like I I just value guys so much ⁓ but I
Mary Farrelly (31:14)
Yes.
Dr. Rachael Carreon (31:25)
Anytime we're restricting any movement, it's gonna cut. So if we're taping down, we're gonna impact the tongue. If we're taping up, again, you're kind of infringing on that palate and the palate needs that stimulation. The tongue needs to be able to rest in the palate. And so if there's something kind of blocking there, that that's gonna cause an issue. If we're taping like kind of like over the cheeks and over the obicularis aureus here, we're gonna have issues with mouth closure. So it's just, there's...
There's no real good way to do it and we just need to do our best to help baby grow and thrive in the moment and then we can deal with all of that stuff afterwards. There's no, exactly, exactly. Yes, I love it, I love it.
Mary Farrelly (31:57)
Right, everything is repairable, everything is fixable, everything is figure-outable. That's my motto in life in general.
So that's really helpful because I feel like as people are listening, they're gonna be like, okay, well, as a parent in the NICU, you should be advocating for taping in a certain way, should I be doing this? But you're right, we're just doing the best we can in the moment with what is available. And then we're able to repair and intervene as the baby is better.
Dr. Rachael Carreon (32:15)
Mm-hmm. Mm-hmm.
Mary Farrelly (32:22)
able to tolerate that and to continue to evolve. Speaking of evolving, one of the things that many NICU babies go home with is bottle feeding because that is such a key part of the NICU journey for a variety of reasons. Oftentimes it's the logistics, especially if a baby's had a longer NICU stay. The parents may not be able to be there 24-7, especially breastfeeding is part of their
Dr. Rachael Carreon (32:34)
Yes.
Mm-hmm.
Mary Farrelly (32:48)
goal. So bottles are often introduced and especially with those itty-bitty babies in the beginning that might be super, super controlled flow or different size nipples or positions. Oftentimes bottle is part of their story. That being said, a lot of families really have this vision and dream for breastfeeding and for having potentially even exclusive breastfeeding down the road.
Dr. Rachael Carreon (32:53)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mary Farrelly (33:11)
How do you help support families, specifically NICU, Premier or not, with their transition from more bottles to more breasts, if that is something that is a goal for the family?
Dr. Rachael Carreon (33:24)
Yes, ⁓ I do see this quite a bit and especially with those NICU babies who just did not get that early opportunity to be at the breast and kind of develop that, ⁓ you know, or have that golden hour ⁓ with mom because they had some medically necessary interventions that needed to probably take place. ⁓ And so it can be so.
hard for moms and parents in general to just kind of shift their vision of what their feeding journey looked like. So I joke that I'm not only a physical therapist, but sometimes I'm also like a therapist therapist with the families that I'm working with and just kind of teasing out like, yes, this is not what we envisioned, but we can get as close as we can. It's just gonna take some patience and some time on everyone's part. But if this is what you really want, that is your goals are my goals and that's what we're gonna work towards.
Mary Farrelly (33:57)
Mm-hmm.
Dr. Rachael Carreon (34:13)
and transitioning from bottle to more breastfeeding is doable when we get in there early enough. And so I usually suggest to families, especially if they haven't latched like baby in a while or baby has been like fussy at the breast or not latching, I usually suggest offering a bottle first. That way you know that baby is fed. You're not adding that extra anxiety of like, are they getting enough?
⁓ And baby is a little bit more regulated and satiated because they've already had a bottle. They're not as frantic, they're a little bit more regulated and they can approach the breast with a little bit more calm. They've also kind of prepped themselves and have been practicing that suck, swallow, breathe with the bottle. And then when they get to the breast, they're like, I know what to do here. ⁓ And so I usually say off the bottle first and then off of the breast afterwards as dessert. And it's just a bonus. You're just going to practice and as much skin to skin as possible, which we love for all babies, but especially our NICU babies.
⁓ And so doing as much skin to skin as possible. I once had a client who had the most success latching. Baby was bottle fed primarily ⁓ and she really wanted to latch and she had the most success with baby latching when they were taking a bath together skin to skin. ⁓ And she's like, it is the sweetest time. I love it. We do it sometimes twice a day because I'm like, this is where you're latching. This is where we're gonna do it. That's where the baby was most calm and regulated.
and just accepting of latching. So I always suggest to parents like play around with it where you're practicing and how you're practicing when you're doing it what kind of day because that can also impact baby. We know that that that witching hour is very real. And so sometimes that is not the best time to practice. ⁓ But just making sure that everybody involved is in their most calm and regulated state before practicing is a big key component of that.
Mary Farrelly (36:01)
Yeah, I think that that's something that is undervalued is if you yourself as a parent is not, if you're hangry and not regulated and you're feeling uncomfortable, you're not gonna be able to regulate a child or a baby or really anyone else in your life. It's just that like idea of being, you're the thermostat and not the thermometer. So the thermostat can bring everybody down, the thermometer, you're meeting people where they're at and your baby might be up here. So.
Dr. Rachael Carreon (36:14)
Mm-hmm. Mm-hmm.
Exactly.
Mm-hmm
Mary Farrelly (36:29)
able to regulate yourself before you try something new. And also I always say like let's just be curious about what this feed is. Have no expectations for it. If we have expectations and we're going to be potentially disappointed and then it has this like emotional investment in a way that being curious and open to it does not. So, lower stakes can also help families I feel like step into each feed with an open mind because it I mean feeding feeding is is relentless. It just
Dr. Rachael Carreon (36:38)
Mm-hmm.
Mm-hmm.
Yes.
Mary Farrelly (36:59)
It's non-stop. You can't say no thank you. I don't want to do it
Dr. Rachael Carreon (37:00)
It doesn't stop. Yes.
Mary Farrelly (37:05)
⁓
Which is also acknowledging for those listening that that is very much a reality and there are some Days that are good days and there are days that are bad days, but it is possible. There is this like evolution But it does take patience. I feel like especially when I do pre-NICU consults talking about expectations around breastfeeding and just gently Opening the door that it's going to look different like it is going to different. There's nothing the experience especially money babies in the NICU in the beginning
Dr. Rachael Carreon (37:10)
Mm-hmm.
Mm-hmm.
Mm-hmm
Mary Farrelly (37:35)
are truly NPO or nothing by mouth. They cannot have anything in around their mouth for a variety of reasons.
Dr. Rachael Carreon (37:38)
Mm-hmm.
Mm-hmm
Mary Farrelly (37:43)
And that is important. So it's going to look different. There's going to be pumping. There's going to be this evolution in this journey. And it can still be beautiful and it can still be exciting. And either way, you and your baby are going to bond and thrive and connect. And it is possible to have a positive feeding experience, breast, bottle or anything in between.
Dr. Rachael Carreon (37:50)
Mm-hmm. Mm-hmm.
Mm-hmm.
Mm-hmm.
It
is, and just adjusting those expectations because sometimes we do use ⁓ extras to kind of help baby get used to latching at the breast if they're so used to the bottle. Sometimes that's a nipple shield. Sometimes it's a SNS or a supplemental nursing ⁓ system, which is essentially where you're... ⁓
providing baby with milk ⁓ next to your breast. They may be latched, they may be not, but you have baby next to you and then you're providing that milk that you've pumped previously to babies so that they're like, I do get fed here. This is not just an unhappy experience. And we're again, getting those happy feelings, those positive associations with the breast ⁓ so that baby's not just like, this is the worst. I will never do this.
Mary Farrelly (38:47)
right. Thank you. Babies are smart
and they're people. They're not robots. We cannot actually trick them. We can we can gently influence their environment, but they are smart independent little buggers and they always win. So we have to create their positive environment and not make it a battle.
Dr. Rachael Carreon (38:51)
They are! Yes.
Mm-hmm.
They are. Yes, they do. Yes.
Exactly. Another thing I often say is that typically, like at the beginning of my evaluation, I usually tell parents, I have a plan of how I want this to go, but we know who's actually in charge here. So we're going to follow baby's cues. And if baby needs a break, baby needs to pee, baby needs to poop.
That's what we're going to do. so they they are they start off in charge and they yeah, they continue that way. Yes. mercy me. ⁓
Mary Farrelly (39:31)
and continue.
As parents of toddlers, we know this very, very deeply. are some battles. You
just surrender right away and go away from there. Okay. So we talked a lot about feeds. Let's just do a quick thing because you mentioned the P word. Let's talk about Dr. Rachael's favorite hacks for pooping. ⁓ Because that is another huge part. The GI system is one long tube and what goes in must come out. And if it's not coming out, then it's not going to want to come in as much. So let's talk about pooping really quickly.
Dr. Rachael Carreon (39:41)
Mm-hmm
Yay!
Mm-hmm.
Exactly.
Mary Farrelly (40:03)
Bye.
Dr. Rachael Carreon (40:03)
Yes, oddly one of my favorite topics. If you ask my husband what I do, he says that all I do is help babies eat and poop, which essentially is true. ⁓ Eat, poop, and move. ⁓ But.
Mary Farrelly (40:06)
Hahaha
Dr. Rachael Carreon (40:17)
This is one of the things that whenever I have a friend who has had a baby and I'm bringing them a meal, I have to hold the baby ⁓ if they're open to that. But they usually will pass off the baby and be like, Rachael, teach me all the things now. And so I'll kind of take them through my gassy baby tips. ⁓ So one of the first ones being back to that like flexion ⁓ position. So think of it as like a baby squatty potty. Anytime we're getting those knees up towards that chest.
baby is going to be able to relax that pelvic floor, they're going to be able to release a little bit better and they're just gonna be a little bit more regulated. ⁓ Oftentimes their instinct is when they are straining and having that gas again, they're in that extension position and that's just gonna tighten everything up and make it even harder for things to release, ⁓ if you will. And so when we flex baby's feet up ⁓ in any kind of position,
like against your chest, flexing them up and kind of like a little froggy or a baby Buddha ⁓ or even just like on your lap with them in your knees, having those feet flexed up can be really helpful. I say skip the bicycles and just bring both knees up is usually my go-to. My other favorite trick is opening up that left side. We know the left side is where that descending colon is and where all the major GI stuff happens. So if we can open and elongate that side again to kind of
open up that tube, ⁓ that can be really helpful as well and is one of my little magic tricks. So we flex baby's knees up and then I kind of tip their hips towards the right and open up that left side and and then the magic happens. ⁓
Mary Farrelly (41:52)
Sometimes he's almost, I
literally think of it as like a tunnel. sometimes you just have to like align the parts and then the liquid can flow.
Dr. Rachael Carreon (42:00)
Yes. Yes.
Exactly, exactly. It's like a marble run. ⁓ But I often find that even if their baby didn't have a NICU stay parents are sometimes so nervous to move their baby, which is understandable. They're so little. ⁓ But especially if they've had time in the NICU and they just seem so fragile still, parents can have some hesitancy with moving them. And I say babies will let you know when they don't like what you're doing.
Mary Farrelly (42:08)
I'm sorry.
Yep.
Dr. Rachael Carreon (42:34)
They are very, very vocal about that. and oftentimes the things that I'm trying to teach families typically feel good for babies. And if they don't, then there's something we need to tease out. ⁓ But that flex position is my ultimate, ultimate go-to to kind of relax and release everything. Like a squatty potty.
Mary Farrelly (42:50)
Yeah, I
love that. I said that if it was like we don't eat a cheeseburger and then lay down and think that we're going to poop like it's just not going to work that way. ⁓ Everybody else is up right. Why do we expect babies to be able to just do this on their bottom? And I do think that bicycles somehow they must have been branded at some point. Why does the world have such a fixation on bicycles? That also just doesn't make sense. You want both legs up and out we go. ⁓
Dr. Rachael Carreon (42:57)
Exactly. Exactly.
Mm-hmm.
I know. ⁓
Exactly. Yes. Mm-hmm. Yeah, just skip them
Mary Farrelly (43:19)
They're cute, guess,
Dr. Rachael Carreon (43:21)
Yes
Mary Farrelly (43:22)
I also feel like babies don't always love that, but they do like being scrunched back up and just letting off all that magic release.
Dr. Rachael Carreon (43:28)
Mm-hmm.
Mary Farrelly (43:29)
So we talked a little bit about eating, we talked about pooping. Let's talk a little bit about the other part that you probably work very closely with families on and in that is like gross motor development and skills. But before we dive into that, something that is very misunderstood and can be really confusing for families of preemies specifically is what is, like how do I know if my baby's meeting milestones on this chart that I'm seeing in my pediatrician's office? What is my baby? Do we have an adjusted age? And what does that look like for families?
Dr. Rachael Carreon (43:36)
Mm.
Yes.
Yes.
Yes. So I get this question a lot because it's not really... I have seen that it's not really educated on a ton. I feel like when parents are, at least the ones that families that I've seen who are discharged from the NICU, like they're just like, oh, now my baby is fine. And they are, you know, X amount of weeks or months old and they should be doing XYZ. But just because we're discharged from the NICU doesn't mean that we are...
on that same path. So adjusted age is really important for parents to keep in mind when that horrible c-word comparing babies to those charts or to other babies around their same age. So adjusted age is simply their chronologic age. So how many weeks or months they are minus the weeks that they were premature. So if baby was born at 32 weeks and they are 16 weeks now, they were about eight weeks premature.
their adjusted age is eight weeks. So we don't expect them to be meeting the milestones of a 16 week old. We expect them to be closer to more of that eight week or two month, two month milestones. And so parents will come in panicked that their baby is not holding their head up in tummy time or that they're not showing signs of rolling. But really we're dealing with more of a two month old than a four month old. And so adjusting those expectations with the adjusted age can be.
really, really important for managing those expectations ⁓ and also supporting your baby and what they should be doing versus what you think that they should be doing based on all of those fun charts that they have at the pediatrician.
Mary Farrelly (45:34)
How, I know this is gonna kind of vary depending on what's going on with the baby, but typically how long are parents going to be kind of following their correct gestational age versus their adjusted, like when is the, even out a little bit, when do they need to stop thinking about it?
Dr. Rachael Carreon (45:46)
Yeah. Yes, it usually
I have seen it even out. So some babies again, they're so resilient and strong and smart. Some babies like catch up really quickly. But generally I tell parents to keep that in mind until about age two. Again, you might see it even out a lot sooner. You might see some areas even out while you know, baby might have an issue with speech or fine motor ⁓ or something of that nature.
but other skills are more on par with their chronologic age. But generally around two, that's when all of those ⁓ bigger milestones ⁓ have kind of caught up. Baby should be walking, moving, ⁓ and starting to chat a little bit more around that age, and we expect things to be kind of ⁓ caught up. If baby is super duper early, or have some other medical complications, then sometimes it's closer to three years.
Mary Farrelly (46:38)
Okay, that's good to know.
When families are looking at, say that we're talking about this baby that's 32 weeks, now there's 16 weeks and we're looking at eight weeks, are they like hard and fast at that eight week mark or is there like a little bit of wiggle room since they've been earth side for longer than the baby that was actually is simply been out of the uterus for eight weeks?
Dr. Rachael Carreon (46:54)
Yes.
Yes, there is a ton of wiggle room. And like I said, oftentimes there is kind of like a, what's the word I'm looking for? Oftentimes there's a range of what we see in development. That's why there's those huge ranges for milestones, but it also applies to adjusted age. So yes, we're expecting them to be kind of around eight weeks. And typically like their reflexes will probably be.
around that timeline. And so if baby was born early, they might have those reflexes seemingly hang around a little bit longer and kind of have to work to counteract those. lots of buzz these days about like integrating reflexes and all of that stuff, which I'm not going to touch on. But in terms of like oral motor skills and gross motor development, there's some like reflexes that we see motor wise that ⁓
tend to hang around a little bit longer. But there's a ton of wiggle room, especially depending on if there are other medical complications when they were discharged from the NICU and all the interventions that they may have had there that can kind of impact their development of where they fall on that chronologic adjusted age range.
Mary Farrelly (48:09)
that. And kind of thinking this through too, so some there's such a wide variety of babies NICU experiences as we touch babies are in the NICU for four hours, summer for four days, four weeks, four months, a year, month plus. So it's really hard to speak in in general realities. Some babies, most babies in the NICU have PT or OT at least once, twice, sometimes three times a week or more. Many babies go home with a plan for follow up.
Dr. Rachael Carreon (48:16)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Mary Farrelly (48:35)
typically, especially those that are clearly needing additional support. Others do not. Others are discharged and they're simply sent to their pediatrician, which are wonderful resources, but those appointments sometimes are a little bit spread out as we're getting further and further away from the point of discharge. What are some things that if a family is interacting with their baby, what are some maybe not red flags, but maybe light pink flags that families should be looking at or eyeballing to say, hey, maybe we
Dr. Rachael Carreon (48:40)
Mm-hmm.
Mm-hmm.
Mary Farrelly (49:05)
do need to go back in and find Dr. Rachael, find another PT in our area and explore these different things that might be going on with our baby.
Dr. Rachael Carreon (49:10)
Mm-hmm.
Yes, I love that pink flag. I'm gonna steal that one.
⁓ So one of the other things that we see when babies were born premature is that their development seems to kind of flip. with a typically or ⁓ full term baby, we will see kind of development start like from head. So they'll get head control, they'll get that oral motor control and go from head to feet. ⁓ But with our...
Preemies especially, we kind of see that seemingly reverse and that's because they have more of those extension patterns. So they seemingly have more control of their legs ⁓ and their trunk versus their head because they didn't get all of that time in utero to develop that head control and that midline control specifically. So that can seemingly flip if we are noticing that baby is not bringing hands to midline ⁓ frequently or not having trouble keeping either their head.
or their hands in midline, then that is kind of a pink flag for me. We want to be able to see baby ⁓ bringing those hands to their midline and to their mouth for regulation purposes, but also for motor development purposes, as well as that chin tuck, that almighty chin tuck that we love. Tummy time gets all of the press, but that chin tuck is equally important. We need to make sure those flexors are also working. And so if baby's having a hard time keeping their head ⁓ in midline or even just having any kind of head control, that is a...
a pink flag for me for sure. The other thing being if baby on the flip side is having a lot of trouble in tummy time, ⁓ either because they have some really tight extensors ⁓ or they're just like uncomfortable in their GI systems. If I always say you wouldn't want to chug a Diet Coke and then do some core work that just doesn't sound appealing to anybody. So babies who have GI issues and extra air and bubbles.
Mary Farrelly (50:57)
Right.
Dr. Rachael Carreon (51:03)
Tend to not love tummy time and so if that continues to be a struggle even like in the weeks following discharge Then we want to really touch on that because there are some critical ⁓ There's some critical points that we want to hit as baby continues to grow and develop
Mary Farrelly (51:19)
That's so helpful to hear too, because there's my other thing to say to families is like if your gut says there's something wrong, get it checked out. Like just get it checked out. It's better to have another set of eyes on your baby that says, okay, like, no, this is appropriate and we'll keep tracking follow up at this point. Or have someone say, hey, actually, maybe there's something that we can do to tweak their...
Dr. Rachael Carreon (51:27)
Yes. Mm hmm.
Mm-hmm.
Mary Farrelly (51:43)
exercising or release tension or do something there around feeds just to optimize and make their lives more comfortable and more pleasant to be around because sometimes those uncomfortable friends they will let you know all about it all the time ⁓ which is challenging as a parent in so many different ways ⁓ but that's a really important thing to to kind of consider. So if families especially are listening to this and are like I love Dr. Rachael so much how can I have more
Dr. Rachael Carreon (51:49)
Yes. Mm-hmm. Yes.
All day long. Yes.
Mm-hmm.
Mary Farrelly (52:13)
What resources do you have? How can people work with you, find you? Tell us all the things.
Dr. Rachael Carreon (52:19)
Yes, so I am on Instagram and Facebook. Instagram is a great way to share. So ⁓ I do not gatekeep, I say. So I share tons of tips and education on Instagram. So that is a great place to start. And my handle is foundations underscore pediatric PT, I think. ⁓ And then I'm on Facebook just as foundations pediatric therapy and wellness. And then my website is www.
Mary Farrelly (52:39)
You
Dr. Rachael Carreon (52:48)
Foundationspediatricpt.com and there's a contact form. There's also a blog that I try to update frequently ⁓ with some more broader expansion on topics that I cover over on Instagram. But yes, I do virtual consults with people and again, I have a lot of free resources on my website that people can just download and go to town with as well. There's no use in gatekeeping. I just want to help all the babies.
Mary Farrelly (53:15)
I love that. I'm
here for that too. There's just so much of what I feel like causes stress and overwhelm in families is just both not having enough information and information overwhelm.
Dr. Rachael Carreon (53:17)
Yeah
Yes!
Mary Farrelly (53:27)
Having
a trusted couple, trusted resources that you can have in your toolkit to build up your own knowledge and your own education and your own understanding and then kind of drown out the rest of the noise too is just essential to being able to navigate these early days home. So as a closing question, what if for the parent who's listening to this, who's maybe worried about feeding or head shape or developmental delays or all the things, what is one thing that you want them to know about their baby's potential and their ability
Dr. Rachael Carreon (53:38)
Mm-hmm.
Mm-hmm.
Mary Farrelly (53:57)
support that.
Dr. Rachael Carreon (53:59)
I am of the belief that babies have limitless potential and when we put limits on what they can do and expectations on them, then we are doing everyone a disservice. So you know your baby best as their parent, you are their person and you know exactly what they need and just don't be afraid to advocate for that. I will say it over and over again. You just...
you can't stop advocating for them because they can't advocate for themselves right now. ⁓ But yeah, you can't put a cap on their ⁓ potential to grow and develop ⁓ and just become their own little person.
Mary Farrelly (54:38)
I love that. always say babies don't know what statistics are and nor do they care. So they will do what they're going to do. And they're just little powerful little people. We all should take a little note from the potential, the limitless potential of the babies in our lives. Thank you so much for joining us today. We'll put all of your contact information and links in this show notes so you guys can continue to learn with Dr. Rachael. So thank you for coming today.
Dr. Rachael Carreon (54:42)
Yes.
Mm-hmm
Truly, truly.
Yay! Thank you for having me. ⁓