Meet Liam | Specialized Feeding Therapy and Virtual Visits Help Baby Liam Thrive
Virtual visits, the expertise of a pediatric feeding-swallowing therapist, and a determined mom helped Liam overcome a condition that prevented him from taking in nutrients to grow strong – all as COVID-19 shut down outpatient services.
Kathy Yukna knew something was wrong after her son, Liam, was born. He wasn’t able to nurse.
“The more he struggled to latch on, he would get so frustrated,” says Kathy, of Kingston. Both mom and baby were exhausted after long feeding sessions that left Liam still hungry. His pediatrician referred Liam to Spaulding Cape Cod’s Eileen M. Ward Outpatient Center for Children in Sandwich for a pediatric feeding-swallowing evaluation.
He saw Cheryl Pelletier, M.S., CCC, SLP the Lead Pediatric Feeding-Swallowing Therapist and an Advanced Speech-language Pathologist at the center. She observed that Liam couldn’t sustain an effective suck while feeding. The cause: a condition in which the cords of tissue anchoring the tongue to the bottom of the mouth and the upper lip to the gum line are overly tight. An estimated four to eleven percent of newborns are born with tongue and/or lip ties.
In Liam’s case, the oral tetherings meant that he couldn’t properly nurse or bottle feed well enough to gain weight. In fact, when Cheryl evaluated him at 11 days old, he had lost three ounces in one week. “Liam struggled so hard to feed that he was using more calories than he was taking in,” says Cheryl. “He was gasping, coughing, and swallowing so much air that he had developed colic.”
Cheryl developed Liam’s treatment plan in consultation with Abby Berner, the program’s pediatric nutritionist, and Jess Kaplan, M.D, a pediatric gastroenterologist at Massachusetts General Hospital for Children. The goal was to help Liam increase oral-motor range of motion so that he could take in enough nutrient-filled milk to grow.
As COVID cases began to rise across the state, Spaulding, like other outpatient centers, adopted new procedures to ensure the safety of patients and staff.
“They asked questions before the visit, called us in when Cheryl was ready,” noted Kathy. “It was comfortable. We didn’t feel rushed, and they allowed enough time between patients to disinfect.”
When the spread of COVID-19 necessitated suspending in-person visits altogether, the team quickly pivoted to offer virtual visits.
Continuing Liam’s care and having Cheryl’s ongoing support were important to Kathy. “It was tough. Liam couldn’t move his tongue. I was crying, saying he’s never going to eat. And Cheryl was there, rooting for both of us, calming me down. She had so many techniques to try. She’s got the patience of a saint.”
Though Liam showed progress, it wasn’t enough. He needed a simple procedure to release the ties. But just as Cheryl made the referral, new COVID-19 mitigation orders effectively closed doctors’ offices and hospitals for all but emergency services.
It was a difficult setback. Kathy resigned herself to having to wait indefinitely for an appointment. Then Cheryl called. “She’d found a nearby dentist who was doing this procedure. That was going above and beyond. She didn’t have to do that.”
After the procedure, Kathy was buoyed by the changes she saw in Liam. “His face was so relaxed and expressive.” During virtual visits, Cheryl taught her to fine-tune feeding techniques. “I was nervous. I didn’t want to do this without Cheryl. We’re sitting on a Zoom call and she’s picking up on a flick of my wrist, how to bring in the spoon straight. Working with Cheryl was a game-changer.”
By mid-July, Liam weighed 15 ½ pounds. “He was growing like a weed,” says Kathy. “His doctor was amazed at how he was sticking his tongue out, blowing raspberries. He wasn’t afraid of food – and he was gaining weight.”
“I’m thankful we had the resources to provide Liam’s care virtually,” says Cheryl. “Actually, seeing Kathy and Liam at home allowed me to recommend what was best for him in their home environment and to make adjustments in a natural setting.”
As Thanksgiving approached, Liam, now 19 ½ pounds, continued to thrive. “He loves to taste and try everything,” says Kathy. “He’s quite the happy baby.”
“It was so satisfying to help this worried mother so Liam could reach his feeding and swallowing goals and grow healthy and strong,” says Cheryl. “Working with families to help their children eat safely and effectively is so rewarding. Each of the babies and children have unique challenges that our team meets with compassion and skill. Every discharge is a victory celebration for my patients.”