Episode Transcript
[00:00:00] Speaker A: If you came to last year's conference, you already know how powerful it was. But this year, we didn't just build on it, we transformed it. We expanded to 34 hours of education. Yes, 34.
For the first time ever, we're centering ethics and Nutrition with Keynote Dr. John Liesecker and the Shun and Goldwater Summit for Change micro keynote. Alex Turnbull, the family nutritionist. Last year we focused on multidisciplinary teams. This year we went even further. More dietitians, more nurse practitioners, more BCBAs, more NICU voices, more behavior based sessions with one clear message fee. And development disorders and differences require everyone.
And yes, our lived experience sessions are back. They're powerful, emotional and unforgettable.
If you're ready for broader perspectives and deeper conversations, this is your year. Register now@feeding matters.org conference and we'll see you there.
[00:01:02] Speaker B: Presented by Feed Matters with host Jacqueline Peterson and Dr. Haley Estrom.
Feeding DOES Matter.
Hey, everyone. Welcome to Feeding Does Matter. I'm Jacqueline Peterson, CEO of Feeding Matters. Today we are continuing with our 20th anniversary interview series.
And so it's my great pleasure to talk to Dr. Matters, Matt Abrams today. Dr. Abrams, thank you for joining us. So excited to kind of take a walk down memory lane in these interviews. So I'm grateful for you to join us today.
[00:01:42] Speaker C: Well, thanks for having me today.
[00:01:43] Speaker B: Yeah. So kind of before we get into your history with Feeding Matters, love to just introduce you to our audience, just maybe share a little bit about yourself, how you got into your career, all of those things.
[00:01:55] Speaker C: Sure.
So I've been, I'm originally from Milwaukee, Wisconsin.
I've been in Phoenix now for over, let's say, be 22 years and did my undergrad at University of Wisconsin, Madison, go Badgers. Did my medical school, Tel Aviv University in Israel, and my internship, residency, chief residency and neonatology perinatology fellowship at Riley Children's Hospital as part of Indiana University in Indianapolis, Indiana.
And, you know, it's, it's sometimes you just stumble across things in life. You know, if you would ask me before medical school, I would have given the generic ER doctor, cardiologist or E or, you know, surgeon. I had volunteered in ers and did some research in college. But, you know, honest, I didn't really know exactly what area I wanted to practice. And then, you know, typically in the second half of your second year and third year, you start doing more clinical stuff. And so when I was doing my clinical rotations, in fact, I remember a week before my pediatric rotation, I was like, I do not Want to do pediatrics. I don't want to deal with kids with running noses and, oh, you were
[00:03:11] Speaker B: out on pediatric, et cetera.
[00:03:13] Speaker C: Well, it was a week before my pediatric clerkship and I did not. I was like, oh, I don't want to do pediatrics. I had no interest in pediatrics at all.
[00:03:21] Speaker B: These kids can't stand them.
[00:03:24] Speaker A: Yeah, yeah.
[00:03:25] Speaker C: Until then I had my own. So. But. And then a week later I was like, I think this is what I want to do. Like, I had no idea. Honestly.
I had had a rotation with a lot of interesting diseases and other stuff that a lot of times in the first year of medical school, year and a half medical school, everything's adult based. There's nothing that's talking about pediatric stuff, pediatric diseases, genetic diseases. So you just think in your head, coughs and runny noses, all the.
And so I had some very intriguing cases that got me interested. And so about a week later I was like, I think I want to do pediatrics.
And then the last week of the rotation we spent in a newborn intensive care unit. Now, I mean, if you have anyone before medical school, what they want to do, no one's going to say neonatologist. Like, it's just not something you, you know, unless you had a family member, something else. Not something you really think of. And so I spent a week in the nicu and I was like, uh, this is what I want to do. I was also, that week also got me really interested in congenital heart disease. So I was kind of trying to decide between neonatology and pediatric cardiology. But pretty much after that rotation I was like, that week I was like that, that this is what I want to do.
And so when I got to internship residency, I.
Back in the day when people had more intensive care training and stuff, I, at the beginning of my first and second year did neonatology and cardiology to try to see which one I want to do. And then I realized I don't like kids that talk.
[00:04:59] Speaker B: And so it's younger ones.
[00:05:01] Speaker C: Five kids of my own later, and I still don't. So.
But so, yeah, so that got me interested. And neonatology was a way to kind of satisfy that interest in congenital heart disease as well as all the other things that we deal with in neonatology.
[00:05:17] Speaker B: So, yes, I mean, such a complex and very challenging area. And I know that so many families of our community start out in the NICU and are just always say amazing things about their neonatologists. So I know that it's truly an important field and especially has such a crossover in feeding. And so kind of before you, I mean, as you like honed in on this as a specialty, had you heard about feeding difficulties, kind of quote unquote, feeding difficulties or what was kind of your exposure to feeding problems?
[00:05:57] Speaker C: You know, so there's a couple things. One, medical school and residency has unfortunately little emphasis on feeding and nutrition.
And then you get into, when you get into residency though, I mean really through a combination of gastroenterology rotations and then NICU rotations, then you start really dealing with, you know, nutrition and feeding things. And I've always had a interest myself just with exercise and weight training and things like that, with nutrition. So.
But there's a lot of, you know, healthcare providers that aren't really interested in it. It's kind of a side thing, but I was very interested. And so in fact I remember my, the director of neonatology who's now retired with his wife in Tucson. His wife was one of the, I can't remember, she was speech, but yeah, speech and feeding. So I learned, got exposed to a lot of that stuff in internship, residency and fellowship.
And so, you know, one of the things that we, you know, that tends to get people interested in newborn intensive care ICU is you know, taking care of complicated multi system organ issues and things like that.
But you know, really the majority of the NICU stay for most kids and again, we take all sorts of things is really, you know, nutrition is the only thing you do 24, 7. It's the only thing you do 24, 7 in all areas of medicine, honestly. So yeah, everything else, you may have respiratory issues, you may have other things, but 24, 7, you need to address their nutritional state, right?
[00:07:42] Speaker B: Yes.
[00:07:43] Speaker C: And I always make the comment that malnutrition and starvation is not a treatment for anything in any area of medicine. No, it is not like, oh, let's starve them and give them poor nutrition.
[00:07:54] Speaker A: Right.
[00:07:54] Speaker C: No one ever says that. And yet in neonatology for many, many years, nutrition kind of fell a little bit by the wayside.
And I would say over the last 20, 25 years, which seems like a long time for people, but if you've been practicing it, you know, you remember the days when kids were admitted to the newborn intensive care unit and they didn't get good IV nutrition and things like that, they would leave the NICU really growth restricted from after birth. And then one of the more complicated things is that transition to oral feedings for babies that were all tube fed. And so, you know, for example About a third of the brain maturation happens the last five weeks of pregnancy, and that'll still happen after birth, but the more premature you are, the later that can happen. But ultimately, it's a complexity of the brain and development that controls the complexity of feeding. Suck, swallow, breathe is the most complicated thing we do. That takes a coordination of a lot of different muscles, 26, 27 muscles that have to work in sync so that you can do all those things without aspirating, without coughing, et cetera, et cetera.
And, you know, it's a difficult thing for parents because, you know, they either one, maybe the child wasn't that premature, that sick, or they've recovered from all that. Now they're just kind of feeding, growing. They see their kid starting to get big and healthy, and they want to go home. They're sick of the NICU. They have NICUatis, you know, where before they were worried, you know, whether they were going to come off the ventilator and whether they had an infection. Now they're worried about when their last poop was. And I joke to parents about that, but that really becomes a focus. You move into kind of more normal kid, baby stuff. But. But it gets very frustrating because that kind of latency phase of the NICU is really frustrating. And as part of that is the big part of that is feeding stuff, right?
So that navigating that pathway for families and for healthcare providers of those kids developing that you can't make go faster, you're trying to kind of push and pull. You want to help them long. You don't want to push them too much because then they may get aversion or they could aspirate, things like that.
And, you know, and everyone has different ways of saying things. And so families get frustrated. They think people tell them different things. They like this nurse feeding, not that nurse feeding. And so that three month in the hospital stay, you know, six weeks of it, for example, really was sitting there watching the grass grow, which can be hard for the family. When I say that, I mean, you know, that progression to oral feedings. And there are kids that have relatively uncomplicated initial courses that go on to have feeding issues that, you know, isn't clear why.
And. And you have kids that sometimes that were more sick initially, that later on progress, you know, without a problem.
And there's other kids that take a long time. Like we have kids that are 22, 23, 24 weeks. They're not ready to go home sometimes till they're 42, 44 weeks or even later.
And, and then of course, you're dealing with family dynamics as well. You know, it's. We deal with all sorts of different social situations and family dynamics that can affect managing those things in the nicu. So I think, you know, feeding is just one of those things that it's easy to kind of put to the side and have somebody else deal with it, but it's really front and center for families as the kids mature more in the newborn icu.
[00:11:23] Speaker B: Yeah. And as you're kind of preparing a family to go home, I know that that is such a critical piece for lots of different things. I mean, feeding being one of the top.
How do you support and prepare a family to think about that going home, either to take home the practices that you're implementing and you want them to take home and, or be aware of anything that may be coming down the path that they need to be aware of. How do you kind of support a family in that transition?
[00:11:53] Speaker C: Yeah, so it's a, it can be complicated because, you know, when we're giving our stamp for babies to go home, it's not a lifelong guarantee. Right.
You have kids that either seemingly are nippling great, there's no obvious anything. Sometimes you have little things, but that doesn't make them have to stay in the hospital or do more tests. Some of those kids, though, that seemed perfect or even mildly can go on to have feeding issues down the road. And it's not because somebody missed something. It's just that they're, you know, if they're not having any events and they're in room air and they're feeding and everything, there's only so much sometimes you need to see how things evolve over time. Right. And then of course, we have more complicated kids that either one have significant feeding issues because they were very premature, they have lung disease, they may have underlying genetic or neurologic issues that may need to go home with either a feeding tube support or gastrostomy tube in the stomach wall.
And then of course, you're just dealing with all the different family dynamics. Every family is different, how they're navigating those things. And you can have complex complicating factors like reflux or other things.
And so it's really important to have the family there as much as possible to work on feedings, get the education from the nursing staff and feeding therapists as well as the physicians, and then make sure that they have follow up.
Because again, there are kids that, you know, it's not that somebody missed something, it's Just that at the time they left the nicu, they seemingly were doing well enough to go home.
[00:13:29] Speaker B: Right.
[00:13:29] Speaker C: You can't watch them for weeks and a month later. Oh well, they're not, you know, they should have done this in the nicu. Well, when your baby left the nicu, they were doing great. You know, some things just evolve over time, especially when, you know, in babies they don't rely on higher brain function for more basic things like feeding and, and breathing stuff. And as they mature more, they start to incorporate more of their higher level of brain function.
And, and sometimes even if you have an MRI or other thing that looks normal doesn't mean it always works normal.
And again, they can have. Go ahead, sorry.
[00:14:08] Speaker B: Oh no, that's so true. And when we've, what we've tried to raise awareness of, this too is just the skill development that occurs that it's like those initial early infancy pieces. But then even as the months are going on, there is still like that skill piece that's being developed in partnership with the brain piece of it all too.
And that's what we really try to raise awareness of too, that that's like the development that could go get delayed at any point.
[00:14:36] Speaker C: Yeah, I think it's important that they are one in close contact with their pediatrician, that if things seem to be going off where they were, they can get referred to feeding therapy and get evaluated further. For the kids that are more complicated, making sure they have follow up with feeding therapists.
And so it's, you know, just like in any other area of medicine, leaving the hospital is a step towards your care. You may have had a heart attack and now you're fine. Well, you have to follow up with a cardiologist and who's to say that you still may not have some problems or whatever it is in hospital care is just a piece of those things. And of course, having a baby in the NICU is like nothing else in life. Most people go in the hospital because they're sick, but for preterm babies, that's not the case. They're there because they're premature and they may not be sick. They just need to mature more.
And so that is just a step in their lifelong care. And there's kids that can do well for the first couple months and then have problems. There's kids that can do fine with liquids and then have problems with solids as you know, or even longer term things. And so the follow up with the pediatrician and having some guidance that they follow up with feeding therapy, if there are Any concerns is really, really important. You don't want to. It's hard, too, because we don't take care of them as outpatient. Right.
You know, there's a lot of areas
[00:15:59] Speaker B: of medicine breakdown happens a lot of times, I think.
[00:16:02] Speaker C: Yeah, yeah. And. And the pediatricians are, you know, need guidance as well in terms of managing these things as an outpatient, because just like in hospital, there's going to be different pediatricians that have an interest in feeding, nutrition, and some that may be less interested and then navig where to drive these families for more comprehensive care. So it's not just like piecemeal, because, yeah, you can send a gi, but GI is going to see if you have reflux and esophageal, you know.
[00:16:34] Speaker B: Yeah. No one's looking at the esophageal.
[00:16:37] Speaker C: Yeah. And the cardiologist is going to say, well, let's do this. And again, they're all doing the thing, but you need a comprehensive that says that can put pieces together, that says, you know, something about what you're telling me is this. And yes, cardiology wants this and GI wants this from respiratory wants that. But we need to put all these things together, not just do what everyone says.
And again, it depends on the baby and what kind of things they have going on, but they need guidance. And one of the things the moms back in the day when we first started chatting, was really that there seemed to be quite wide variation nationwide in terms of how to approach feeding issues, not just in four manicu babies, but in. In any child that, whether it develops in the first couple months or later, seemed to be kind of a very. They were hearing very different things from
[00:17:31] Speaker B: people as an outpatient and kind of getting into that. How did you, How. How did you get involved with feeding matters? I was around, like, 2014 or so. I want to say maybe.
[00:17:45] Speaker C: Yeah, it's probably about right. So I was. I was.
So they. So we were having a NICU reunion for the hospital that I was at, and they had a table out there and we started talking beforehand and they kind of wanted to bounce some ideas off me and I. I can't remember. I didn't take care of any of their kids, although I think the triplets were at a hospital I had previously worked at but were taken care of by a different group and stuff. So.
And it may have been.
It may have been after I wasn't there for a bit.
And so we just kind of started talking and I don't know if somebody kind of drove them to me. Because they knew that I had an interest in feeding and nutrition.
But, you know, as I'm very openly opinionated, I was more than happy to offer some ideas and opinions on things. And so I kind of, you know, became a member of the board, the sounding board, to kind of help rally people and navigate, you know, things bounce ideas off. You know, I don't do outpatient. And so a lot of this is, you know, there's truly things in the nicu, but a lot of this is about, you know, outpatient and as the kids develop. And so, you know, it's important to get other healthcare professionals and experts that deal with things as an outpatient and after the NICU involved, because that's really the majority of. Of a lot of the things that people are running into. You know, again, the NICU is kind of relatively. And a lot of kids are that have feeding problems weren't even in the nicu, so.
[00:19:25] Speaker B: Yeah, but it's so helpful to. I mean, that's why. I think that's probably why they sought you out, because it was really important for us to make sure that we were thinking about, what do we need to do to support the nicu, what do we need to do to support the transition? And what do we need to do to support all the. Those kids that maybe weren't in the NICU or that are still having challenges in outpatient and as they're growing.
And it. It was really trying to gather many different perspectives to, like you said, bounce around different ideas. And you all gave such great feedback and really thought strategically with us in terms of what we needed to do.
Is there any favorite, like, memory you have from back then or any project that you liked working on? I wanted to say, because I was, like, looking at your records and I want to say you kind of helped with the conference. You helped a lot with, like, the brainstorming around PFD and kind of the naming for that. But anything that sticks out to. You
[00:20:21] Speaker C: can't remember what I did yesterday. Sometimes
[00:20:25] Speaker B: I'm like, remember 10 years ago, this one conversation you had?
[00:20:29] Speaker C: Yeah, yeah. All I remember is driving my kids back and forth all over town to their sports yesterday and today.
Yeah. You know, I think that that initial gathering of things and talking with other healthcare professionals was really rewarding because being in the nicu, you're kind of just in the nicu, don't really. Yeah, you're on your own little island.
Yeah, you're on your little island. You don't really have direct contact, you know, with a lot of outside healthcare providers. And it was interesting and rewarding for me to hear.
You know, they kind of rounded up some of the feeding specialists around the country that they respected and had clinics. And even with them, you know, sometimes. Sometimes people can do things differently, but if they do what they do consistently, they can get similar outcomes. And so.
But it was. It was really interesting to hear healthcare providers in the areas of nutrition and feeding and some of their perspectives and some of their skill sets.
And then kind of, you know, how we could bring some of that back to the nicu, but and also understanding how we could help facilitate when babies go home, some of the things that they may need.
And that can be challenging. I mean, every hospital is different. You know, you figure NICU has been around for many, many years. We should be always moving forward. We're not. It's kind of like you're always going back and forth because you have new nurses, new staff, new. This hospital has a case coordinator that takes care of everything. This hospital doesn't.
And, you know, things that would seemingly be common sense to people sometimes aren't the most easy things to implement.
But in any case, yeah, it was, you know, those early conferences and honestly, the.
I still vividly remember sitting and talking with them outside at their little table in there. I think they were wearing yellow shirts or pink shirts, all three of them, and just talking about them.
[00:22:26] Speaker B: Oh, yeah, probably like the popsicle colors.
[00:22:29] Speaker C: Yeah. So it's one of the most vivid, actually. I remember that. Sit and talk to them. I remember specifically where the table was and everything. And so that, that. I think just the fact that they wanted my input and me involved and, and having an opportunity to talk to people about feeding, nutrition was really, really engaging for me because, again, you know, you get kind of a hit or miss in, in medicine, whether people have an interest or training or even, you know, want to dedicate time to talking and listening about. I mean, Nutri. Nutrition and feeding obviously go together, but sometimes they have to be separated, you know, and I, you know, that's. That's a challenge is, you know, you have to get the nutrition. For most of us, that's, you know, through feeding. But sometimes you have to separate those two things to make sure the child gets the nutrition from the component of activity.
[00:23:28] Speaker B: They have to prioritize for what they need.
Well, so because you have that interest in feeding and nutrition, I do think that that made you especially, like, helpful on the medical professional council, but in kind of even thinking about how to support either your colleagues or other NICUs, do you see do I know you said that you've seen more of a focus on nutrition and feeding in nutrition over the last 20 years.
What do you. Do you see it changing? Do you see more people interested in it because it was a special interest of yours and that's why you became more of an expert in it within the nicu. But I know that that's not always the case for your colleagues or others that are in the nicu.
[00:24:09] Speaker C: Yeah, I don't think it's changed a ton other than still some work to do.
Yeah, I mean, unfortunately you don't necessarily inherently change human behavior and interests. You know, I would say there's still a core of kind of people that out of majority that have an interest in feeding nutrition. I think the things that have changed is hopefully there's better education and training for feeding therapists and or we call speech therapists.
One getting involved with families very early. Preparing families for the transition to oral feeds.
There are things like many NICUs do where you start with the mom's going to breastfeed as milk. We'll do a couple days of breastfeeding before we introduce a bottle.
You know, these preterm babies need extra nutrition fortification, but they can, you know, usually do at least some breastfeeding. But you got to have a mom who's making milk and mom that's available.
So I think early on. And every NICU is different, you know, like some NICU's, you know, speech. Again I say speech but not to confuse people. That's feeding therapy. Get involved with every baby less than 30 weeks. Sometimes it's every baby less than 34 weeks. Some nic, it's every baby and doing some education.
[00:25:28] Speaker B: And I was even going to say that it depends on where you're at because there, because there is such a lack of education for feeding therapists.
It's kind of a lot of them had to self educate and all the requirements are different in different states.
And so you kind of have some places where more are reliant on speech and some are more reliant on OT depending on what their skill level is. And it's kind of in their both scopes of practice. It just seems to be very NICU state region specific.
[00:25:58] Speaker C: But yeah, and their training and skill sets can vary quite a bit. You know, just because you did a speech therapy program.
[00:26:06] Speaker B: Yes.
[00:26:08] Speaker C: Taking care of babies and kids transition to oral feeds is different than anything else. And you have to have a little wiggle room and a little bit of understanding that kids have ebb and flows it's not like an outpatient 4 month old or 8 month old that you know is going to be the same yesterday as they are tomorrow in the NICU. Yesterday and tomorrow can be nippling 50% to all of a sudden the switch turns on, you're nippling 100%.
[00:26:34] Speaker B: Yeah.
[00:26:35] Speaker C: And you have to be able to work with things and it, it's, you know, ideally of everyone that works as a team, you know, works together and that you have feeding therapists that respect that nurses are feeding kids eight plus times a day, multiple kids.
You have nurses that understand the feeding therapist training. But it does just as much as it varies on an outpatient. It varies in the nature just like
[00:27:06] Speaker B: collaboration and outpatient too. You kind of have to have that mutual respect, that openness to collaborate. Yeah.
[00:27:12] Speaker C: And it's, it's tough because you get, you get a mix, you get some feeding therapists, speech therapists in the NICU that are fantastic and work with everyone and have a little bit of that, you know, ebb and flow with how they deal with kids and other people that are like very not comfortable with babies at their managing babies. And so it's an interesting kind of dynamics to navigate in every different nicu. Yeah.
[00:27:41] Speaker B: You really have to be open to being on a team that like I interviewed someone, I interviewed Mary Beth, who's the dietitian and in on the medical professional council with you and she was like, you, you have, if you're going to be in feeding like you need to be able to work with other people. Like you're not going to be like a single person. Like, you just have to know that that's part of your world.
[00:28:01] Speaker C: Yeah. And some people aren't built for that. Like they should have their own outpatient, you know, and it's, it's difficult because you can do all the education you want and use all the fancy words and all the this and then that, but a baby maturing in the nicuhas feeding is different and not, they don't do those things. But there is, you know, doing one assessment twice a week on a kid for 10 minutes, that baby at that feeding maybe didn't want to feed well or vice versa. And so it's challenged sometimes navigating that because the parents then sense all of that. So the more cohesive you can be in kind of one team, the better. But it takes hiring the right people that can work together. And I would just say it's as much of a challenge in the newborn intensive care unit as it is probably as outpatient.
But you have limited options in the newborn intensive care unit because usually there's only one or two, maybe three speech therapists that work or cover a nicu. And they can all be very different too, you know, personalities, et cetera, et cetera.
[00:29:09] Speaker B: And what you're really pointing out is what I'm hoping that the next 20 years has for us at Feeding Matters, which is better support for that educational specialty pathway to be able to not only be a speech or an OT and specialize in feeding, but then also understand the specialty in the NICU or the specialty in all of the different areas. Because we know that there's just so much need in education. And that's why I think you do see it vary so frequently in addition to just general variability between personalities and individuals in general.
But yeah, hopefully we can make a little bit of progress in that, in that direction too.
But I think that's also why PFD as a diagnosis in the framework of PFD was helpful. Because if we really tried to make it in a way that you could kind of talk across discipline, that it was like centered on collaboration. And that was, I think, the hope that you all had behind even getting the PFD diagnosis and the PFD framework in general.
[00:30:09] Speaker C: Yeah, I think, you know what my vision, you know, participating was that there'd be some sort of logical, common sense approach based on symptoms to how you work up and evaluate a child, baby, whatever, that has feeding issues. And again, not talking to the nicu, but kind of outside.
But whereas, you know, it's like, oh, they're feeling, we're going to send them to GI or he turned blue, so we're going to send them to cardiology or things like that and. Or we're going to thicken. You know, there's just. There seemed to be like a lack in. And what I hope, you know, that there'd be some sort of almost algorithm won't necessarily work for everyone, but the idea being that you kind of have a little bit more of a standardized kind of approach, at least that you could then teach people and say, okay, somebody comes in you, their child, you know, isn't gaining weight, seems to have some issues with feedings. What are things that you need to think of? So like, for example, like in the newborn icu, it's not really feeding, but you know, there's kids that have bad lung disease that are being tube fed into their stomach.
Well, those kids may be refluxing, aspirating, and no one knows that they have no Other symptoms other than you can't wean their ventilator or other things. Well, if people don't think about that, they're never going to think about, well, what if we for a week or two, instead of feeding their stomach, skip the stomach, go past it and go into their, their small bowel, which is the initial parts called the duodenum. And see, since they don't really have stuff to reflux as much because again, these kids are have immature sex while a breathe. Well, if they have a breathing tube and they're still immature and they're refluxing, where's it going?
Well, for most kids, hopefully down. But if they're micro aspirating little bits, their lungs aren't going to get better, right? They're not going to suddenly aspirate and get really sick and et cetera. It's more of this kind of chronic like adding a little drop. And if you don't think of that, you're never going to think of doing something different. And that kid's lungs may not actually kind of get better. Or you have a child, for example, that's a couple months old and has failure to thrive and they're kind of breathing a little fast. Well, does that kid have a misdiagnosis or has that kid been refluxing and aspirating and has been micro aspirating now for a while and they're not growing because they're micro aspirating or they have some underlying doses diagnosis that you know, wasn't picked up on a newborn screen. So I think it's really important that people, you have to listen, you have to listen to someone's story because sometimes there'll be something in the parent's story or what they're telling you that drives you down a certain pathway or makes you think of something and you know, it's. Somebody may come in for one thing, but something in a story or history may trigger something in your head that. But we need to evaluate this for that. So you can't make it just blanket for every child, right? You can't. There's kids with genetic neurologic former preemies. They're not all the same. And what's going to work for one may not work for the other.
And so you can't make it 100% just a. This is our only algorithm. But you have to be able to help people navigate it because I think in the past, you know, it's pretty haphazard depending who you got sent to
[00:33:16] Speaker B: and, and really trying to get to the whys behind things and continuously asking questions.
I think we've jumped into things quickly without the kind of. The full framework of things.
[00:33:28] Speaker C: Yeah, I mean, unfortunately, sometimes you need genetic studies, sometimes you need an MRI of the brain.
Sometimes you don't always find the cause because those are all just kind of pictures of things. They don't necessarily always tell you function.
But then you have to have ways beyond that to, okay, how do you navigate? And again, I don't deal with this personally, but you know, how do you then approach that?
Not just the diagnosis, but then the evaluation and management of kids with feeding issues.
And my sense was from speaking with them, they were getting quite variable input from different feeding clinics and therapists throughout the country.
Why? I mean, people saying completely opposite things.
[00:34:10] Speaker B: Oh yeah.
[00:34:11] Speaker C: And so clearly a need for better education. And not that everyone knows right or wrong, but I think one of the things that is pretty well supported in medicine is if you do things at least consistently, you can then reflect on what things work or don't work. Everyone's just doing things differently.
It can be.
It's hard to reflect on it and learn from it. And then of course, it'd be tremendously frustrating for families too.
[00:34:38] Speaker B: Yeah, no, I think that's so true. I think that that is exactly what I would envision for our future too in the field of feeding, which is if we can do things consistently enough to be able to better practice by reflection and by learning and growing like that would be huge. Because it does. It is so haphazard sometimes and inconsistent or not, everybody on the same page that that makes that reflection learning piece really challenging. Well, Matt, thank you so much for your time today and kind of ref with me on feeding matters history.
Is there anything else that you remember, Anything that you didn't get to share that I didn't ask about?
[00:35:21] Speaker C: I'm always so, so short with my words.
No, you know, again, I, I think it's, you know, it's a long process. Right. It's not quick changes.
And I hope the energy stays with feeding matters. And it's a long term endeavor and is always a resource. You know, there's nothing like it in the world.
And I think that's really tremendous to have that resource here in Phoenix.
And I know some of the original moms have kind of moved on. You know, their kids have grown up and everything and they've still had to deal with things over the years. It's not like they suddenly were. The kids were suddenly fixed.
But you, you know, you get to different stages of their lives and everything. And so, you know, and I'm sure there's a lot of parents and that I always give information. So for like kids that are leaving the NICU that have any issues, I give it always gave families resource because that's the other thing is families, you know, you, you can't imagine the thought of nutrition and feeding being separate. Like, you just don't process that as an adult if you're otherwise healthy. Right, right. Like, oh, I'm, I'm hungry and because I need to get nutrition. But I also, you know, the joy of eating pizza or whatever it else it is.
[00:36:45] Speaker B: Yeah.
[00:36:46] Speaker C: No matter how old your kids are, you're still always, it doesn't matter what you. I, I went for lunch with my daughter yesterday and you still, as a parent, you always have some sort of reward when they eat. It doesn't matter how old they are, you know, whether they're babies or bigger adults, when they enjoy a meal. There's nothing more enjoyable as a parent to see your child enjoy a meal. So think about the opposite. How disheartening it is for a parent to see their child not enjoy a meal.
That would be, you know, really difficult. And even when you have kids that are just like, you know, picky eaters and stuff, it's frustrating. You know, imagine now picky eaters and just picky eater. But really something significant.
And now you have the stress of my kid doesn't either won't eat or won't eat. Right. How am I going to get the nutrition in them? You know, I can fake a Kodiak waffle with some Nutella on it to get my kid to get some protein and stuff. And you know, when he's a teenager, he'll be fine.
But there are kids that you can't do that and how disheartening that would be as a parent to not be able to do that. So effect on family dynamics and relationships and all that kind of stuff. It's a significant issue. So, you know, I look forward that Feeding Matters continues in its endeavors and continues to grow and provide education, you know, worldwide. Because I mean, we've had people involved from all over the world and continue at the forefront of those kind of things to help families and healthcare providers.
[00:38:18] Speaker B: Thank you.
It's been cool to think about the last 20 years, but also like, how much further we need to go to bed, be consistent with it.
Yeah, I, I hope that for us too. So thank you so much. Yeah.
[00:38:30] Speaker C: One of the, one of the things I do want to say is, you know. Yeah, the difficult thing is in medicine and, you know, as you get further in medicine, you realize is that everything isn't always moving forward.
And that can be fostering because you have always new. New nurses, new providers, et cetera, et cetera. People get older, retire, move on, whatever it is, and you have new people. So you're constantly going like this. You're never just going forward.
And so that can be frustrating because you think you're always just gonna be making progress. A lot of times you have to go back to the beginning with some and redo that. So although you may be moving, that move forward is a lot slower than you kind of hoped, because it's not like you can just take everyone with you and there's no new people coming behind.
And that can be a real challenge in many areas of medicine. But I think particularly for something like this, where there's not a lot of education in medical school or residencies and where the nutrition, the education for feeding therapies can vary quite a bit as well, you know, you gotta stay on top of those things. It's never gonna be like, we did it, we won.
[00:39:40] Speaker B: I would love for that switch to be flipped, but it just. It won't happen. It's just. We gotta keep chipping away at the mountain.
Awesome. Well, thank you for joining us and thank you all for listening, and we look forward to continuing this. This series throughout the year. And we'll see everybody next week. Thank you. Thanks, Matt.
[00:39:58] Speaker C: Thank you for having me.
