What is a Comprehensive Infant Oral Assessment?
A large part of resolving breastfeeding and bottle feeding challenges is getting a comprehensive oral assessment for your baby. But this isn’t easy, and often, parents believe they have had this done when it simply hasn’t happened that way.
All too often, what I see when discussing how a baby’s oral assessment was done, or when reviewing client notes from previous providers, is not comprehensive. Parts of the evaluation may have been done, but functionally, these assessments have been the equivalent of a mechanic being asked to find out why your car won’t start by checking the tire pressure. I also see a lot of cases where a problem was visually identified, but the full assessment of how it is impacting your baby’s ability to feed wasn’t done, leading to an incomplete solution.
I genuinely understand how frustrating that is as a parent struggling with feeding challenges or pain from a bad latch. I’ve been there crying in the dark trying to Google symptoms, frustrated that the issues consistent with my experience had already been “ruled out.” I don’t wish those feelings on any parent, ever.
I’m here to help you find the answers to your baby’s feeding challenges no matter where you are at in your journey.
I can help you whether you are:
Looking to make sure your baby doesn’t have any issues before things can go downhill.
Trying to figure out if this is a latch and positioning issue or a more serious oral function issue.
Trying to decide if a tongue-tie revision is the right decision.
Trying to figure out why the tongue-tie revision didn’t work to solve all the issues.
What Happens in a Comprehensive Oral Assessment and How?
Only once we have that comprehensive evaluation can we make decisions and develop a plan to support your goals.
Oral assessments can be broken down into 3 parts:
Functional | Visual | Structural
The Functional Assessment
The functional component of the oral assessment is, in my opinion, the most valuable and needs to be done first! The functional assessment involves assessing what your baby physically can and cannot do with their oral anatomy. Functional assessments are carried out in one of two ways, In-Person or Virtual:
With an in-person visit: I’m going to pop on a glove and feel around in your baby's mouth. I have a series of short exercises I do to check your baby’s range of motion and reflexes to see if there are any issues with function and to check their oral reflexes.
With a virtual session: I have you complete these exercises yourself (don’t worry, I give you instructions that are easy to follow) and answer questions to gather this data. Typically, I prefer to do this before the session so that we have time to do the exercises while your baby is nice and happy to get the best information possible.
The Visual Assessment
The visual component of the assessment involves looking at your baby’s oral anatomy and watching how they are using their oral anatomy to meet their needs. Babies are fantastic at finding ways to work around their challenges which are called compensations. Visualizing their oral anatomy and watching how they feed and compensate at the breast and bottle are absolutely necessary to shape a care plan, but without the functional component, the visual assessment alone often fails to provide lasting solutions. It is also possible to misattribute something you see visually as a problem when the functional assessment may show that, regardless of how it looks, it’s not actually an issue. During the visual component of the assessment, we often trial different positions and techniques to see if we can alleviate the challenges with these strategies.
With an in-person visit: This is accomplished by watching you feed your baby at the breast and the bottle. I also visualize your baby’s oral anatomy during the hands on exam to make sure I have seen how the anatomy is structured.
With a virtual session: We use videos of your baby crying, videos of you doing an oral assessment maneuver so I can see the frenulums (again, I give you easy to follow instructions), and videos of feeding at the breast and bottle. Some of this we may repeat on a live video call, but I prefer to get video beforehand so that I know we see what we need to see, and we can spend our time together finding solutions since we gathered the data (and likely the answers) beforehand.
The Structural Assessment
The structural component is where we look at the baby’s full anatomy from head to toe. Baby’s are full body eaters, and what’s happening in their bodies is often manifested in their mouths and vice versa. So, we are looking from head-to-toe to see what is going on with your baby’s posture, tension, muscle tone, and reflexes. We are checking for obvious concerns with tone, or issues such a plagiocephally, or tortocollis, as well as the less obvious concerns that can be easily missed by the untrained eye. We check infant reflexes to make sure they are presenting in an age-appropriate fashion.
With an in-person visit: This may be accomplished by assessing the baby in live time, or by photos and videos submitted ahead of time. With my practice, I prefer to do all of the same paperwork ahead of time with pictures to review so that I can focus my assessment. The more focused the assessment, the quicker we can get you the answers you are hoping for. It also allows me to assess your baby’s anatomy over several different positions to check for consistent, atypical positioning.
With a virtual session: We do the photos beforehand so that we can make sure I have been able to see everything before the session in case baby is not tolerating the camera well, or the connection is unstable. Oftentimes, I am looking for very subtle misalignments and asymmetries, so relying on a video consultation to achieve this isn’t a good plan in my experience.
I often get asked how much can you tell with these photos?
Here are a few pictures of my oldest son as a baby. He was experiencing extreme feeding difficulties, and we saw so many lactation consultants trying to figure out why. Looking at his baby pictures with the training I have today, the issues are incredibly obvious to me, and it explains why he was slow to respond to interventions. Just look at the things we can tell from these simple pictures. If someone had done this assessment for me, I would likely have gotten his issues resolved much faster and without as much emotional distress. The lack of this assessment led to care plans that took far longer to get results than it really should have, with less optimal outcomes.
Often times, parents read a description like this and become overwhelmed! It’s a lot of things that we are looking at to make sure we capture the full picture of what is going on with your baby.
The good news, while your part of the work for this assessment may take a little bit of time to complete, it’s all fairly simple. You will be doing some simple exercises, answering questions, and gathering photos and videos. The time and effort this will require on your part will give me a fantastic starting point to help make sure we get to the root causes of your baby’s difficulties as quickly as possible, so that we can get results for you! It’s this comprehensive assessment that allows me to work some magic to help you meet your goals.
