What to Expect: Virtual Lactation Consults

“Are virtual consults for lactation really effective?”

“ How can a functional assessment be done virtually?” 

Trust me, I hear your concerns and I have answers.

As an IBCLC it is my goal to help you learn how to feed your baby and understand your baby. The only way for you to effectively learn, is by doing. Which means, even in a home setting, I remain fairly hands off because I want you to learn how to latch and hold your baby. It is rare for me to actually touch a parent and baby to help them latch. Instead, I use effective communication strategies and analogies to explain exactly what you need to do to latch your baby. You can think of me as your guide to understanding breastfeeding and understanding your baby. 

Extensive clinical experience on my end means that I know exactly what to ask and look for to assess you and your baby.

Since I have extensive training and experience, I know all the right questions to ask and signs to look for, so as you feed your baby I will ask how the latch looks, how the latch feels and ask questions about what you see and feel to help you make adjustments and asses you baby virtually. Based on your feedback and how the latch feels to you I am able to determine what issue is occurring.

I use HIPAA-compliant platforms which means your privacy is protected during our consults. 

How we Assess Muscle Tightness

Sometimes a baby’s body gives very clear signals to the trained eye that there is muscle tightness present. This could be something as significant as torticollis or something as minor as restricted movements of their limbs or facial asymmetry. I can ascertain restricted muscles based on what you tell me about your feeding experience . Additionally, I may ask you to position your baby in a particular way on a flat surface and gently play with them by moving their limbs so I can assess any areas of restriction. Structural tightness is one of the main causes of latch problems and it is also a symptom of tongue ties. Understanding where and how the restriction exists helps us to decide which interventions and accommodations will help you and your baby with feeding. 

How we do an Oral Assessment

Doing an oral assessment involves having your baby suck on a finger and then observing how the tongue moves and how the suck feels. Typically, I will have parents complete a series of playful oral exercises to elicit a response from your baby. I then observe through the camera how the tongue moves and whether or not a response is noticed. This is part of the functional assessment. I use grading tools to give a score based on this data to determine the degree of oral function or dysfunction that is present.

Subjective Experience

I will have you fill out forms prior to our consult that involves a birth history, early feeding history and a Subjective Oral Function Questionnaire. This questionnaire helps me determine if there are other underlying breastfeeding issues that may be present and when combined with the other assessment criteria above, it helps me understand if there is a functional issue present and any other breastfeeding issues that we may be dealing with.

Visual Assessment

I may also request photos of your baby's upper lip and tongue frenulums (the piece of tissue that attaches the lip and tongue to the gum ridge and floor of the mouth). While a visual assessment is not enough to determine oral function alone, when combined with the above-mentioned assessments, all of the pieces come together to form the whole picture. There are appearance details that are important to observe and there is functional data that can be gained from still images. 

How to Take the Pictures

Lip Stretch Photo - lift lip back towards nose using your first finger on each hand. The lip may not reach the nose and that is okay, lift as far as you can. Have someone else take the photo when the lip is fully flanged back.

Tongue Stretch Photo - using your first finger on each hand, slide your fingers under the tongue, lift up or back so the frenulum is visible. Have someone take a photo in this position. It helps to swaddle your baby and position them with their head towards you and feet away from you to achieve a better tongue lift.

Using the flash on your phone may help get a better picture if the area you are taking the photos is dimly lit.

Here is what a parent had to say about virtual consults with me:

“Previously, I had a hard time accepting help as a new mom. I didn’t want to admit that I wasn’t sure what I was doing as I felt that it reflected poorly on me. However, I soon realized that I truly needed help to better provide for my daughter. I was a little unsure of how things would go, especially doing an online consultation. Now, I am so happy that I was able to work with Jennifer! She was very knowledgeable through the whole process. If something wasn’t working for me and my baby, she was quick to come up with a new suggestion. The online format was actually very useful and I would do an online consultation again if needed!”