When should I get a feeding evaluation?
I recently got to meet the sweet ladies at the High Country La Leche League. They meet every first Friday at Cornerstone Summit Church to talk babies and support parents who are breastfeeding. Miriam, one of the leaders and mom of three, had invited me to talk about when to get in touch with a professional for extra help. As two of her littles played (and we watched a visiting 4-month-old sleep), I talked way too fast about occupational therapists, speech language pathologists, and lactation professionals. Here’s what we covered - with additional thoughts for bottle-fed babies.
If feeding is difficult
If your baby is having problems eating, you can ask for help. Parents (particularly moms) often put up with pain, discomfort, and struggle for a long time. But we don’t have to. If your baby is refusing the breast or bottle, crying when feeding, “working hard” when eating, falling asleep without seeming like they’ve had enough, or staying asleep all the time without asking to eat, you may want to contact a professional. If you the parent are experiencing any pain, don’t just try to endure it! And if you or anyone on your care team are concerned about weight gain or milk supply, reach out.
You do not need to wait until you have tried everything else.
If you decide you want help, you can ask your pediatrician for a referral for a feeding evaluation, or you can self-refer. Speech Language Pathologists (SLPs) are generally going to focus on safety and efficiency of feeding, Occupational Therapists (OTs) are generally going to help with sensory issues, and lactation professionals are going to be your go-to for breastfeeding support. Some SLPs and OTs are also trained in lactation. If you living in the high country, I’m working to compile a list of professionals and their contact information.
If feeding may be difficult
I am a big believer in gathering a support team before I need it. Some realities can make feeding more challenging for baby and mom (if breastfeeding). You may decide to proactively get in touch with a support group or professional if you or your baby have experienced the following:
Baby
Prematurity
Delayed breastfeeding and/or separation from mom
Cleft lip and/or palate
Tongue tie
Down Syndrome or other genetic syndromes impacting feeding
Other medical episodes or diagnoses that required feeding intervention
Breastfeeding parent
Surgery, injury, or improvements to breasts
Type 3 nipples (nipples never evert)
Uneven breast sizes - one breast is significantly larger/smaller than the other
Re-lactation, initial lactation (not pregnant with this child), or lactation following use of hormone-impacting medication
Overweight
Hemorrhage at birth
Trauma while breastfeeding and concerns with supply
Cost and insurance
Lactation consultations are supposed to be covered by insurance as a preventive services per the Affordable Care Act. However, insurance providers frequently find ways around reimbursement. If you are talking with a lactation professional before there is a problem, it is more likely to be considered prevention and covered. If there is a problem, the IBCLC credential operating with a medical provider is your best bet. Or you can self-pay. Prices are in the $100-150 range for an in-home consultation. I and many others also offer a short visit price for quick questions and follow-up.
An SLP feeding evaluation is almost always covered by insurance, whether you have a pediatrician referral or self-refer. At Appalachian Pediatric Therapy, we charge $50 for self-pay evaluations and therapy sessions. I cannot speak to other providers, but you can ask when you call.
I don’t know at this point about typical cost of OT feeding evaluations, but I’ll update this post as I find out :)
SOMETIMES HELP CAN BE FREE! The Mother-Baby Visiting Program has nurses with lactation credentials who will come to your home once during the first 12 weeks after birth to check on you and the baby. The Women, Infants and Children program has trained peer breastfeeding supports for qualifying families. Support groups like Babes on Blankets have lactation professionals running the meetings. Check the resources section.