The University of New Mexico is home to all types of learners. From 18-year-olds fresh out of high school, to retirees dipping their toes back in, to everyone in between, UNM has lessons and experiences for all–that includes students who don't even know their ABC's.
These little babies are pupils of the UNM Speech & Hearing Sciences Gap Clinic. Launched as an expansion of its feeding clinic in 2021, the Gap Clinic focuses on the gap between neonatal intensive care and early intervention care.
"These babies for various reasons have difficulties with feeding. For some who have a complicated start, it may take a couple of months to develop the skills needed to safely and efficiently eat. Some may be readmitted to the hospital or develop more serious complications around feeding if not provided support. Without support those issues could go on for a really long time, so I wanted to do something that would fill the gap between the great support they receive in the NICU and Early Intervention. Thus the Baby Feeding Gap clinic arose," Gap Clinic Director and Speech & Hearing Sciences Clinical Instructor Andrea Martinez-Fisher said.
The purpose is to serve a variety of needs for a variety of ages, all centered on alleviating challenges related to feeding safety and efficiency.
"Sometimes they're sent home from the hospital without a solid plan in place, this may be due to not having a provider in their rural town, or needing more time to grow and develop, becoming stronger. Often they need to either work on becoming a little bit more stable with their breathing or they're un-interested in eating," Martinez-Fisher said. "For many reasons, they've had a pretty traumatic start, so it's providing assistance to the caregivers and infant so they can safely eat and grow or begin eating for the first time."
Martinez-Fisher noticed the need firsthand, after 18 years of experience in the field.
"I've worked in the community with Early Intervention and in the NICU (neonatal intensive care unit) as a speech language pathologist and a feeding specialist for a really long time. What I noticed is that there was a gap in services between the NIC-U and early intervention," Martinez-Fisher said.
Infants with pediatric dysphagia may include a need for g-tube placement, having a cleft lip/palate, oral aversion, requiring a ventilator therefore complicating feeding, troubles growing, trouble with reflux and so much more.
"It can be infants that are born with syndromes, babies that are coughing and choking while they're eating. It can be a variety of things," she said,
Martinez-Fisher's passion project has become an invaluable part of Speech & Hearing Sciences services. Parents and their children come from all over the state to take advantage of what is actually a quite rare offering in the U.S.
"There's such a need for it. There aren't a lot of feeding specialists in rural areas, so either they have to travel to find someone to service them, or they just don't get services. Families in very rural areas are left to figure it out on their own and everyone's doing the best they can," Martinez-Fisher said.
There are no limits to sessions, either. Each Gap Clinic session is specifically catered to serve every family's needs, no matter how long it takes. Martinez-Fishers' caseload rotates between 20 to 50 families at any given time.
"The cool thing about the Gap clinic is that we are filling a Gap, so my caseload is constantly rotating as they move on to the next level of care, usually Early Intervention. When we are able to help the infant feed safely and efficiently and parents are feeling more confident as far as feeding goes that's a huge improvement to their day and the outcomes for the infant," she said.
Referrals from doctors guide the start of the program, but the rest is up to Martinez-Fisher, the parents and the infant.
"My program specifically coaches parents on how to work with their babies. It's a lot of education to parents–a lot of hand over hand. I do feed babies, but it's often just to figure out what's the best plan is so I can turn it over to the parents," she said.
"Hopefully we can take the load off families because when they're in that situation it's so stressful. If we can get that going smoothly, then they can share that with other family members and it improves the quality of their life as well as the babies lives." – Clinical Instructor Andrea Martinez Fisher
Martinez-Fisher is also assisted by multiple graduate students, who all want to be speech pathologists and/or feeding specialists someday.
"I always have a graduate student with me because we're here at UNM. Over the course of the semester, they'll figure out how to work, handle, evaluate, treat a baby, make recommendations to caregivers and write up reports. They're involved in every portion of their care," she said.
That means it's not just good for day to day, but the good of New Mexico for years to come.
"It's good for the families, but it's also really good for our graduate students. Getting more graduate students trained in pediatric dysphagia and feeding means after graduation, they will hopefully go back to the rural communities they came from, and provide services where they are so desperately needed," Martinez-Fisher said.
The Gap Clinic has helped dozens of families just in the last two years. Each step of the way, especially the moment when the babies are eating well, thriving and can graduate, is rewarding for Martinez-Fisher.
"Pretty much every single family I work with is very worried about feeding or they wouldn't be here with me. For a baby, feeding happens every two to three hours. It happens around the clock. If you can imagine, they're so stressed and so worried all day, every day," Martinez-Fisher said. "If they can come in and we can give them a plan that works, so that their baby is thriving, healthy and doing well, it makes all the difference. When they are successful, that stress can start dissipating and they can start feeling better about feeding their baby and spend that energy working on bonding."
You can learn more about the Gap Clinic and what it can do for families by contacting Andrea Martinez-Fisher.
"The Gap Clinic is here to help families learn how to safely and effectively feed their babies," she said. It's also here to help students grow their interest in pediatric dysphagia and make them competent clinicians. Our goal is to increase access to needed services for all babies in New Mexico, rural and urban, by training more providers to go out and work in the community."
