PediPals' Wisdom: Pediatrician's Thoughts on Normal Infant Development as it relates to feeding

 

Brianna Miluk: Hello, hello, and welcome to The Feeding Pod. This is your host. I'm Bri, Brianna Miluk, and I am a speech language pathologist and certified lactation counselor. I specialize in infant and medically complex feeding and primarily see patients in the home health setting, although I do have some that I see an outpatient or via tele practice.

I'm also an instructor at the university level and a PhD student studying communication and information sciences. I have a huge passion for evidence-based practice and supporting information literacy in speech, language, hearing, feeding, swallowing sciences, specifically as it pertains to social media and translational research.

This podcast is meant to share anything and everything related to being a pediatric feeding SLP feeding therapist with sprinkling in a little bit about working in academia, being a PhD student, and how to access, appraise, and implement research into clinical practice. Some episodes may contain guests, and I'm already looking forward to some of those coming up, while others might just be me rambling about something that's been on my mind.

Regardless, my goal with this podcast is that you walk away not just with newfound knowledge, but with the inspiration to think critically and not be afraid of research. So, without further ado, let's get into today's episode.

Welcome back to the feeding pod. I'm so excited because I have Dr. Ana here today. And if you do not know who Dr. Ana is, Dr. Ana is one of the pediatrician and best friends behind the PediPals. And so, Dr. Ana and Sami created the PediPals and they share just amazing information on there for caregivers and honestly, like healthcare professionals as well to really consider in our practice, as well as as a caregiver who's raising a child of like what's typical development? What should I think about this? What do I think about that? How can I support families in the best way possible? And if you don't already follow them, it's all going to be linked in, so make sure that you do, because I, I just, I just love what y'all are doing. So, I convinced Dr. Ana to come talk to me today about some things, but before we get into that and going through, you know, some commonly asked questions at the pediatrician office and some myths around feeding. Why don't you give us an introduction of who you are and really how did you get into the PediPals and, and starting that, that journey?

Dr. Ana: Yeah. Thank you so much for having me. I mean, we love your content. We love your podcast. We are big fans from the beginning, so we had to do this. And I know Sami wishes she could be here and we're just kind of crazy right now with our work and our social media. So, we're tag teaming, but she definitely sends her love.

So, Thank you so much for the support. Like you said my name is Dr. Ana and I'm a general pediatrician, so I have a day job and I see lots of little kids and their families and yeah, totally love my job because we get to kind of grow with the families and grow with the kids. So, I wouldn't definitely not trade it for the world. And me and Dr. Sami, we went to residency together. So, we did our training and we instantly connected and bonded. And we have the same type of humor. We like the same type of thing. So, we just instantly connected. And as we ended up in the same practice over the years, we thought, well, we really want to do something for the community, because a lot of our patients mentioned to us that, you know there's not enough time in this checkup and we have so many questions and, you know, do you have any resources? Do you have, do you do any kind of community gatherings where you answer our questions or can you go online?

Because we'd love to hear more actually both of our patients kind of mentioned that to us. So, we tried to do little gatherings in the community, but parents are just so busy. And, you know, as we know, everyone consumes their information online and it's just so much easier for parents to get their information online.

So, we thought, well, we'll start with a podcast. So just like you, we started with our podcast, it's called The Well Child. And so, we thought, Oh, we could talk forever. So, we'll just do this podcast and we'll talk about all the things we want parents know that we can't cover in that, you know, short visit at the doctor's office.

And so, then one thing led to another, we somehow ended up on social media. And then here we are, both of us are not good at social media. We're both introverts, but somehow we ended up on here and it's been a great journey and it's been really fun getting to learn, understanding what parents really need and what they need us to talk about, and then hopefully dispelling some myths and, and providing some education. So, it's been fun. 

Brianna Miluk: I love it. I, I do not think y'all are bad at social media. I love what you put out there and I feel like I can just like get the idea of your humor in your posts and in your videos of like, just what that is probably. What the experience would probably be like if, if both of you were in a room together. I'm sure it's a lot of fun, but yeah. 

Dr. Ana: Thank you. 

Brianna Miluk: I love what you all are doing. And I think it's, it's just like you said, like parents are super busy and as much as they would love to attend something in a community setting, like, Oh yeah, let me just like go to this. It's like, okay, well. I got to bring my kid to it or got to find someone to care for them while I'm there.

And if I can't do that, then I bring, you know, my kid or like my four kids, you know, and like, what that looks like while- 

Dr. Ana: Nap time and all this stuff that happens in between. Yeah. 

Yeah, absolutely. And, you know, I also love what you all stand for because we've both talked about this before, how social media can be an awesome, awesome resource for good information, but it also Have not so good information.

Brianna Miluk: And so, you know, really trying to bring to light like, Hey, here's, here's what the evidence actually shows. Here's, here's what we, you know, know what's going on developmentally, which is why I'm so excited about our talk today and kind of dispelling some of those myths and, you know, we're gonna talk more specifically about myths that are related to feeding and you know, what, what goes on in that realm.

But of course, definitely refer to the PediPals pages if you want information on other developmental pieces as well. So. Okay let's start with one of the first ones, which I see all the time as being miss and over pathologized, I'd probably say is, is talking about reflux in infancy. So, I would love to just, let's just talk about like, what is actually normal?

What, what, what can we expect from infants in terms of reflex, reflux, excuse me. And. When does it become GERD? You know, when does it become an actual problem? And what can we kind of look at for that delineation? 

Dr. Ana: Yeah, this is a great question. Because so many people deal with this with their babies, you know, and if you look at it, reflux for parents that are still learning about what it is, it's, you know, we refer to it as heartburn in adults.

You know, when you, when you see like stomach contents that come up the esophagus. And, you know, as adults, we might not throw up like babies do, but we feel it, you know, in babies, their anatomy is still developing, they're still growing. So, the little, the little flap that kind of keeps food in our stomach and prevents the food from going up is still developing in kids.

So around six to eight weeks of age reflux tends to become more of an issue for babies. So, in that first couple months and then it kind of peaks around four to five months where it gets a little worse before it gets better. So, there's some babies that will, you know, we call them the happy spitter uppers, you know, they just, the food comes up.

Some of them, it just comes up to here. The, the stomach contents, their milk you know, undigested milk. All kinds of things come up to here. Sometimes they swallow it back up. Some babies, they spit it out through their mouth and some it comes out through their nose, their mouth, everywhere, you know.

And it's a lot of babies. They just they just go about their day, you know they spit up, it's a mess. We have to change everything. And then they go back to feeding and there's no issues. And then some babies are really uncomfortable as the, as the acid comes up. A lot of them will arch their back and stiffen up and, and it can be really painful and sometimes not comfortable, you know?

And so, when we counsel our patients about reflux, we let them know, you know, the main things that pediatricians are looking at is is the reflux impacting their growth? You know, is it preventing them from growing? So, we look at those growth charts consistently with every visit. And so, we don't want them falling off the curve.

Now every child is different. You know, one might weigh, you know, be at the top of the growth curve. One might be at the bottom. But as long as they're tracking along their curve and the reflux is not preventing them from gaining weight then that's, that's very reassuring. And we're very happy about that.

And a lot of times those babies don't need any intervention for their reflux. And we can get into more details about, you know, what we do, what we recommend, but usually when it becomes a problem or, you know, gastroesophageal reflux disease versus just the reflux is when it's causing a lot of pain, comfort, prevention of- you know, when it's preventing them from growing and developing and those are kind of the main things that we're looking at when we're deciding, okay, this needs more, you know, more of our attention and this is kind of the normal baby spit up. 

Brianna Miluk: Yeah, that's super helpful. I have two things that really like stood out to me. One is you talking about happy spitters. I feel like there's this like rampant, like there's no such thing as normal reflux and nobody's a happy spitter, you know? And it's like, No, there is. That's why we, that's why we say that, you know, because it is totally normal part of development. And if an infant is not bothered by it at all, like we don't need to pathologize it. Like it's okay. But I also love that you did mention the growth curve. Cause that is one of the criteria I'm thinking about even in my practice of like, okay, like what's going on from a growth standpoint, but it's not like average growth. It's on their curve, how well are they following that? Whether that's at the top of the curve or the bottom of the curve, we don't want to see a major drop anywhere depending on how they've been following.

So, I just appreciate you bringing that up. Cause I think that, you know, talking about growth curves and, and weight gain and development can be very stressful for some caregivers to look at that. 

Dr. Ana: Yeah. 

Brianna Miluk: And so, understanding like, it's okay if your child's on the lower end or the higher end. It's just their growth trajectory. So. 

Dr. Ana: Yeah, that's just their body type. And one other thing I forgot to mention is, you know, babies, they really just have one emotion, you know, and I tell parents that they're, they're just crying, right. And whether it's pain, whether they're cold, you know, whether they got water on them, whether they got a gas, you know whatever the situation is that makes them uncomfortable, their only way to it is through crying, right?

And so, a lot of times we interpret that as pain. They're in pain, but as you know, you're changing them, you know, you're moving them a little, they'll start crying, right? And so not every baby that cries is necessarily in pain. You know, there's lots of other factors. So, we counsel our families a lot about, You know, when is it really affecting them?

And I can understand, you know, we're not with them with the baby all night long. And, and, and for some kids it can be very difficult, you know, so we definitely try a lot of things along the way to try to treat reflux naturally and without using medications, you know, that's always our primary goal. There are some babies that sometimes need the medication if they're falling off the growth curve or they're not growing or you know, it's, it's some of the preemie babies. They have a prolonged, you know prolonged reflux time that, that they go through. So, there's a lot of factors that go into it, but babies cry for so many reasons. It's, it's not always pain, you know.

Brianna Miluk: I'm so glad you bring that up because it is true. It's either like babies just hanging out or anything possible could be going on and they're crying. You know, I remember when I was growing up, this is a total side story, but I remember I'm, I'm seven years older than my youngest sister. And I remember her crying distinctly one time for like, It was, it felt like hours.

And we were just like, what is going on? Like her diapers been changed. Like she had it out and we were going through, she had like a hair wrapped around her toe. That was like irritating her. And I was like, I'll never forget that. Cause like my mom finally, like she was doing a diaper change and saw it and unwrapped it. And she was just like. Perfect, I'm fine. Oh, my goodness. 

Dr. Ana: That's amazing that you found it because that's one of the things they teach us too, the hair tourniquet, because it can sometimes get really, you know, block off the circulation. And so, we definitely scan the baby all around because those tourniquets can get in anywhere, you know, the little.

The hair gets wrapped around their little finger or, you know pretty much anything. So yeah, that's a great example that we always look for. 

Brianna Miluk: Yeah, yeah it was just like, we were like, what is go? I remember that so vividly. Okay. So, in terms of, of reflex management, you know I think really briefly, I just kind of wanted to share the NASPGHAN recommendations that, that have been updated.

So, these are from the North American society for pediatric gastroenterology, hepatology, hepatology. Hepatology. Am I saying that word right? 

Dr. Ana: I say hepatology. I don't know if it's 100%. 

Brianna Miluk: Ok I said "hepa" and then I was like, that's not right. Hepatology NASPGHAN, which is also just hard to say. 

Dr. Ana: I know. 

Brianna Miluk: But really the recommendation from, you know, from that reading is that you want to just, like you said, go in a more natural approach first before you go to medication.

So, you know, let's, let's thinking about positioning changes or from a feeding perspective, I'm thinking about, is there an overactive letdown? Is there an oversupply? Is the infant being overfed, which can also show up as that like GERD and sometimes not with the weight loss, but you'll see like a huge weight gain.

Which I feel like isn't always associated, but thinking about like, you know, the feeding patterns that are going on and looking at all of those other factors before going to the medication. 

Dr. Ana: Yeah. Yeah. No, that's definitely important. We spend a lot of time talking about, okay, how is the baby feeding? Because as you know, some babies they might take two ounces and they're, you know, very happy. Some take three or four ounces and every child, every person's the size of their stomach is different, right? So, if you think about anatomy, you know, if that stomach fills up in two ounces but they're hungry, hungry hippos and they're eating more, you know, and that, that milk just hasn't had time to empty out, then of course it's going to shoot back up, right?

It's going to reflux back up and the flow of the nipple is very important. The letdown. So, if you're breastfeeding, your flow is going to vary from mom to mom. I even look at the babies that are bottle fed and the nipple, you know, there's the slow flow nipples. They're the ones that are faster. So Sometimes babies have different flows with how quickly they eat, you know, and babies are born with a suck reflex.

So, if you put something in their mouth, they're going to suck, you know, whether it's a pacifier, whether it's a bottle. And so, they don't always recognize that, okay, my stomach is full now I have to slow down. And so sometimes some babies are very intuitive. And they pick that up, you know, from the beginning, but other babies will just keep eat, keep feeding, you know?

And so, the parents sometimes have to pace them. So often slowing down the feeds, pacing them, taking breaks, it is more tedious. It does take more time to get through a feed, but it saves you a lot of times with how much spit up comes back up and changing clothes and that whole mess, you know? So, slowing the feeds down can really help.

Brianna Miluk: Yeah, for sure. That's a lot of what I'll see in my practice as well is, you know, a lot of times it's sort of related to what's going on in the feeding environment. And again, like we don't expect reflux to completely dissipate cause there's going to be a little bit of it because they're a baby. But a lot of times we can kind of support the maybe more excessive nature of what's going on.

So awesome. Okay. Let's move into the next topic here. So, I want to talk about gassiness in infancy. So, I think this is another one that's very much used to used as the, the topic of misinformation and what that actually looks like and what we can expect. And yeah, I would just love to get your, your take on that.

Dr. Ana: Yeah, gas is our favorite topic, especially in the beginning, you know I mean, if you think about it gas can be uncomfortable for all of us, for babies, for adults. We know that the big gas bubbles, you know, I always kind of explain it to parents that, you know, our guts the receptors of our gut work through stretch. So, if we actually go in and we cut our stomach or our intestines, actually, it doesn't hurt. Yeah, it actually hurts when they're stretched. And so, gas is one of those things that causes stretch, bloating, all those things. They cause pain and discomfort. But that doesn't necessarily mean gas is a bad thing.

A lot of our gut microbiome, all those good bacteria that we have their job is to make gas is to produce gas. And that is a sign of a healthy gut, especially for a baby. If they have, if they're breastfed, they're getting even more of the microbiome from their moms, you know, doing skin to skin, they're building up their gut in these first few months.

And if you look at that growth chart, that first four months, their weight doubles. So, if you think about it, their body is doubling, their intestines are doubling their bones, their, you know, their entire body is rapidly growing. And so, as that gut grows, they're going to produce a lot of gas because they're going to, it's going to get populated with all those bacteria.

So as much as we get distressed by gas, unfortunately, or fortunately it's, it's a normal, healthy, it's a sign of a healthy gut and a healthy baby. Now there are some things that you can do to help minimize the gas. You know, I'm sure you talk about it a lot when they're feeding, you know, if babies are swallowing a lot of air as they're feeding, if they don't have a good latch, you know, if their nipple is, is not the correct size or flow, then they can swallow more gas and that can make them more gassy and more fussy. It's not going to harm them, you know physically, but it's not comfortable. So, there are some tricks we can do. Sometimes the massages, you know, the cycling of the legs, you know, little things like that can help release the gas. There's not much great evidence with the with the gas drops.

You know that those are available. We just don't have great data to say, Are they safe? Are they not? But sometimes people use those techniques if it's if it's really, you know, a bother for the family and for the child. But with kids, less is more. So, we try to do the least possible because everything has a potential of side effects.

So as much as the social media accuses us of throwing medicines and throwing things a lot of pediatricians try to do the least invasive, you know, go the least invasive route. And if it's not something that's going to harm them, leave it alone. Like gas. 

Brianna Miluk: Yeah, I love that. And I think it's, it's so funny you say that. Cause it is like, you know, Oh, pediatricians are going to throw like the medical side of stuff and we need to go more natural. And it's like, actually a lot of times pediatricians are are actually suggesting less than some of these other like, you know, quote unquote holistic natural providers are because you're like, I'm saying don't even use that.

Like, if, if the child is growing and developing like know that it's annoying, that they're uncomfortable a little bit. 

Dr. Ana: Yeah. 

Brianna Miluk: But like, Like you said, that's a sign of a healthy baby and like throwing something else in there could, could actually take that off track if we don't have enough evidence to show benefit. So. 

Dr. Ana: Yeah, I think that's what parents, I mean, it's a natural thing because you want to do something when your child is in distress. You know, your natural need is to say, okay, let me do something. You know, that's where the whole cough and cold medicine, you know, culture comes from. But you know, that's why you have us to say, you know, in this situation I know that it seems that the baby is not always comfortable, but it's safer and sometimes better to just let nature kind of run its course. But there are little things you can do to, to help them along. 

Brianna Miluk: Absolutely. I love that. And I think too, like, like you said, parents want to help. And I know like as healthcare providers, we want to fix it, right? Like we want to make things better. And so, you know, doing some of those things that like, You know, maybe it'll help. Maybe not. But at least it's very low risk. It's not likely to cause any negative side effects that like, okay, we can try that out. 

Dr. Ana: Yeah, I think one thing that parents really kind of appreciate when I kind of word it, you know, a lot of times parents will come in and say, Oh, they're, they're sick. They need an antibiotic, you know, or they need this medicine, you know, and I say, well, it takes me literally two seconds to write an antibiotic or to write a prescription for you. And it takes me maybe 30 minutes to explain why there could be potential risks of this medicine and why I think the baby doesn't need it.

You know, so it actually takes me more, more time and more energy to explain. And so that should be a clue to parents. If your pediatrician is taking the time to say they don't really need this medicine or they don't really need that, take it as something that they probably don't need because it's very easy for us to write a script, but it's not always the right thing.

Brianna Miluk: Yeah, I love that. I think that could be carried over to a lot of different healthcare disciplines. Sure. For sure. So, kind of on the subject of gas, let's move in the direction of constipation. Constipation is something that, you know, and we're kind of moving constipation. I'm thinking more of what we see after infancy with constipation.

So, when we see constipation in toddlers or even before potty training, you'll see sort of that increase when starting solid, moving into more textures. And so, kind of in that age range, we're thinking, you know, what, what would be considered quote unquote normal, like is constipation a normal part of development? And, you know, what are some of the things you're thinking about then management wise to support support those patients? 

Dr. Ana: Yeah, this is a really good distinction that you brought up with infancy or what we think is constipated- constipation and infancy versus when they're older. So, babies around one to two months, their gut slows down.

So, remember in the beginning, they're pooping all the time, like 10 times a day. And then around one to two months, a lot of babies will slow down and there's some babies that poop once a week. And there's some that poop daily. And a lot of parents come to me and say, Oh, no, they're constipated. They haven't pooped in five days, but in babies, that's totally normal because their gut slows down.

So, we tell them as long as their stools are soft, they're mushy, they come out easily. If they skip days, no problem. You know, now as they get into toddlers, you know, toddler range ages and older, you know, if they're skipping days, usually they're having harder, larger stools that are difficult to pass.

And a lot of kids remember, you know, when they've had a hard stool and it was painful. And and then they try next time to hold it in. They said, well, why would I have to go through that again and again? So, I'm going to hold it in as long as I possibly can. So, constipation is kind of a twofold thing that happens it has to do with our diet what we're putting in and also the behavior patterns of the child because it can, you know, you can be very motivated to not go to the bathroom when you're a toddler.

And so that's one of the reasons we first tell parents not to rush potty training, because if we rush potty training and they're not ready, they are going to hold it in because they, you know, they're scared or for whatever reason, that is a big motivator. So, if we let them go at their own pace, we deal less of that chronic constipation. 

You know, so that's number one. Secondly, around the age of one we switch usually from formula to whole milk, you know, we'll switch, they'll be eating more food. So, we're relying more on you know, dietary nutrition and less relying on the formula or the breast milk, right? So, a lot of, a lot of times babies are still, you know, stuck on the milk and the dairy.

So, they will drink a lot of milk whether they're breastfeeding or it's whole milk. So, we really try to stress around nine to 12 months to really cut down the milk volume. So, after one, they only take about 16 to 20 ounces max of milk in a day. So, like two cups. you know, of milk and focus more on food and fiber and veggies and fruits and water.

And that's really going to minimize the constipation that happens in that you know, one to two, three-year age group. So. You can do a lot of things by controlling what they eat, getting more fiber, getting more water, reducing the dairy, and then you know, of course they inevitably get picky around two to three, right?

We're going to talk about that later, but the pickiness will inevitably get there. And so we'll talk, you know, we can discuss more strategies there, but these are the first kind of initial steps of management that I do again, avoiding medicine if we can, you know, now there are times where it gets really difficult and they're holding in their stool and, you know, parents are having to go to the ER because they haven't pooped and they're in pain, you know, so do we use do- we do use stool softeners and there are some good stool softeners. I, my typical go to is MiraLAX. You know, we, I try to avoid some of the stronger laxatives initially. But that one works really well. A lot of GI doctors, a lot of specialists will use MiraLAX first. So definitely talk to your doctor because you don't want to be missing something, you know but you definitely want to try those things first and then talk to your pediatrician.

Brianna Miluk: Yeah, I'm so glad that you brought up the point of like constipation being twofold. So, it's not just what's going in, but also the behavior of pushing it out and how that can really manifest. Cause I, I've definitely seen that with patients where they've had a really bad experience with constipation.

And every time if they go to the bathroom and even remotely seems like they have to push, they're just. Nope, I don't need to go. 

Dr. Ana: Yes, yeah. 

Brianna Miluk: I'm not going to do it. And then of course it manifests even worse. And I will say too, like, that's something that I'll see. Obviously with the populations that I'm working with tend to have developmental disabilities or other diagnoses.

And I see that pretty frequently with the autistic population. And if we think about like the sensory differences there, probably feels even worse than when we are, you know, passing a hard stool. So. I definitely have seen it reflected where it's that behavior piece of like, I don't want to go. And so sometimes in those cases, if they also have difficulty with getting enough in, in their diet, then a stool softener can be helpful.

And I've seen the same thing in my practice where physicians are typically recommending MiraLAX as the first option because it is just the lowest sort of like lowest side effect, lowest addictive properties. And then. I love your mention on the milk because I think that's overlooked sometimes and we think about like, oh, like their milk intake is causing constipation because they're relying on so much milk but thinking about it from if they just go from formula to milk, they're still going to be taking in that same volume amount.

Dr. Ana: Yes. 

Brianna Miluk: And you know, 30 ounces of milk is a lot. 

Dr. Ana: Yeah. 

Brianna Miluk: So, thinking about that of like, okay, as you're progressing, it's a slow process. And I'll even tell some families like if they haven't cut back very much of the formula or breast milk at 12 months old, reminding them like we can keep doing some of that and cut that slower and not just do like you know, cold turkey to milk. It can also be a slow transition there that gets them more comfortable. 

Dr. Ana: Yeah. That's why we really start talking about it at nine months because a lot of it is just comfort. You know the reason a lot of parents have a hard time getting rid of the bottle because it's soothing for the child, it's comfort, the milk, the bottle, it's soothing.

So, if you try to break that kind of behavior, that that pattern early on, it just it's much easier. And I'll tell parents if it's, it's more like they don't necessarily need a lot of milk, but for the comfort piece, if you just cut down the volume in each cup. So, let's say they want it four times a day.

You know, you do four little four-ounce kind of cups or like you said, as you're transitioning from formula to whole milk, you can do half and half and slowly kind of get them through it. There's, you know, there's multiple ways to do it. As long as the bottom line is you're minimizing that dairy intake afterwards.

The other thing I wanted to mention, I'm so glad you brought up the, the kids with sensory processing and autism. And we definitely sometimes have to have them on a stool softener for a longer period of time because we know that they struggle with sensory things, you know, when it comes to food and texture, so they might not have an ability to have a varied diet, you know, and with stooling things that might take them longer, you know, so definitely knowing your child and knowing kind of what is difficult and what's easier, you know, that really goes a long way because You know, you know your child best.

And so that's really important. The other thing I wanted to mention is even as they get older, a lot of kids, especially after they're potty trained, we'll see this constipation thing kind of prolonged, you know, get into the eight, nine, 10-year olds even. And a lot of kids are just busy bodies.

And so, they'd run to the restroom and they are like, okay, I'm done. You know, they, they haven't emptied out all the way. They haven't emptied out their bladder. They haven't emptied out their stool. So, they just run off. So, a lot of parents are like, oh yeah, they're pooping three times a day and they're fine, but it's hard stools, they're not fully emptying. And then they come in with tummy stooling. You know and so as they potty train and as they get into a stool regimen, having parents kind of sit with them and say, okay, we're going to take this much time and we're going to make sure we completely empty. So, we're not just in a rush and running off. And then we have accidents later. So, there's lots of things that you can consider. 

Brianna Miluk: No, that's very helpful. And I think just like also recognizing that like, if this happens, it does not mean immediately that something, you know, major is going on and that many kids experience constipation during these transitional periods.

And so being aware that like, we can a lot of times make some of these more simple changes in effect to support them. So awesome. Okay. So, thinking now moving a little more into like the feeding, feeding side. So, when starting solids now, this is one that I think we, we've briefly talked about in the DMs before about just like signs of readiness and the guidelines and thinking about like when to start solids exactly.

And like, what, what are the current recommendations, especially according to the AAP, like. What, what type of approach, what type of readiness signs are we looking for? And then I would also like to, as kind of a secondary, talk about allergy introduction and making sure that we're introducing allergies.

Dr. Ana: Definitely. This is a big topic of discussion and you, you know, a lot of there's different schools of thoughts and a lot of information that gets circulated through the internet with regards to this, you know, and so just as a disclaimer, of course, every baby is different. And so, the reason we do these checkups so frequently you know, two months and four months and six months and we're seeing babies so consistently is because their milestones are changing rapidly. And so, pediatricians are having to stay on top of their motor skills. And, and, you know, when they're, when they start reaching these milestones, if they're doing everything appropriately. So, you really want to have a pediatrician or a provider that you trust that can guide you through these milestones. And so, you really want to trust your pediatrician when they're saying, okay, now I think they're ready for this next step. So typically, most healthy newborn term babies that, you know, that were born on time are usually the ready, ready to start solid introduction between 4 to 6 months.

We say the earlier you do it, the more time they have to experiment with food to get used to foods, you know as you know, in the beginning, the primary source of calories is going to be from their milk, right? The food is not providing them the calories. We're getting used to the textures and the flavors and smells and you know, half of the food comes out, you know, they throw half of it on the floor, half of it gets spit out.

So, it's really part of the discovery process. And so, I always, if, if my child, you know, if they're holding up their head, you know, they're showing good head control. They're not having you know, they're not gagging when they, when you try to feed them, you know, they're not choking on the foods. Their, their motor skills their tone, we look at all of these things to determine, okay, is the baby ready?

And most babies are ready around that four to five-month time period. And so usually the earlier we start, the more time we have to practice. But I tell people it's not a you're not under pressure, you know, because really you want these solid foods to be a part of their diet after one, you know, nine months and beyond.

And so, this is your time to practice and have fun with it. And a part of this introduction process is to make sure they don't have allergies as well, right? Like you mentioned about the allergies. So, we start usually one food at a time you know, pureed. A lot of people, we can talk a little bit more about baby lead weaning and some of the thoughts about that but some parents prefer to wait to feed their baby, you know, until they can pick up the food and, and eat.

And then there are people that can start with the spoon and feeding purees. And there's multiple ways of doing it. And I'm not, you know, to say that baby led weeding is wrong or anything like that. I think that's one way to do it. And that's totally fine. But if your child isn't motivated to eat at that time, we really try to push them to get started earlier, you know, so that's where it really helps if you feed with the spoon and get them to the practice of feeling those textures.

And all the studies basically show that early introduction helps with less picky eaters later, right? You introduce these foods so they are more comfortable with them earlier and reduces allergies later in the future. So, there was a study that came out called the leap study many years ago, and it looked at peanut allergies and they saw the, the lowest incidence of peanut allergy was in countries where they introduced peanuts as early as three to four months.

And and where we noticed a lot of high peanut allergy and in the West and the United States, a lot of families were waiting till the age of 123 or beyond because they were so worried about the peanut allergy. So, we saw an increase in the rise of peanut allergy. So, I will start talking about veggie, fruit, peanut, egg introduction at the four-month checkup, you know, not to say you're going to start everything right away but one at a time and slowly. And so that's kind of how I approach it. 

Brianna Miluk: Cool. No, I appreciate that. And I think like. I'm learning some of the thoughts from you right now, because like, when I think about starting solids, I'm usually thinking like, okay, exclusively you only need breast milk or formula through six months old from a nutritional standpoint, but looking at it from the perspective of it's okay to introduce some flavors and some textures earlier to just kind of support the experience more so than saying like, okay, we, we kind of need them to get a little more iron and we need them to get a little more vitamins at this point. 

Dr. Ana: Yes. 

Brianna Miluk: Than those things are providing. And so, kind of thinking about it from that lens I think is, is really helpful. And like you said, we're, we're talking about full term typically developing babies. In that realm. And I also like though that you mentioned how, like, there's so many like differences when we're looking at, like, you know, the signs of readiness and like, oh, you know, is this, is this baby ready? Is this baby ready?

What are we looking at? Because there really isn't like a direct consensus on readiness signs. Like we, we talk about like, okay, we'd kind of like to see these things from, I feel like more of like that safety perspective, but it's it's not like a set-in stone, like you don't have to see every single one and everything is a little bit different.

And I'm, I'm talking about just for reference, things like, you know, sitting up independently. Is that for one minute or is it for 30 seconds or is it with support? You know, is it, are they- the tongue protrusion reflex? Like, is it totally integrated or is it like still there? And it integrates when they start food, which is kind of more what I see. But just kind of those signs. 

Dr. Ana: Yeah, yeah. And definitely that that's a good point. And like you said, not all babies you know, they, like you'll notice some babies, for example, with walking, right. Some will walk starting nine months and some won't walk till 18 months, right. Some babies roll you know, right before they're four months old and some are just like, I'm fine.

I'm hanging around, you know, I don't need to roll so they might not roll till later. You know that doesn't necessarily mean that their muscles are lacking. You know, there's a little bit of motivation that is involved in some of these motor skills. And so, babies might not be independently sitting up all the way until seven months, you know, by themselves and some will sit up with support.

So, it's a combination of the, the baby, like you said, individually and then also the comfort level of the parents, you know, we, we talked through them a lot to make sure they're comfortable. And of course, if you notice these signs where they're choking. They're gagging. They're not fully ready.

You know, then they come back to us and they let us know so that we can work through it. We might want to wait a little bit longer. We might want to see a therapist. You know, if it becomes an issue. So, I just wanted to add for the vitamin bit that you brought in. So, The reason we need iron after six months is because usually maternal supplies of iron lasts until six months.

So typically, we recommend either an iron supplement or getting ready with baby foods and getting iron in the diet. Now formula has already vitamin D and iron. So, if your baby's formula fed, then that is covered. You don't have to worry. But yeah, the reason I start talking about it at four months is because they're not going to be eating all that food, you know, and you're a right off the bat. So, it's going to take about a month or two just to get used to eating. So yeah, I'm glad you got that. 

Brianna Miluk: I love that point. And I'm- thank you for clarifying the difference with the breast milk and the formula. Cause I definitely did not even realize that at six months old, there wasn't still more that was going to be needed.

So, I appreciate that. And then, yeah, thinking about readiness, you know, which during that four to six months range, when I'm thinking about a child, whether that's, you know, they're adjusted or chronological age, you know, if they're full term or preterm is when I'm thinking and guiding parents through pre feeding skills.

So, okay, we're going to work on sitting and playing in the high chair so that they're comfortable there. We're going to work on just mouthing teethers, or maybe we're going to like do some- the breast milk or formula from a spoon. Like it doesn't necessarily have to be that we're introducing something extremely novel at that time, but we just want them to get used to like what the experience will be so that when there is a little bit more pressure of like, all right, we need them to take a little bit of something- by that time, we're not like, Hey, learn the skill and accept something new from a sensory perspective, like all at once.

Dr. Ana: All at once. Yeah. The more time you give them and the earlier you start just across the board with feeding, with sleep, sleep and sleep training. We talk about that early. So, this is just a, it's, it's kind of a human trait. You know, it takes time to develop all this stuff. And, and just because there are a certain age doesn't mean that they're automatically going to get that skill right away. So yeah, that's really important. 

Brianna Miluk: Awesome. Thank you. Okay. So now moving into like, you know, we've started solids. They've been eating. A lot of times I hear about this with like kids, like they used to eat everything, but now they're picky. So, let's just talk about like, what is the actual, like, is picky eating a part of normal development?

Like what are, I feel like. What I typically see is like sort of a mismatch between like caregiver expectations and like developmentally what really is going on. 

Dr. Ana: Yeah, right. 

Brianna Miluk: So, I would love for you to kinda talk about that and then we'll kind of go into like when does picky eating crossover into a pediatric feeding disorder? And I can talk about it from my perspective, but kind of what are you thinking about? I need to refer to a feeding therapist. 

Dr. Ana: Right. 

Brianna Miluk: Like they do need additional support at this time. 

Dr. Ana: They need additional support. Yeah. Now that's a great question. I mean, I talk about picky eating all day long on social media, in the office you know, it's a big thing.

And honestly, I, I, me and Dr. Sami, both, we kind of consider it a milestone in itself because more often than not kids will have this kind of change when it comes to their relationship with food. And, you know, and everyone describes it in a different way. And all parents have different expectations.

You know, I grew up in a, an Indian family household where, you know, food was a big part of everything, you know? So, food is love for a lot of people. And if their children are not eating how they think they should be eating. It's a problem and it's a point of distress for the parents, you know, so I kind of always describe it as- Typically around sometimes as early as 18 months, but typically around two to three is when you have this kind of change where kids, you know, at between one to two, they would eat everything you would give them, you know, now they're running around, they're playing.

Their main objective in life is to explore and to play, you know, food is the last thing on their mind. And it's kind of something that they're using just quickly to get energy and move on to the next thing. You know, they're not sitting there having meals, you know, compliments to the chef. We always make this joke.

They're not sitting there eating three-hour meals. It is a necessity and they're going to do the minimal possible thing that they need to get the glucose and get the energy and move on to the next task, you know, so realize that kids and their relationship with food is totally different from our relationship with food and So putting that expectation on them is first, you know, one thing we have to look at.

Secondly a lot of kids will not get hungry at the times you want them to get hungry, right? They're going to get hungry at random times. It won't be breakfast, lunch, or dinner, right? And those are times that are created by our work schedule, and our hunger patterns and all of that and our work schedule, honestly.

So, kids operate totally different. So, we commonly see kids that will just graze, you know, a couple of grapes here, a couple of this here, some goldfish, some crackers, fruit snacks. And so, they are wanting to snack a lot. And what happens with snacking is that they inevitably get quick, easy snacks, right?

So, a lot of kids are grabbing the goldfish, the crackers, the fruit snacks. And while they're all okay, and you know, small amounts and small quantities, if you're only eating snacks, you're going to fill up and you're not going to want to eat the other food, right? So snacking is a big thing that leads to picky eating.

So, I there's a common saying that we say in pediatrics is you pick the foods. You let the kids decide when and how much so you don't want to force them to eat too much. If they say, I just want, you know, two strawberries and a cheese, you know, a little bit of cheese and a cracker. Fine. You know, you move on.

So, you pick the types of foods you want. Now, if your pantry is full of a lot of those processed foods that they can easily grab, they're going to fill up on those. If you have a lot of juice lying around, they're going to drink the juice. They're going to fill up their stomachs are still tiny. And they fill up easily.

And then you get to dinner time and you're like, they're not eating. Now I have to make a separate meal. I have to make mac and cheese and nuggets and pizza or whatever they like, because that's all they'll eat. While we forget that they have had foods and if you accumulate all the snacks that they've had, they've got in the same amount of calories you know, that they probably would have.

So. It's less about the volume or the amount, and it's about the quality of foods. Now, of course, busy parents, they're on the go. They're going to have snacks around, right? But I tell parents when, when kids come to you for a snack, you know, say, okay, you want apples and peanut butter, yogurt and berries, leftovers.

So, keep foods that are nutrient dense around so that they are more likely to snack on those instead of the other foods that makes them less picky. But it's, it's, it's a topic we can talk about for hours, you know, but number one, just to summarize, I would say it is a normal part of their development at that age.

There's going to be some days they eat nothing. And there's going to be some days they eat lots of things and that's okay. You can let them do that. You know, there's going to be days where they eat in school or daycare really well. They come home and they don't want to touch anything or vice versa. You know, I'll have teachers say, oh, they don't want to eat anything here.

And then a lot of parents will be like, oh, they eat great at school, but they don't eat at home, you know, and that's okay. And that's okay. As long as you're providing them with the foods that you're okay with them having and this typically around the age of, I would say two to five or six. If you look at the growth chart, you see that their height goes up really fast.

But their weight stays steady. So, they all lean out, right? And you see the BMI curve and you see the weight and height curve does this, does a little dip, but every child does that. So, their height goes much faster than their weight. And so, they look skinnier. And a lot of people panic because they're like, they're getting skinny.

They're not eating. And that becomes another point of stress. So, then they're throwing foods at them, right? And that is another misconception that I clarify. I say this is a natural part of their growth process. They're going to get taller here. They're going to lose that baby fat. That does not mean that something is wrong and they're not getting their nutrition that their need that they need. So, sorry, I get long winded when it comes to picky eating. 

Brianna Miluk: No I was going to say, I was going to say that was that was a point I was going to ask was that I feel like this is right around the time that there's so many developmental things going on, and so many changes that are significantly different from that first year of life or even those first few years of life, where, you know, they're like, they are not worried about the food at all.

Like you said, it's like, is this enough to get me through? Perfect. Cause I got to go because you know, I'm playing with my, like, that is way cooler than what's going on. And I think that's something that I reflect on a lot and find myself having to like slow down sometimes, even on my, my own practice and expectations is.

Feeding therapy requires a client to be, to be motivated, to be like, yeah, I'm, I want to engage in this. I'm ready to engage in it. And sometimes like we're problem solving through where that motivation isn't. And sometimes there isn't a motivation because they've been snacking all day. So, they don't have a hunger to motivate them to want to sit and eat and do whatever.

And so, you know, problem solving through a motivation is not there because they're like, I could not care less. About the foods I'm eating because I'm just doing the bare minimum so that I can go back outside and play in the hose. You know. 

Dr. Ana: Exactly. 

Brianna Miluk: It's like literally anything else but being there. And I think also at that age, I was actually talking to someone not long about this where when we think about mealtimes for us, for, you know, as adults, like it's a social endeavor.

Like we're there. We're talking, how was your day? What's going on? Kid is not, they don't want to sit at the table and say, how was your day? Did you have a good time at work? Like, you know, did anything happen? Because they learn through, like you said, through play. And so, if a mealtime. If they're not engaged in a mealtime as if it's play and getting some of that, it's not going to last very long.

And, you know, I totally understand. Not every meal can be just like this all for fun, you know. 

Dr. Ana: Yeah. 

Brianna Miluk: We're having a party and doing all kinds of things, but it's just something to reflect on to say like, okay, like, what else could I change in my routine to get them to the table for just a couple minutes and- 

Dr. Ana: Right. 

Brianna Miluk: See how it goes. And then you, your, what you said, which is consistent with like the division of responsibility, right? So, like you decide what is served and when it's served and they can decide which the, when it's served thing, I kinda sometimes have an issue with, but you know, you decide what served. Cause like you said, they have different schedules.

Like they're not always going to be hungry at the same time, but if they're asking for food, you know, you can say, Here's, here's what the options are, but whether they have it or not is totally up to them or how much they have is totally up to them. And I think this can be a hard thing to push through. 

Dr. Ana: Yeah. 

Brianna Miluk: But if you can stay consistent with that, I think it's really going to help decrease the likelihood of it staying around and hanging around. 

Dr. Ana: Right. 

Brianna Miluk: You know, you becoming a short order cook for everything and, and moving through all of that. 

Dr. Ana: Yes. Yeah. And I think we have to give ourselves grace too, because parents are often working multiple jobs. They're busy. I mean, this is not something that you're going to be perfect with overnight.

You know, there's going to be those days where you're just going to have to have those snacks and, you know, you don't have time to get, you know, the food, all the food cooked and ready. And, and, you know it's hard meal, meal planning enough for just for adults, right? But for a whole family, it's very difficult.

So, you know, give yourself grace don't feel like you have to do everything overnight. This is more about I think dealing with our anxieties like you brought up the expectations that we feel that kids need to be constantly eating a certain amount or a volume. They're actually intuitive eaters.

They are, you know, we call it picky. But we kind of ruin them a little bit later, right? They are listening to their bodies. If, if they're not hungry, there is nothing that will convince them to eat. Right? No emotion, no nothing, you know? And so, they are very intuitive from the beginning. And so, to help foster that, I think that's the biggest thing.

So, if your child, you know, does well, like a lot of children will do well in, in a social setting. Like, so in daycare, when there's other kids, there's teachers, there's playtime, and then there's designated food time. They will do well in that kind of discipline setting, you know, once they get home, they know, okay, all rules are gone.

So, I don't have to sit here, you know, for dinnertime or whatever. So, some of it is socially motivated. Some, some of it is motivated through the family. So, You know, when you can eat together, that always really does help, but it's not going to be realistic for the two-year-old that's going to be running around, right?

So, you're going to have to do the best you can with your resources. And I just tell parents, you know, one thing you can do is save money. Don't buy the juice. You really don't need it. It affects your teeth, causes cavities. It's not nutritionally beneficial unless you're making the juice smoothie at home and you're using all the fiber from the fruits.

The store-bought juices, even if they say no sugar added, they still have a lot of sugar, right? And they fill up kids and they make them more picky. So that's one easy thing you can get rid of. And then second, when you buy the snacks, just buy minimal amounts of the processed snacks and put a bunch of fruit and, and different variety of things, and you might not have to be prepping it, but just having a place where you can put a bunch of different fruits and veggies there for them to pick at you know, that also makes things easier for both you and the child. So, but it's not going to be easy and it's not going to be overnight. 

Brianna Miluk: Absolutely. No. And I think that's a good point. Like it's not something that's ever perfect. And I do want to like you know, make sure to, to clarify that like, this is, this is not even remotely similar to the approach we would be using for like a neurodivergent child or when talking about children with other diagnoses, you know, we're, we're really thinking about a picky eater at this point.

Not even a child with a pediatric feeding disorder, like the, the, those require very different approaches, but I think in order to support. How you're approaching or treatment and assessment and management of those, you have to be aware of what, what is typical and what we expect in those situations.

So did want to throw that in there, but I absolutely agree with, with, you know, what you're saying and all the variabilities there. And I also try to remind the parents I'm working with of like, I totally understand that like fresh produce can be expensive and if nobody eats it in time, it can feel wasteful.

But like canned fruits and vegetables, frozen fruits and vegetables. Like all of those are really, really good options as well. You know, it still holds onto the nutrients that you're trying to that you want. And so, you know, like understanding that there's, there's other options there that can be just as easy. It just kind of takes some finessing and change of routine a lot of the time.

Dr. Ana: Yeah, and definitely creativity. I saw, I saw a couple things on social media. It's like the toddler charcuterie board, you know, I thought that was really cute. Like, you know, they have some fruits and cheeses and meats and lots of little things that you can get creative and decorated, you know, pick at it.

And I saw someone else post about how they'll put their children's food in their plates, you know, and so it's like, it's mommy snack, you know, don't touch mommy snack. And then of course, definitely they want to get in there, right? 

Brianna Miluk: Yeah then they want it. 

Dr. Ana: Yeah. So, there you can use some reverse psychology there and there's, you can make it fun to, you know, one thing I tell people, because inevitably they'll say they won't eat their vegetables.

You know, what do I do? They won't have their vegetables. So sometimes I'll do like smoothies with fruits and veggies and you can freeze them, make popsicles. That's a more reasonable snack, you know, than having a bunch of processed things. I also do a lot of sauces. So, if parents are making pasta or spaghetti sauce, you know, they can puree a lot of vegetables and sauces are great for dipping and for pouring over things. And so, they're a great way to sneak some in, but it's a, it's a very slow thing. And sometimes they'll just, you know, lick the vegetable and they're like, I don't want it, you know? And so, these are some things that we, we go through, but normalizing that all food is food, you know, we're not trying to food shame, you know, and sometimes you just have to do the best that you can. But I did want to mention one thing before I forget. When it comes to the growth charts, a lot of parents get really nervous about where their child is on the weight curve. And we do use the weight curve to decide when we refer.

to, you know, people's therapists like you and a feeding specialist when they're falling off their, their curve, their particular curve. Yeah. So that's kind of the big things that we use if they're getting nutritional deficiencies. Of course, if they're, you know, if we're not able to keep up with their iron and their, their vitamin deficiencies are happening, if they're falling off the [growth curve] and then of course the neurodivergent children, the children with other chronic disabilities, we definitely want to outsource and get help for those kids.

But for those really slender, thin kids that are, you know, that are tall and skinny and scrawny I always spend some extra time with parents because I feel like they often feel that they have to throw calories at those kids, you know, and as you get older, I tell people, if you're at the top of the curve or you're at the bottom of the curve, we all got to eat healthy.

So just because one child might be on this part and one is this, they're not going to get different foods. We're trying to eat a variety of things for everyone. So, we see a lot of eating disorders happen this way. We see lots of kids that were super, super slender and on the bottom of the curve and then later in life they have high cholesterol, diabetes, you know, because there was that anxiety that they got to eat, you know, so definitely you have to look at their weight and height for, for them, for them individually and not in comparison to other children.

Brianna Miluk: Yeah, that's so helpful, and I'm glad you brought it up, too, because I think even with picky eaters, you know, we want to offer the opportunities for them to explore, but that's when they feel safe, when they feel ready, and making sure that we're very careful to not, you know, assign moral values to certain foods over others, because in the short term, it can feel really hard, and it could feel like my child's never going to eat a vegetable in their whole life but by doing that its just, just the opportunities and the exposures and making sure mealtimes focus more on just like connection with the family and those, that psychosocial component, like more likely to have a child that likes vegetables long-term than the child who feels that they were forced for, you know, a really, really long time. 

Dr. Ana: Right, right.

Brianna Miluk: Yeah. I'm glad you brought that up. All right. So, I'm going to skip into the rapid-fire questions now. And for those of you that might be listening for the first time, I do not prep guests on what these questions are. Um, and I change them up every time. 

Dr. Ana: I have no clue. 

Brianna Miluk: So, you can't even guess what it's going to be. But I've got three for you. I've got three. 

Dr. Ana: Okay. Okay. I think I can manage. 

Brianna Miluk: Okay. Your first one is your favorite book currently. Or you can share your favorite children's book. Either one. 

Dr. Ana: Oh my god. I'm not going to be very rapid about this.

Brianna Miluk: It's okay. It's okay. 

Dr. Ana: There's so many that I love. It's really, really hard. Oh my gosh. Favorite book or children's book? There's so many to choose from. So, there is this one book that I really love and I think it'll be perfect for this particular episode. It just comes to my mind because we were just talking about picky eating. But there is this book that we recently read by Dr. Yami, and she talks about picky eating as like superpower for kids.

And I'll send you the exact name, but it's already slipping my mind, but it's about the, the intuitive picky eater. And so, it, we recently read it and we actually had her on our podcast as well to talk about it, but that's the one that just comes to my mind right now. 

Brianna Miluk: Awesome. Yeah. Yeah. Put a link in our Google Doc and so I'll be sure to reference people to it. Okay, next thing because I don't know if you're more of a TV watcher, music listener, or both, but what are you currently listening to or watching? 

Dr. Ana: Oh, oh my gosh. Okay. So, I do like I like the the, the spy dramas, you know so I'm watching, I'm watching this this one Apple, it's like an Apple TV show. It's with Idris Elba. It's called hijack. I'm just stuck on that right now. And another really good show that I was on was called Bear. Have you heard of this? 

Brianna Miluk: No. 

Dr. Ana: No? It's it's it's, it's got like amazing reviews. It's about this Michelin star chef. So yeah, I got lots of TV shows. 

Brianna Miluk: Oh, interesting. That sounds like something that my husband would like. We might, we might have to look into that one. Okay. Last question. Which of the social media platforms that you're on? So, I'm thinking Instagram, YouTube, TikTok, which one's your favorite? 

Dr. Ana: Okay, I think my favorite is probably Instagram. TikTok is probably our largest platform where we have the most people on there, but I feel like sometimes TikTok can be a little bit difficult for our mental health because we get so much thrown at us. 

Brianna Miluk: Well, we've talked about this. I still am like, yeah, yeah, I'm coming. I just, I don't know if I can. 

Dr. Ana: It definitely, it definitely burns us out. I mean, there is a lot of opportunity to reach a certain, you know, demographic of parents on TikTok, but I feel like we get the most genuine kind of conversations from parents on our Instagram.

You know, just honest questions and feedback and you know, back and forth when we do our question and answer series on there. I feel like we get the most interaction and people are just, you know, that they're generally want to be there, you know? So, I think they all have a little bit of their woes, but I Pick Instagram. 

Brianna Miluk: Prefer more of the like community esque from Instagram than just the large outreach of TikTok.

Dr. Ana: Yeah. 

Brianna Miluk: Yeah, I get that. I get that. That's what I enjoy about Instagram as well. Though it's got its things that give me issues. Probably daily, specifically when I'm editing a video in there and the text disappears. It takes a hundred years to upload. I'm like, I feel like almost every other day I'm like, I'm quitting it! I'm done! 

Dr. Ana: Same here. Same here. 

Brianna Miluk: But okay. Well, thank you so much, Dr. Ana. You're amazing. This was, this was so, so enlightening and so helpful. And I think it's going to be an episode that hopefully will be very helpful. Not just to caregivers that are listening, but also to clinicians, because it's so important for us to be aware of these ranges of normal, these ranges of development that happen and how we need to be just really careful not to over pathologize and understand that like, there's a lot of stuff that goes on in childhood and infancy that's actually, totally normal. So. 

Dr. Ana: Yeah, well. 

Brianna Miluk: Before we go. 

Dr. Ana: Thank you so much. 

Brianna Miluk: Yes. Where can people find you? Where can they find you? 

Dr. Ana: Yes, so our handle is thePediPals. So, P E D I like pediatric pals. And you can, we have a website called www.thePediPals our Instagram. Tick tock. All our social media handles are the same. We're also on YouTube. We have a podcast, it's called The Well Child, and you can find it on all of the platforms that have podcasts available. So yeah, where you find us, we're there, we're somewhere. 

Brianna Miluk: Awesome. And I will be sure to link those in the show notes so that hopefully everybody can, can get quick access to it, but thank you again so much. This was awesome. And. I'm sure we'll be in touch. 

Dr. Ana: Yes. Thank you so much. It was, it was such a pleasure. It felt like we were just having a fun conversation, just the girls, right? 

Brianna Miluk: Yes! 

Dr. Ana: So that's why we, that's why we love you. So, thank you so much for all your support and for having us on and for everything you're doing to bite the misinformation and get good information out there.

Brianna Miluk: Thank you, it's, it's much easier when, you know, there's people like you and Dr. Sami who are, you know, helping lead the way too. So. 

Dr. Ana: Thank you.

Brianna Miluk: Thanks for tuning in to The Feeding Pod this week. If you enjoyed today's episode, please don't hesitate to share this podcast with your friends and colleagues and leave us a five-star review wherever you're listening from.

If you're interested in learning more about pediatric feeding and swallowing, be sure to follow Bri, me, on Instagram @PediatricFeedingSLP, or check out my website where you can get access to more courses and information, www.pediatricfeedingslp.com. Again, thanks for being here and listening to my ramblings, and I hope you'll keep listening. Until next time, cheers.

• PediPals: https://www.thepedipals.com/
• Dr. Ana’s IG: Instragram
• Dr. Ana’s TikTok: Tiktok
• Dr. Ana’s Podcast: YouTube