Field of lactation gains child psychologist

The field of lactation just gained another amazing care provider. Kenya Malcolm, PhD, CLC is a child psychologist, consultant, and trainer in Rochester, New York. Dr. Malcolm’s work focuses on programs and interventions in early childhood in mental health settings, preschools and pediatric offices. Among her many responsibilities, Dr. Malcolm is the HealthySteps program coordinator at a large pediatric practice.

Dr. Malcolm says, “The research is pretty clear that working with caregivers early to support children is the best way to promote optimal family and child health. So, that’s what I do!”

In fun, Dr. Malcolm is not only passionate about mental health, but she’s a self-described stationery nerd.

“I think that color coding is a great way to take notes and stay organized but I’ve been mocked for my pen collection!” she begins. When her LCTC instructor Dr. Anna Blair recommended using multiple ink colors on the Lactation Assessment & Comprehensive Intervention Tool (LAT), Dr. Malcolm says she felt validated.

She was again validated during the first few sessions of the course while learning about the benefits of breast/chest feeding not only for the baby but for lactating people.

“That’s when I knew I’d made the right decision to sign up for the course,” she reflects.

Because Dr. Malcolm is new to lactation counseling, she says that “every successful chest feeding story is my favorite right now.”

Photo by Luiza Braun

“All the moms have been so happy that they’re successful!” she explains. “I was not supported in breastfeeding my own kids when they were born and honestly, being a CLC is like an opportunity to be the superhero I wish I had 20 years ago.”

In becoming that superhero, Dr. Malcolm subscribes to reflective practice as a guiding principle in her work, and more specifically, in her leadership roles.

Dr. Malcolm remembers the words of one of the founding members of ZERO to THREE Jeree H. Pawl: “How you are is as important as what you do.”

Here’s more of what Dr. Malcolm had to say:

“Reflective supervision is a special kind of supervision that focuses on the practitioner’s own thoughts, feelings, and behaviors to support their ability to provide good care to the folks they are working with. Working with caregivers and children is tough work and usually includes navigating systems that are very siloed with rigid expectations. As humans, we often respond in ways that are just as much about ourselves as about the family in front of us. Reflective supervision is a necessary space for slowing down and looking at our actions to improve care, reduce bias and disparities, and improve the well-being of everyone involved. Reflective capacity is a skill and reflective supervision is considered a necessary component of support for people who are working with young children and families by most major organizations working toward the health of families.”

In Dr. Malcolm’s side gig with The Society for The Protection and Care of Children, participants introduce themselves with their baby pictures “as a way to hold in mine our own younger selves who continue to show up in our work.” The work focuses on training staff in Infant Mental Health (IMH) principles, Reflective Supervision, and infant/early childhood mental health conceptualization and diagnosis using the DC0-3 across New York state.

“One IMH principle is that we always hold the baby in mind,” Dr. Malcolm begins. “But it’s not just the baby in front of us. We also have to be aware of the baby whose needs are still present in our own selves. That’s why reflective spaces are so important. Our own biases and histories are present in all of our current interactions–another IMH tenant is that our early experiences matter– and we want to be mindful of how those are showing up in our work in both helpful and not so helpful ways.”

Dr. Malcolm tackles another big idea. Responding to an article on moral injury she wrote on social media, “I… think there’s a savior fantasy that many health professionals have that is sometimes traumatic to lose while in the field.” This phenomenon often rings true for lactation care providers. Dr. Malcolm advises doing the self- work it takes for true humility and reflection.

She shares this anecdote:

Source: United States Breastfeeding Committee (USBC)

“I was observing a lactation counseling visit last week and a mom came in with questions about a possible tongue tie and some nipple pain with feeding. Since the latch was poor, the LC provided some strategies for improving latch that helped to address some of the pain. Like, mom agreed that there was less pain with position changes. But mom was not actually interested in working on latch; she was focused on the possibility of the tongue tie. The LC did a great job of talking through her observations and assessment and providing next-step ideas to Mom. But the LC and I really wanted mom to want to improve her latch. It would be easy to feel like that was an unsuccessful visit because we didn’t save the day in the way we wanted. But mom left feeling heard and supported. Many of us go into human services work to be a hero (I actually used the words “being a superhero” two answers ago!! I’m tempted to change that answer now, but I’m not going to.) of our own design. Families don’t need that. They need support to be at their own best.”

You can connect with Dr. Malcolm here.

Guiding informed decision making about tongue-tie revision

In the service industry, the customer is always right. In lactation, ‘Mother knows best’. 

Lauren Zemaitis MA, CCC-SLP, is a pediatric speech pathologist who specializes in infant, toddler and school-aged children with feeding disorders. Her son– now three years old– was diagnosed with tongue-tie by a hospital-based IBCLC when he was about one day old. 

“It is still such a vivid interaction in my mind,” Zemaitis begins. 

“We had some difficulty latching within the first 24 hours. I had some [birth] complications so I was a little groggy and the two of us were just trying to figure [breastfeeding] out,” she remembers. 

“The nurses were having trouble helping me, so an IBCLC came in and was very aggressive talking at me through the latching process. She shoved her finger into my son’s mouth while he was crying and told me he had ties and said, ‘You won’t have a good breastfeeding journey. These have to get revised before you leave the hospital,’” Zemaitis continues.

“I was just like, What?” she remembers, still affected by lingering medication. 

Throughout the rest of the day she and her son laid skin-to-skin, and he latched. 

The following morning, the lactation consultant returned. She inquired about Zemaitis’s conversation with their pediatrician the night before. 

Zemaitis explains: 

“She was very aggressive again and said, ‘I know the ped came in last night. Did you talk to him about what I said? I said we did talk with the ped and right now we don’t want to pursue a revision, he’s not even 72 hours old. She said, ‘Well I just still don’t think this going to work for you.’ I explained what I do [for a profession] and she said, ‘Oh, so you know this is going to affect his feeding skills and speech development.’ I finally said that no we’re not going to do this, that I want to see where this breastfeeding journey is going to go. She said, “Fine” and left the room.” 

From that point on, Zemaitis often doubted her ability to breastfeed her baby. 

“The specialist set me up to think I wasn’t going to be successful,” she says. 

Even so, Zemaitis and her baby went on to breastfeed for over a year. 

Their story is a great reminder that we look to lactation care providers (or any health care provider) for guidance, not dictation. Professionals are positioned to help us make informed decisions. Ultimately, parents are their children’s health authorities, and in this case and in many others, Mother knows best. 

Their story is also a powerful anecdote about hotly debated tongue-tie diagnoses and treatments. 

Zemaitis considers tongue-tie a “buzz word” among some professionals meaning it’s an overused term, and it’s being over-diagnosed. 

She points out a few concerns she has. 

“Between professionals, there’s a lot of gray area; one person might say it’s a true, very taught tongue tie that needs immediate revision and someone else may say we just need to do something else like working through the re-latching process or sucking skills,” she explains. 

She also worries that pointing out tongue ties (especially if done in the manner she’d experienced personally) might plot doubt in moms. 

“The doubt continues to get bigger and bigger in terms of their emotions around it and then when something goes wrong, or different than they thought it would, they immediately doubt themselves and their decision around tongue revisions,” she goes on.

What’s more, Zemaitis notices that many revisions are being performed around three to four months of age, at which point babies have established motor patterns. Sometimes, a revision can disrupt those patterns and has to relearn them. 

Tongue-tie revisions, which sometimes sound as benign as clipping one’s fingernails, can be simple, but they can also require a more involved surgery, cutting into muscle and requiring extensive pre and post exercise and follow up care.  Zemaitis points out that parents can be apprehensive to touch the revision site to perform this care.  

When tongue tie is suspected, she and her colleagues look for a functional deficit like limited tongue mobility and/or strength and the impact on feeding development and skills, not solely the structure of the mouth. 

They’ve found that things like suck training, repositioning at the breast, and counseling mothers to allow the baby to latch rather than trying to “control” the nipple and baby’s movement can be effective tools before referral for revision is suggested. 

Through personal experience and after completing the Lactation Counselor Training Course (LCTC), Zemaitis centers her work in good counseling. 

“I think the counseling piece is something that we all really strive to continue to do better,” she says. “The counseling piece in the training was really valuable. I learned a lot by doing the small group projects and working with other professionals from other settings; how can we all do better with the active listening piece?” 

Zemaitis has the opportunity to uplift and celebrate her clients in their natural environment when she’s doing home visits. She particularly loves working with families with premature and medically complex babies. 

She explains that one of these families biggest challenges is transitioning from hospital to home and feeling like they have to start back at square one with their infant’s care. 

Zemaitis considers some of her biggest successes when she sees babies go from being completely reliant on tube feeding to becoming oral eaters. She and her colleagues are inspired by the work the children and their parents go through to ultimately “trust food”. 

“[Parents] thank us,” she begins. “We say, it’s because of you. We are guiding you. You are making the choices for your children.”

Never underestimate a mother

This photograph brings the kind of smile to my face that lifts my ears up several millimeters and presses the tops of my cheeks into my bottom lashes. The athletes are so expressive, I almost squeal in excitement as if I’ve just witnessed their victory. 

The story behind the photo is summarized by Ann-Derrick Gaillot in 10 Women’s Sports Stories That Would Make Great Films:

“When the winners of the women’s 4x100m relay at the 1992 Summer Olympics in Barcelona were announced, no one was more thrilled to win than the bronze medalist team from Nigeria. Teammates Beatrice Utondu, Christy Opara-Thompson, Mary Onyali, and Faith Idehen were relative outsiders in the international running scene and were not expected to stack up against powerhouses like France and the United States. Though injury and traditional cultural gender norms would threaten their chances of competing in those Olympics at all, they would leave Barcelona that summer as the first Nigerian women to win Olympic medals. Onyali eventually went on to become one of Nigeria’s most successful runners, appearing at the Olympics four more times.”  

Underdog stories are always inspiring, and they’re happening every day when a woman becomes a mother. 

That’s Nurse-Family Partnership supervisor in Buffalo, N.Y. Daynell Rowell-Stephens’s MS, RN message.

“Stay open no matter what the circumstances the mother may be going through,” Rowell-Stephens offers. “[Mothers] have the ability and the capability to be the best moms, to flourish. Never underestimate a mother because motherhood drives women to be the best.”

Photo by Sai De Silva on Unsplash

She continues, “Support moms no matter what; whether it’s drug use or homelessness– I’ve seen it– motherhood really launches them into directions they never imagined they could go into.” 

Rowell-Stephens and her colleague’s agency is just over a year old, and in that short time, they’ve managed to make a great impact on the lives of mothers and their new families. 

“We are so excited about all that we are doing,” Rowell-Stephens says. 

It’s well-documented that people of color have less access to health care resources and are faced with structural barriers that inhibit good health outcomes. Amani Echols points out some of those barriers in The Challenges of Breastfeeding as a Black Person:

  • “Many Black people work, and breastfeeding at work is hard…
  • Black neighborhoods are also lacking in hospital practices supporting breastfeeding…
  • The societal stigma of breastfeeding is heightened for Black and brown people.” 

These are big gaps to fill, but Rowell-Stephens and her team readily take on the challenge.

They make sure their clients receive proper prenatal care by connecting them with various health care providers including midwives and doulas. They provide nutrition counseling. They help them secure housing and jobs and continued education. They impact decisions about cigarette and drug use. They support them through mental health crises. They educate on how to navigate different stressors. They support healthy infant feeding and bonding.

“All of the nurses on the team are very passionate about breastfeeding  so we love to see so many of our moms interested in learning to be successful at breastfeeding,” Rowell-Stephens comments. 

She’s the most recent member on her team to complete the Lactation Counselor Training Course (LCTC). She says the experience was “quite eye-opening.” 

“It is really going to change my practice overall,” she says. 

Maybe most importantly, the team teaches their clients how to healthfully engage with their children. 

“It makes me so excited to see these girls change their whole outlook on life,” Rowell-Stephens says of her clients when they become mothers. 

She celebrates the story of one of her clients who set a personal goal to complete a rehabilitation program and acquire a living place before the birth of her baby. 

“She accomplished that!” Rowell-Stephens reports.

Not long after, the mother’s roommate was using drugs in the home. 

“Her motherly instinct kicked in and she knew she needed to get out of that environment,” Rowell-Stephens begins. “She recently found another apartment and she’s providing for her child.”

Rowell-Stephens goes on, “She’s taken what might seem like very small steps, but for her, as we look back at just this past 9 months, she has done so many things. She has changed the world around her.”