Initial Evaluation of Infants
Fees and Services
Infant Treatment Per Hour
Initial Evaluation of Adults in Office
$110
Initial Evaluation of Adults
Seen with Dr. Diers
$125
$100
Adult Treatment Per Hour
Seen with Dr. Diers
$110
All payment is due at the time of service. Cash, checks, all major credit cards and FSA/HSA Cards are all accepted. Itemized insurance forms provided upon request.
$110
Adult Treatment per Hour
in Office
$100
At Home Activities to Promote Successful Feeding
Protocol for Collaborative Treatment with Providers who release Tethered Oral Tissues
Infants are usually seen once before they undergo the procedure to release their tethered oral tissues, and one time 4-7 days after the surgery.
Treatment goals for the first session:
1. Establish a functional oral motor pattern. According to Lynn S. Wolf, MOT, OTR and Robin P. Glass, M.S, OTR, as defined in their book, “Feeding and Swallowing Disorders in Infancy”, 1992, pp 16-19; a functional suck is established when a lip seal is competent combined with the jaw and tongue dropping down to create a vacuum. This vacuum draws the milk into the oral cavity. Nearly 90% of the pressure needed to transfer milk is suction. The remaining 10% is accomplished by compression of the nipple by the tongue. Infants with tethered oral tissues often default to the compression aspect of oral motor function, creating a pattern referred to as “squash pump”. The squash pump action is what causes nipple damage. It is also grossly inefficient. The infant very often fatigues before he or she is fully satisfied. In most cases, a functional pattern can be established despite the ties, but the baby has to work hard against the restrictions imposed by them. The benefit to doing this work before the release is activation of the neural network used for the functional suck. Then, once the ties are released, the infant can easily establish rhythmical, functional suck/swallow/breathe pattern.
2. Get the baby full, satisfied and content. As mentioned above, a baby using the squash pump method of feeding often fatigues/shuts down before they are full. It’s commonly reported that the baby naps for 15-20 minutes and wants to eat again. I typically see under weight babies and stressed out mothers, baffled as to why their baby is so difficult. These infants are often adrenaline driven and stuck on a sympathetic nervous system response. This is the alarm section of the autonomic nervous system. The autonomic nervous system regulates all bodily functions. The other branch of the ANS is the parasympathetic system. The vagus nerve is this branch. It is known as the “rest and digest” nerve. I typically hear a mother exclaim
“I have never seen my baby so content”.
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The follow up session is designed to fine tune and correct any residual feeding concerns if needed. Craniosacral therapy is utilized in both the pre and post release surgery sessions.
Central to these outcomes are the concepts of having the baby COLLECTED and CONTAINED. Feeding is a function of full body flexion. (Similar to “fetal position”.) Tummy Time in particular, if implemented before 4 months of age, over develops spinal extensors (the back muscles) and babies often end up in a self reinforcing pattern of arching and over arousal. There are also activities being used to help the baby “relax”. I see babies “splayed” out with arms and legs going different directions, unable to organize their body so that they can latch. I often use a soft wrap to gently bring the baby’s limbs into midline (collected) and are positioned so that they are contained in a flexor position. Nursing pillows, rolled up towels or small pillows are used to support the baby in flexion. Flexion is a position of comfort and safety.