Terri Major-Kincade (1s):

The most important thing about having a premature baby that I usually try to emphasize the families is How Premature you're baby is. The adjusted age is how there milestones or going to develop is not there. Chronologic age.

Katie Ferraro (14s):

Hey, there I'm Katie Ferraro, registered dietitian college nutrition professor and mom of seven specializing in baby led weaning here on the baby led weaning made easy podcast. I help you strip out all of the noise and nonsense about feeding, leading you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. Hey guys, welcome back today. We're talking about premature babies and in particular, how can premature babies succeed with baby led weaning? Now, baby Led. Weaning is not something you're thinking about in the first few days of life. When you're in the NICU, there's a lot of other stuff going on, but down the road, when your baby's got that six month adjusted age, Marc and show, and those other signs of readiness to feed, there are some special nutrition considerations for babies who were born preterm.

Katie Ferraro (1m 5s):

And so my guests today is a specialist in this area of neonatology. Her name is Dr. Terri Major Kincade she's on Instagram at Dr. Terry MD. She is a board certified pediatrician and a neonatologist. Now, Dr. Kincade works in a very unique area of neonatology in that she runs NICU follow up clinic. So she is still is practicing as a NICU doctor. She actually covers five different states. She said she does around that 50 different hospitals. She is one of those people that's everywhere all the time is such an absolute expert in her field, but the follow-up stuff for the NICU babies is really important because if you ask your typical NICU doctor, a question about six month olds and infant feeding and baby led weaning, they'll be like, whoa, hold up.

Katie Ferraro (1m 48s):

That I was like way past when I deal with babies. And they usually don't see babies that far down in the lifespan, but Dr. Kincade does. So she is uniquely qualified to talk about some of these nutrition needs that our premature babies have and some of the concerns that parents have and what we need to look out for when we're making the transition to solid foods for baby led weaning and for babies who were born prematurely. So with no further ado, I want to introduce you guys to Dr. Terri, Major Kinkaid. She is going to be teaching us about How Premature Babies Can Succeed with baby led weaning. All right, well hello, Dr. Terry, thank you so much for joining me.

Terri Major-Kincade (2m 25s):

Thanks so much for having me. I'm super excited to be here.

Katie Ferraro (2m 28s):

I have, I've had like a long, long list of questions. I got to narrow it down, but before we jump into the questions, could you tell us a little bit about your background yourself? What inspired you to become a pediatrician and then specialized in perinatal, the neonatal medicine?

Terri Major-Kincade (2m 41s):

Sure. I'm Dr. Terry MD and my full name is Terri Major Kincade. And I've been a neonatologist for 22 years. I have known since I was six years old that I wasn't going to be a neonatologist, even though I didn't know that that was the name of them. My sister was born premature in 1968, and my mom always say she was small enough to fit in your hand. And when she came home, she could sleep in a shoe box. And that I was fascinated by that the doctors who take care of the babies who were in the plastic boxes. So by the time I got the high school, I realized that those doctors were pediatricians called neonatologists. And I'm like, well, that's what I want to do. I want to take care of babies and the plastic boxes. So he trained in Texas and went to medical school in Los Angeles.

Terri Major-Kincade (3m 23s):

And so I've been taking care of the babies in the plastic boxes now for 22 years. And I left. I mean, there's just nothing like holding the human in your hands and then eventually getting them, being able to send that baby home with the family or taking a family that's like totally freaked out and then empowering them to take their baby home. You know, when they leave the NICU

Katie Ferraro (3m 40s):

Is the plastic boxes thing is true because my husband is born in 1975 and he was one pound. And it was that at a military hospital, thankfully, because he probably would not have been a viable of birth if you were anywhere else in my mother-in-law talks about box. And then also a tube sock, I believe is this true? Are that he's just analogies. So

Terri Major-Kincade (3m 58s):

Is there are incubators, but like the incubators we have in the NICU now, they were like the Cadillac. They were like, the Rolls Royce is, you know, the plastic boxes. But in the beginning they were literally just like plastic boxes with tops on them. And they had, you know, a spice for the oxygen and the space to put your hands. And in fact, the original NICU started as a traveling carnival show and Coney island. So there was a book about how the original premise is you could go to Coney Island and see 'em and this little display, and they'd be in these plastic boxes with the doctors. So,

Katie Ferraro (4m 27s):

Well, the, you know, that's interesting, 'cause the original quadruplets. They used to put them on display, the Canadian family, and people could parade through the quintuplets and take a look at them. So I'm glad things have changed,

Terri Major-Kincade (4m 37s):

Right? So my mom, like, I'm always telling you how much time we spend with the families and all that stuff. And she's like, I don't understand what you do. Your sister was there for three months. They told us to come pick up one day and we did. And I'm just looking at 28 weeks in 1968, like mom really <inaudible>

Katie Ferraro (4m 55s):

The sister's story inspired your entire career. And you knew what you wanted to do before you even knew what it was. The thing

Terri Major-Kincade (5m 1s):

She did, my baby sister. So normally I show her and I were, I gave a talk, I'll show up picture of my sister before I start, because I said, she inspired like, well,

Katie Ferraro (5m 9s):

Get a picture of her in the show notes. I was sharing with you. I had set of quadruplets. They were 34 weeks. So there are only in the NICU for about a month, but my sister has a 24 weeker. And when her 24 weeker was in the hospital and she was in the NICU, she got pregnant with another baby on accident, not on purpose. And he was born at 25 weeks that they were four and a half months, each in the NICU back to back fully there. Fine. Now they are all in regular school. One of them have, he had a stage four brain bleed. It was so touch and go for a while, but we always laugh because she had the NICU baby. And then she got pregnant with the other NICU baby. And ironically her husband sells birth control. And we were like, oh, you know how this happened? You know? And so it, wasn't funny at the time, but I've really come to respect and just appreciate the work that every one in the NICU does is it truly is a team approach.

Katie Ferraro (5m 53s):

And that sounds like you're a fabulous team leader.

Terri Major-Kincade (5m 55s):

I love it. I love it. So you, your quads, but I'm only there for four weeks. I'll only say, you know, whether you are there two weeks or, you know, eight months, it's still unplanned birth experience to have your children and go home without them.

Katie Ferraro (6m 7s):

Yeah. But then once you have babies in the NICU, because then my twins, they were 38 weeks. We were not in a NICU. And I was like, please, can you tell you them to the next three weeks? Because I need to get some sleep. And those peak it's a one-to-one ratio in the NICU. Like they are really watching your babies, you know?

Terri Major-Kincade (6m 18s):

No, I have parents that are leaving. So like, oh my gosh, well, we have our next baby. We hope we get to see you again. I'm like, no, no, no. Like, no, I get in the NICU. And they're like, no, we are able to get the come back up.

Katie Ferraro (6m 30s):

I have waited so long to do this episode because it's really hard to find a doctor from the NICU who is interested or willing to talk to my audience because my audience are babies who are six months of age, getting ready to start solid food. That a lot of NICU doctors will be like, ah, I don't touch them because I only deal with the little teeny tiny ones and then pass them on to everyone else. So I have some specific questions for you, but understanding that, I mean, you're generally not seeing six months old babies in the NICU is, is that a safe assumption?

Terri Major-Kincade (6m 57s):

Not currently, but, but what my training was actually sent up to do a followfollow-u up. So my favorite part of the NICU is physician, parent communication and seeing babies once they leave the NICU, because if you're not thriving, when you leave, what is the point of what I'm doing in the NICU? That's my position. So I did see babies up to the first year of life or the first six, seven years of my career. I had a clinic for preemies babies that were former premature. So I don't do the clinic anymore, but that's the population I love. Like, how are you doing when you go home?

Katie Ferraro (7m 24s):

Let's talk about that. Then NICU baby. Because a lot of our parents listening, the baby was premature. They went to the NICU, they got discharged home. So when they get home, can you talk to us a little bit about when the baby's ready to start solid foods, what's different for a premature baby? What do we need to look out for?

Terri Major-Kincade (7m 42s):

So I think the most important thing about having a premature baby that I usually try to emphasize to families is How Premature you're baby was for How Premature your baby is. I mean, I think that's the most important thing for feeding, walking, all the milestones, talking everything. So a lot of times what happens when you take a premature baby home is your comparing them to your friends, kids, you know, and my friends kid is five months old in there doing this in mind that you're, maybe it was two months early. You a baby with three months early. So we have a baby that is three months early. Most termed babies will start there solid. You know, when you start introducing around six months, but if you have a baby that's three months early and your maybe six months, then the adjusted age is actually three months.

Terri Major-Kincade (8m 23s):

So I wouldn't expect a baby that's three months adjusted to be doing that. So I think the most important thing, first of all, for our preemies is to remember that they adjusted age is how the milestones are going to develop is not there chronologic age. Even though there are bodies out into the world, there are still going to develop based on there, adjusted age. And then the second thing is there's a range. You know, there is a range. So we, you know, you start introducing that six months. Some babies can do it at five months. Some babies can't do it, you know, six and a half seven. It just depends on the baby walking too. Most of the time we will walking. He has walk, you know, between 12 and 15, some babies walk at nine months, some babies on walk the fuck. I didn't walk up to 16 months. Actually.

Terri Major-Kincade (9m 3s):

I wasn't preemie. That's the problem that my mom didn't think it was the problem, but I think this is a problem. But anyway, and so the first thing is what is there adjusted age? What is the adjusted age thus, when I would expect they're milestones to follow up and then remembering there is a range, there is a range. So the three things that I am concerned about most often in preemies are what was there course. So you kind of mentioned there home now, but I wanna know what was there, of course, where they are disability that were slightly early or there is a Michael primi that had lung problems. So there are micro preemie that has some brain problems on worried about developmental delay. Are they a micro preemie? They had some airway problem's the breathing tube was in a long time. So the group of their palliate is different.

Terri Major-Kincade (9m 45s):

There was a baby, you have some older version because of the way we introduce feeding in the NICU. So what are their medical problems or the course that might delay their entry into feeding around six months. So my adjusted age, what does your medical course and how does that contribute to the neurologic development? So have you say to me and say, Hey, doctor and my baby was in the NICU. We went on five, there were no issues. My baby has been on breast milk and ready to go. I'm going to say, what is the adjusted age? If you tell me that the babies six month's around six months and then the other developmental milestones were being met, I'm gonna say, okay, lets go for it. So those milestones include the cycle term, baby, you know, your first milestone is holding your head.

Terri Major-Kincade (10m 25s):

They should be able to hold your head and not have head legs. You know, once your around six day weeks, then you should able to roll it over from your tummy. The, he should be the welcome from your bed. Then you have a baby sit up. So if you're a baby is not sitting up there, that doesn't necessarily mean you're a baby is behind. That could be right as six months adjuster, but they may be in that range and you need to make sure that there are no issues there. And even before all of these things, Katie, are they growing? Okay. So the most important thing for a premium, once they go home, honestly, we just want them to grow. When babies will come to my clinic, the parents might tell me 20 things, all them on. And I was like crying, but she might be like, he's not as he didn't take as many bottle of this. And I did. They grow that they grow or, you know, so they are growing.

Terri Major-Kincade (11m 7s):

If they are growing, all the other things, you know, generally are gonna catch up. If they're not thriving, we need to kind of figure out, you know, why they aren't thriving. And so when I think about introducing solids, I'm trying to get parents to understand where introducing and experience, but the bulk of their nutrition is still, you know, really going to be from their breastmilk of their formula for A while. tThank you for saying that because that's really a message that, to be honest, too many of your contemporaries are not saying they're stressing parents out about milligrams of iron and grams of fiber and micrograms of vitamin D. And it's like, Hey, these babies need the opportunity to learn how to eat. And with that will come their ability to get you there. Oh for sure. And even then when we see babies in the NICU, we have a version of, you know, you can tell just when you're talking to what they were on speech therapists or occupational therapists, like you'll have babies that are, who look like they're ready know to start oral feeding and people will say, well, there are only 30 for weeks.

Terri Major-Kincade (11m 59s):

They cannot have a bottle to the 36 where the babies is like he is, you know, they are like bringing the hands. You know, you want to be a little more progressive, but sometimes this field, there are a lot of things that we hold onto from the past. We haven't been as progressive. They

Katie Ferraro (12m 15s):

Will feel too, but he didn't feel any better.

Terri Major-Kincade (12m 18s):

So, and I try to bring in my occupational therapists and speech therapists and my dietitian, and then just being like, look, this is the area of expertise. Or, you know, if there are saying, we need to offer this to try this and we need to kind of follow their lead and not because even the parents I'll be like, what? You said that the baby wasn't ready, but they crammed into my shirt while I was on kangaroo care and LaShawn. Right.

Katie Ferraro (12m 39s):

I guess when you get them such a good point, that's, what's so nice about the NIC, that it really truly is a team experience. When you get home into the real world, you don't have the occupational therapists, speech, language pathologist, Registered Dietitian, and Dr. Terry there at your disposal. And that's why I think parents really appreciate a platform like this because we can hear from these experts and the hole, the followup course that you do is so important. And parents need to remember just because your home doesn't mean your home free. You do continue to need to be tracking growth. I wanted to ask you about micronutrients because again, I don't want to stress parents out about milligrams and micrograms of micronutrients, but for a premature baby, there certainly are some unique micronutrient. When I say micronutrient, just to make sure we're on the same page, your vitamins and minerals, what differs as far as those needs go for a premature baby versus a full term baby.

Terri Major-Kincade (13m 28s):

Right, So I think the most important thing for the preemie, and I don't know if we stress this enough to families when we start talking about four to find the breastmilk, but so there is three or four, have they come to mind immediately? So first calcium, calcium, calcium, calcium. So calcium is, is that important for all babies? What is especially important for preemies and most preemies are born with low calcium levels because the mother's placenta is sending the function of your thyroid when you inside mam. So when you get born, your levels of suppressed, so it takes a while for those levels to have come up. And that's the problem because premies need that for their bones. So calcium phosphorous. So those are the days that we first fortify your breast milk with, because we want those bones to grow.

Terri Major-Kincade (14m 9s):

We don't want your child to end up with rickets or weak bones or thin bones. And if you have a micro preemie, like a 23, 24, 25 weaker, that's a pretty big deal that we start that pretty early, because we can see on the x-rays. If your bones are not getting enough calcium and we follow labs, usually every two weeks, that kind of let us know if we've given enough or not. So calcium and phosphorus or the, the first things that I will mentioned. The next thing I would say is iron iron, iron iron is the mineral INR. Then I'll just say it again. And I, and iron and so neonatology, we've learned a lot about what, you know, this, you have a dietician about how we needed to change the way we supplement iron for baby, have some NICU do Ferris all separately to give more.

Terri Major-Kincade (14m 55s):

And some people give the Pali vice on with the iron, but the reason is so important. It's because most premium. So our babies have anemia or I'll start with turn babies, all babies that have turned babies, they show up with the anemia somewhere between four to six months, depending on how well they grew, they will outgrow their bone marrow stores, but preemies have two types of anemia. And usually the first type of anemia is, is what we call <inaudible> is a fancy name for cost while the hospital doing a lot of labs. And so your baby's sick. We do a lot of labs. We do laugh and make sure you're not anemic. And then the baby's like wine, but they may, they may come to him. He took off my blood, but now I am. And so we do it every week, you know, to make sure you're not anemic.

Terri Major-Kincade (15m 36s):

And then we like space it out because we realized we're making you anemic and sew. Premature babies have to reasons for anemia. So when they will be born with lower iron stores, breast milk, doesn't have a lot of iron, but it's very bioavailable to babies. So we don't necessarily worry about that too much. But we do make sure that moms who are breastfeeding, the babies are getting there supplement. So they have preemies have two whammies here. The first is from us having to take blood from them faster than they can make it. The second one is if they're thriving, which we want them to be thriving, that's another reason for anemia. So we have to have the iron and then the last thing I'm office and your, your, or the dietician. So you can correct me. I don't know if the senior micronutrient column, you know, but in the last 10 years, we've learned a lot about the importance of fat for brain development, for babies.

Terri Major-Kincade (16m 20s):

So, I mean, I finished training in 97 and we weren't as concerned about that for babies. And now everybody is adding the fat and were adding lipo on them. And we just making sure all of the babies are getting them because we know even for late preterm babies, they still have that whole extra month where they can get the brain development and it contributes to your Mala nation. That's the covering for the nurse ELs in your brain. So those are the four things. And the primary reason for preemies, that those things are lower is because the mom's placenta was serving that function. And then the baby comes out early. So the baby, you, it takes awhile for the babies stores to kick in. We have to give it through an IV.

Terri Major-Kincade (17m 0s):

We give TPN nutrition, but it's not the same as if the wants the babies on systems and stores are kicking in. So

Katie Ferraro (17m 8s):

Before I ask you about the fat, I want to back up and ask about the iron cause. One thing that I've always wondered is like, we always tell parents, okay, the transfer of iron for mom to baby happens at the tail end of pregnancy. So if you're baby wasn't in there cooking at the tail, end the pregnancy, they didn't get that big bowl as there push have iron for a mom. So it goes without saying that when the baby is born, if they weren't there going to be the iron deficient, like we know that that around what week does that transfer occur? Because we always say the tail end of pregnancy and parents like exactly what week is it? So is there an answer to that question?

Terri Major-Kincade (17m 40s):

The question, and I'm not sure I know the answer. So I would say somewhere between 36 and 40 weeks, but you know, it may not even be then Katie, because I'm sure you're probably aware of this before your audience. One of the things we've had to do to address iron deficiency, even in term babies is as a practice of the field has started doing delayed cord clamping. So perhaps some people and your audience, we get their for their baby. So when babies are first born and delivering, we use the cut the cord immediately. Now, if the baby is stable, we actually delay cutting the cord for 45 seconds to a minute to increase the amount of blood transfusion that baby will get from the placenta. And if you actually do that, it delays the onset of the physiologic anemia that we later see, you know, from growth and for preemies, it delays the likelihood of them needing transfusions.

Katie Ferraro (18m 28s):

I was always confused about that. The delayed cord clamping, is that something you can request as a patient and need to know about, or would that be like a hospital protocol across the board? We delayed cord clamping here at this hospital,

Terri Major-Kincade (18m 39s):

So you can always request. So my position as a parent advocate is you can always request whatever you want. The in the field is actually becoming standard of care. So, I mean, I covered for states, probably 50 hospitals, and we do delayed cord clamping everywhere. I actually don't work anywhere where it's not standard of care anymore. Even if the baby's sick, the OB was shot out. Do you want me to do the led core copy of your like 15 seconds? They can get me to baby?

Katie Ferraro (19m 3s):

Well, you're not asking the mom that when she's in the middle of this, like traumatic Brooke, is that

Terri Major-Kincade (19m 6s):

Okay that they're asking the neonatologist because we want the baby or the asking the pediatrician. So, and then the OB, well, actually you, if the heart rate is robbed or something, or do you still want me to do delayed cord clamping in most of the time, you will still say, yeah, at least for 15 seconds, because it will really decrease the babies rest for iron deficiency, anemia needing a transfusion.

Katie Ferraro (19m 25s):

So I want to go back and ask you about fat, because you mentioned the importance of fat for brain development. And obviously the, we worry with preemie babies. You know, it's the brain, the lungs, the eyes among many other things that could possibly go wrong. And so parents hear that. And what they interpreted as in a lot of times, just the pediatricians are kind of contributing to this misinformation is will, as soon as my baby starts eating, I need to be adding all these high-fat foods. I need to be do avocado. I need to be doing coconut oil. And the baby's like six months have agent doesn't even know how to eat. And the parents are setting themselves up for this like high pressure feeding environment. When the baby doesn't have the skill set to eat, they only say, listen, you need to be working with your pediatric dietitian on for, to find the breast milk or working with a fortified formula.

Katie Ferraro (20m 5s):

So a formula that would be tailored to premature babies. Can you talk a little bit about that using the milk versus the food when we're making this transition to solid foods?

Terri Major-Kincade (20m 15s):

Right? And I almost never encourage families, at least in a baby, not, not someone who is less than age two to expect that the avocado all or the coroner all or whatever there trying to introduce in there is making that 'cause that baby can't even eat enough at that age to me, but we can put a lot into the formula. So at least in the ICU nursery, initially, when we were given the TPN, as you, no, that's the IV nutrition, four, your audience, a lot of babies have IV nutrition. We just give them triglycerides so they can get that through the IV, supporting their brain development. And then once we're off Ivy foods, most Nicky is our work. And now we're doing the MCT, which is medium chain triglycerides. So we add that to the formula and is very easy using the MCT. All you, as, you know, two increase the calories in most baby's tolerated.

Terri Major-Kincade (20m 58s):

Okay. Some of them have, you know, diarrhea or looser stools. They may not gain weight as well. So you have to do something differently before MCT all became standard of care of most of the places where I work, we are in the beginning, we were just use, like, there was so crazy in my clinic. We would just tell parents to add a teaspoon or the coroner, all the Lord, all of all. I'm like, oh, we've come really far now. I mean, if that was like, we would write a prescription and just

Katie Ferraro (21m 21s):

And parents ask about that. Cause when they go home, they hear about MCT oil. And then if they want to go in, they want to be supplementing with, and it's like, this is not something to play around with on your own. You really, really should be working with a pediatric dietitian, even when you're home from the NICU, to make sure that you're getting the right sources that are age appropriate in the right amounts. Because two, you and me as a teaspoon doesn't sound like much, but to a premature baby with is still developing, you know, GI tract, et cetera is not something to be taken lightly, I guess.

Terri Major-Kincade (21m 47s):

Great. And really if a parent's, unless somebody's is failing to thrive, once they go home, we do not encourage additional supplementation, have any of those oils in their diet. And as you mentioned, if you failing to thrive, then you should be meeting with your pediatrician of your dietician, because that requires a very tailored approach. And then some babies, you know, have an increased risk for choking, or they don't tolerate the oral as much as they have changes in their stool. So that has to be followed really closely. So at least up to six months, you know, your breast milk, I encourage breast milk over there, not on breast milk than the 45 formula. I have what they need to supplement that. And then we started introducing the solids. Then I'm usually not telling people to add oils or anything like

Katie Ferraro (22m 27s):

That. You mentioned the fortified formulas for a family who goes home with a premature baby. Who's on either a breast milk fortifier or fortified formula. How long do they generally need to stay on that or who discontinues them from that? I love

Terri Major-Kincade (22m 40s):

This question because I find that so many of us don't talk to the parents about that. You

Katie Ferraro (22m 45s):

Paying for it when there 18 months old, sometimes I'm like, did you, this one,

Terri Major-Kincade (22m 49s):

You don't talk to the parents. And then another thing I noticed is if you had a micro preemie who is growing, you know, sometimes like even a pediatrician, isn't even still asking like, oh, are you still on the 45, 28 30 calories? Or, you know, 'cause the kids growing. And I'll always tell my parents, you know, when is that for you to get your, for my shot, you need to be like, look, I'm still on this. You know, so people can know. So if you have a micro creamy, normally for micro preemie really define that as you know, a baby that is less than two pounds. So 507 50 gram, usually a 22 to 24, 25 weeker. Usually those babies we would incur until is it what dictates? That is how well your Baby can eat. So most of premature babies, if they are don't have any other issues, if they do go on and bottle feeding, they may be taking around two ounces, 50 to 60.

Terri Major-Kincade (23m 34s):

If you have a reel guzzler who is older, maybe they take them, but most of them are taken about 50 to 60. And so if you're taking 50 to 60 or two ounces, then you would need to be on this four to five formula. At least until you take close to the three ounces and most babies can't do that until there are three to four months corrected, you know, but if you have somebody who is taking four ounces, they definitely don't need to still be on the 26th gallery formula, a 28 calorie formula, a 24. So what should determine generally is how much intake they're taking. So I usually tell the parents, you know, around for months, you know, when your getting your for months shots, if you baby is going and just kind of mentioned to your pediatrician, we're still adding this. Do I still need to do this? So you could start weaning off of, and the way my parents usually remember is I try to explain to them cause they, well, you know, there is where your babies we're big butt.

Terri Major-Kincade (24m 18s):

If you have a baby, that was really small. You actually not that bothered when they start getting like your happy, when they started getting all fat Raleigh police. So you actually liked, you don't

Katie Ferraro (24m 27s):

Want to start up point. Like we definitely see parents who are still doing fortified formula as well past the time when they should. And there are actually promoting undesirable weight gain. Exactly.

Terri Major-Kincade (24m 35s):

And that's what I tell them. I said is cute now, but they go around that don't go long and I sat. And then when you come to the NICU reunion, you're mad at me. Cause your like my babies are around. about 28 calome formula. It's like eating a protein shake that I just try to explain to him that sets this mostly carbs or, you know, the is increasing in the calories. We wouldn't recommend for anybody. So you definitely need to win. So normally the pediatrician is the person that supposed to be weaning and based on the Grove, but at least the parents who were my clinic, I just, just try to remind them, you don't bring it up. 'cause sometimes you know that you have so many patients, you don't remember who was on 24 calorie. Who's on 26, who is on 28 calorie. If they go home with oxygen or a G-tube or a trait that's different.

Terri Major-Kincade (25m 16s):

A lot of times those babies that there volume isn't actually increase in that much. They still need the calories. They're not growing as much. They're there growing, but not growing as well as you would like, but for other babies, we need to be getting off those things, get it on to the business of creating experiences with feeding.

Katie Ferraro (25m 31s):

I love the description of creating an experience with feeding. I think that's so important. And especially if coming from the NICU doctor, because no offense to your people are very, very, very focused on numbers as they should be in there in very, very small quantities. And sometimes it's so overwhelming to parents, but I think you give them that permission to step back and be like, listen, your babies still needs to the opportunity to learn how to eat. Just like a full term, baby, does

Terri Major-Kincade (25m 52s):

You want to try and normalize? Cause sometimes when he didn't have a baby of the NICU, it's hard to shift from the patient to baby. Cause we scared you to death. Oh, you don't even like, know how to, you want to have experience with your baby, But we frightened me. You so much. You really wanna be able to normalize that you write about the numbers. When we have residents rotate through the NICU, by the time they leave, there are so big because this is the land of minutia. The NICU is the land of numbers. We live and die on numbers and you know, it is hard to kinda break away from it. But we will, for me, I want you to be the mommy. You know, I don't want you to be the NICU nurse and I'm, I want you to be the mommy. And I want you to find those moments to enjoy that.

Terri Major-Kincade (26m 33s):

Even, you know, and feeding can be fun, but if your not petrified, but if you've seen your baby choked in the NICU or you, your maybe we were worried about aspirations early on, or if the baby have reflux or you remember that you remember your baby having an apnea, stop breathing. You remember your baby's dropping in the heart rate. Do you remember us running into the monitor? So it is sometimes it's hard to get to the point where you can shift. And I totally understand that most NICU parents have some component of post-traumatic stress. I mean, we have good data about that. I mean, I have posttraumatic stress. I have been in the neck.

Katie Ferraro (27m 3s):

Where are you working for 50 hospitals. I feel like they might be making you're posttraumatic stress, the word

Terri Major-Kincade (27m 8s):

I can't. I, you know, so it's hard to make that shift, but I try to make your mom's not looking like you're the best. So you're the expert. You're going to be the expert on your baby. Even when you go see the pediatrician and give them the information, you're still the expert on what is it like to be with your baby from moment to moment and be able to introduce those new experiences,

Katie Ferraro (27m 24s):

Dr. Terry, as far as feeding milestones go, how long do parents of premature babies need to use that adjusted age for like, is it going to be forever? Like they go to enroll in kindergarten. Like, well, how old are they really chronologically? Like how

Terri Major-Kincade (27m 36s):

Long have you do this? There is a Facebook meme like that. And like, instead of sending the child is 3% was like, adjust. That age is 36 months into, you know, I'm like, oh, what's your baby in the NICU. So I normally tell people. So in terms of development, I only really get concerned about it in the micro premium. But as a general rule, we stopped correcting for development is somewhere between 18 and 24 months. Because most babies, by the time they were two, in terms of their developmental milestones, they should be caught up. And so not necessarily for feedings specifically before the other thing is like walking speech delay or you know, words, using sentences, tactile stuff, picking up stuff. We usually stop correcting by the time they are 18 to 24 months in, you can get concerned that they know, you know, they might need some additional help or so, but for feeding, I still think that six to nine months, six to nine month age is there's a such a big range for preemies depending on what their experience was.

Terri Major-Kincade (28m 30s):

And the baby we'll let you know, like if your eating and your babies is pulling stuff out in your mouth and you've come to my clinic and your like, oh, I haven't introduced solids. Yet. Because they taught me to wait time. He was corrected. Okay. This kid is pulling stuff out of your mouth. So approximately you know, your baby is more advanced or not necessarily more advanced that we have a range. And I'm glad that you mentioned this about milestones. Cause for term babies, usually when I asked somebody, if they started serials, a lot of parent's interpreted it. Serial is something, they put it in the milk. And if you start putting milk in the cereal, milk and cereal of three to four months, cause you want is your baby to sleep through the night. Somebody's told you to make it their tummy more full, that I'm talking about a feeding experience where something has, you know, on there tongue, they were pushing it to the back of your throat.

Terri Major-Kincade (29m 12s):

They're swallowing. I'm not talking about serial in the bottle. So a lot of times when I'm asking, trying to see if a baby's ready to move to the next step, people will say, oh, I saw that my baby on cereal, I have two month's, but they mean they put in a bottle, you know, mean that the baby actually picked up something with their hands, you know, and put it in there,

Katie Ferraro (29m 28s):

Man. Okay. And is that time? I mean, NICU doctors are not recommending that. Right. We

Terri Major-Kincade (29m 32s):

Don't recommend that at all. You know, but it all, but sometimes parents do the stuff that we'll recommend in, you know, and my mom did it and my friend did it and you're just like, okay, that's why he can't gain like two pounds last week. They were getting, you know, cereal every night then in the bottle. So we discourage that. And that sometimes for reflux, yes,

Katie Ferraro (29m 49s):

He is a little bit of data for reflux, but it's like let the reflux doctor, but

Terri Major-Kincade (29m 53s):

There was no data. And for it being heavier in your tummy, your sleep for the night is kind of like the old wives tale. But it's

Katie Ferraro (29m 58s):

Like a lot of the nutritional information on a teaspoon, the rice cereal people like, you know,

Terri Major-Kincade (30m 4s):

It's like just let them eat ice cream all night.

Katie Ferraro (30m 7s):

Well, Dr. Terry, thank you. So much, this has been such an interesting conversation. Tell us where our audience could go to learn more about your work and find your resources. So

Terri Major-Kincade (30m 16s):

My websOC is Dr. T R M D is D R a T E R I N M d.com. So that's where most of my resources are. If you're looking for me on Instagram, it'll be doctor spelled out D C T O R Terry M D because somebody else was already Dr. Terry M D by the time I came, there is the grant. So that's why Dr. Is spelled out. So I have a book early arrival. That's a great book for parents in the NICU, teaches you how to talk to the staff. Talk to you the way we've been talking today and the five questions you need to ask all your medical team. So you always know what's going on with your baby. We'll

Katie Ferraro (30m 51s):

Thank you. That is that an absolute pleasure speaking with you, Dr. Terry? Yeah.

Terri Major-Kincade (30m 56s):

Anytime, anytime, keep up the good work.

Katie Ferraro (30m 59s):

Well, I hope you guys enjoyed that interview episode with Dr. Terry. She is one of my favorite people in all of healthcare. I think she is so inspiring. And I know she gives a lot of hope to families that are struggling, especially if you have struggled with a child who was born prematurely and in the NICU, I'm just so grateful that there are people like Dr. Terry out there taking care of our teeny tiny little babies. So I'm going to go ahead and link to all of her resources that she mentioned in this episode on the SHOWNOTES FOR THIS EPISODE, which you can find at blwpodcast.com/158. Thanks so much for listening and I'll catch you next time.