Floating Fat

Recently I was chatting with a pregnant client who was expressing concern about storing expressed milk for her new baby because with her last child she struggled with milk spoiling in the refrigerator. Naturally, I needed to know more about that so I asked a few follow up questions about how her milk was stored and something didn’t add up.

“How did you know it was bad?”

When watching her grandchild this client’s mom would take milk from the refrigerator when preparing to feed the baby and she would find that the milk had separated. She would then pour the milk down the drain thinking that it went bad and was spoiled.

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I felt so terrible for this mama. Her milk was not spoiled. She was experiencing a completely normal reaction of breastmilk that is sitting in a bottle in the refrigerator.

At my house we use a lot of vinaigrette dressing. When I take a bottle of dressing out of the refrigerator I automatically shake it up to mix all the ingredients together before pouring it on my salad. We all do this! If we don’t we would get a salad full of oil (fat).

Just like the dressing, when breastmilk sits in the refrigerator the sticky fat will slowly glob together and float to the top of the bottle forming a distinct layer. Remember back in grade school when we learned that oil floats on water? If you happen to look at the bottle each day that it sits you will notice that more and more of the fat separates out and they layer gets thicker and thicker.

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So if it isn’t spoiled then what do you do?

All you need to do is shake the bottle up so that the separated layers mix back together. Sometimes some of that creamy layer will stick to the sides of the bottle. Warming it up in preparation to feed and then shaking it will help that sticky fatty later mix back in.

Actual footage of my face when I hear this nonsense.

Actual footage of my face when I hear this nonsense.

While I am here let me just address another thing that drives me crazy. You can’t look at the layer of fat in a bottle of milk and determine its nutritional value. That is not a thing. If someone looks at your milk and tells you that it isn’t fatty enough or ‘skim’ milk and not ‘whole milk.’ by looking at the layer of fat floating at the top, please, just ignore them. This is not how we determine the caloric and nutritional value of breastmilk.

When it comes to milk storage guidelines you may have noticed some variation in the recommended timeframes for breast milk storage. This is because there are real world differences in how it is handled and stored including how strict we are with our cleaning methods, the temperature of the places where we keep our milk, where the milk is being stored, whether it is fresh or thawed, the health status of the children that will be drinking the milk, and ideal versus acceptable conditions. Below are some of the basic guidelines set forth by the Human Milk Banking Association of North America for healthy, full-term babies. These guidelines differ slightly for you depending on your specific situation and whether you are using ideal or acceptable guidelines.

Freshly expressed milk left at room temperature (73-77 degrees F): 4 hours

Freshly expressed milk in an insulated cooler with ice packs: 24 hours

Freshly expressed milk in the refrigerator kept at 39 degrees F: 3 days is ideal and up to 8 days is acceptable

Frozen milk that has been thawed in the refrigerator: 24 hours

Expressed milk kept in the refrigerator freezer: 3-6 months

Expressed milk kept in a deep freezer: 6-12 months

My Social Media Conundrum

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Supporting families is the number one goal of IBCLCs. We advocate everyday for support, support, support. We believe firmly that #supportisbest.

Where I live and work there are a number of places for families to look for support on their way towards their breastfeeding goals. I’m a breastfeeding mom myself and I really like checking out one of my local peer support breastfeeding groups on Facebook. I like to post pictures. When I was pregnant I asked for recommendations on new nursing bras that I haven’t heard of yet. I like to keep tabs on which pumps are popular and what people like about them. I like to see all the camaraderie among the participants and follow along with peoples stories. You know I love a good breastfeeding meme.

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As an IBCLC in private practice, I keep a resource sheet for clients that outlines all of the peer support groups in our area. I encourage new families to attend meetups and events because building a strong network of support is wonderful for families. I take my kiddos to the same events.

Oh, but sometimes, sometimes, the peer support groups on Facebook make me twitchy. I see things on these pages that make it hard to stay in my fellow-mom lane and not jump into my clinical-lactation-support lane. There are times when the questions and topics discussed are ones that really are better with the support and professional experience of an IBCLC rather than peer groups.

One of the most common ones that I see are worries about milk supplies.

It is really common for parents to worry about their milk supplies and to have the perception that their supply is low.

The outpouring of advice and encouragement for these parents is amazing and it’s what I found so wonderful as I celebrated my own highs and lows on my breastfeeding journeys. The thread soon becomes filled with advice, ideas, and suggestions on what worked and what did not. The encouraging comments included with the advice make my heart so happy.

So, what is the problem?

As an IBCLC, I have training in clinical lactation. I can help this mom. I can point her in the right direction, make a plan, and help facilitate progress but in order to do that I need to ask a bunch of follow up questions, get a health history for her and her baby, dial in to the basis of the concerns, and perhaps there will be a physical assessment.

What have they tried already? What else is going on in their life? What messages are they getting at home? Are they reading a parenting book? Trying out sleep training? Do they have an endocrine disorder? Are they pumping? What kind of pump is it? How old is the pump? Is the baby bottlefeeding when they are separated? Always? How is it being fed? What bottle? And on and on.

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The nuanced answers to those questions are going to help me figure out a care plan for that family.

It isn’t that the advice is necessarily incorrect. It’s just that it might not be the right answer for the parents particular and specific situational needs and their needs may be better met by professional help.

Sometimes the best comments are the ones that help connect a struggling parent with an IBCLC.

A Hard Start: Part III

Those three weeks were a mix of bliss and stress.

I struggled with trusting the process. I tried to recite the same advice that I give out to my clients. He was pooping and peeing, happy, and sleeping the same. Still, I was second guessing myself and kept asking everyone around me if they thought he was okay. Every moment I was debating if I should feed him again. Everyone was so patient with my repeated questions.

Do you think he is okay?

Do you think he is still hungry?

Do you think he needs more?

I relied on the patient reassurance from everyone around me. My husband would answer my repeated questions and point out all the reasons that we could tell that our son was fine. No one was impatient with me. No one ever sounded annoyed or dismissed me. Everyone was on our team.


The day to day impact of not having to pump, wash equipment, and supplement breastfeeds with expressed milk was profound. Suddenly everything seemed so simple. There was so much time. I kept imagining little moments of my life as a movie scene. Do you every do that?


I imagined a scene where I sat perched on the couch with my baby nestled in my arms. He’s drinking from my breast with soft little gulping sounds, eyes closed and hands relaxed. A coffee cup is in my hand. Around me my older kids are playing, filling their backpacks with their lunchboxes that my husband has prepared in the kitchen behind me. Cereal bowls are out on the table, there is conversation and morning activity. The camera zooms in on me, the chaotic morning sounds fade away and are replaced by a happy little tune, the people and activity in the background becomes blurry but I remain in focus. I raise the coffee cup to my lips and take a long sip. I gaze down at my baby and smile. HA! Lets be serious…that moment would last about a millisecond before someone was inevitably pissed off at someone else because they put the toothpaste on their toothbrush first or sat in the chair they wanted.

In some ways the enormity of the relief I felt from not having to complete those extra steps made me more anxious because if this experiment did not go well I would have to start it again. I had a taste of freedom and I didn’t want to go back.

I continued to offer a dream feed in the middle of the night and pumped afterwards. We packed up all my pump equipment and brought it along to Pennsylvania for Christmas with my family. I wanted to have some extra milk in case ‘something’ happened. If it turned out that this little experiment was not successful I did not want to lose all the milk supply that I had worked to rebuild. That nighttime routine was a little security blanket that I was not yet ready to give up.

The incredible anxiety and worry that I felt the first few days of our trial decreased a bit as the days went on. Every wet and dirty diaper, every sign of fullness, every contented minute of the day helped to convince me that we might actually be doing it. Pretty quickly the day came, three weeks of exclusive breastfeeding and it was time to return to the pediatrician. Luckily the office always been on time and we were called back quickly. I didn’t have to sit in the waiting room stewing in anxiety.

The nurse measured him first. We lined him up on the table along the wooden yardstick and stretched his legs out. I could immediately see that he had gotten taller.

YES!

She measured his noggin. It had grown as well.

YES! YES!

I set him down on the scale. He had gained weight. He gained a freakin’ normal amount of weight! He grew on his growth curve and held his percentile.

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We did it. Just shy of four months old we had figured out how to feed without needing the assistance of supplements and gadgets. Over the next few weeks I packed away all of the equipment we had been using.. I started weaning myself off of that extra nighttime pumping session, packed up the rental pump, and returned it. The only feeding gear left out was two bottles to be used when I was at work and unavailable to breastfeed and the pump equipment I would bring with me to my job. We visited the pediatrician when he was five months old and were able to confirm that he was still growing normally and thriving on exclusive breastfeeding. I came home that day and posted a notice on a local breastfeeding support group that I had milk to donate. I donated over 500 ounces of milk that I had pumped and stored during our experience. Where once I had a decimated milk supply, I now had enough to share with other parents and their deserving babies.

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The nagging doubts and questions about his wellbeing have quieted. I can see clearly that he is thriving and happy. Breastfeeding has settled back into a no fuss part of our daily life. Its a source of nutrition, comfort, and socialization. A parenting tool that I have in my toolbox. It’s everything I have known it to be. Occasionally, I will moments where a memory of that time will pop into my head and this surge of tension and anxiety shoots into my throat until I quickly remember that we are doing well. We navigated the twists and turns, followed our map, and conquered our hard start.

 

 

At the time of this writing, my boy is 9 months old and thriving. We are at the beach for a family vacation and we are boobin’ everywhere we go. I find myself imagining how my daily life would be if we hadn’t overcome the feeding challenges. My vacation would look really different if I was still needing to pump and supplement. If we didn’t have reassuring news at that 4 month visit I would have chosen to continue the pumping and supplementing because it was the right choice for us. I won’t lie. I am thankful that we made it here and that I don’t have to.

I am grateful that I knew when I needed help, that I knew how to find it, that I had skilled practitioners available to me, that I could afford the help I needed, that I had the determination we needed, and that I had support everywhere I turned.

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Here on the other side it turns out I was right.

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I can look back and appreciate the lessons I’ve learned, the hands on experience I have with all these tools of my trade, the deepened empathy I have for my clients in these hard situations, the feeling of accomplishment and the strong relationships that I’ve built with colleagues in the area. I am better for what I have learned even though it completely sucked to go through.

I’ve put together a small list of some of the lessons I took from this experience.

Support is everything.

If there is one area that I have expanded upon in my practice it is definitely talking about the importance of support of the feeding parent. Honestly, support is a HUGE deal whether there are struggles or not. Support or lack of support can make or break a breastfeeding journey. I speak about it in breastfeeding classes, at networking events, and specifically in consults and care plans that I create for families. One of the most common questions I get is about when a baby can have a bottle so the partner can help with feeding. Here are a few other ways to help that, I think, make a much bigger and profound impact.

  • Wash the damn pump parts. Don’t wait to be asked. It’s not just doing dishes. It is facilitating the ability to collect your child’s food in a clean container so they can benefit in our modern world where separation from our babies is a daily reality.

  • Know how to contact an IBCLC. Sometimes when you’re slogging through trouble it is hard to reach out for help. Do it for them. Dial the number and hand over the phone. Help get an experts eyes on the situation as soon as you need it.

  • Learn about breastfeeding. Go to the breastfeeding class and ask questions. Learn about how to tell if your baby is getting enough to eat. Learn how to soothe your baby, change diapers, do skin to skin, babywear, etc. Learn which parts of feeding you can help with and do those things.

  • Show you appreciation in ways that are meaningful to your partner. Words, kisses, hugs, a milkshake that you picked up on your way home, etc.

  • Protect yourselves from discouraging influences. Let people know that unsupportive comments and actions aren’t welcome.

A Pumping station is a game changer.

One thing that really helped me was to create a pumping station. For me, the most convenient place was next to my bed. I had a tray set up with the pump, pump parts, a small container of coconut oil, a phone and charger, and a small touch activated night light. My husband would bring my clean pump parts up to bed with us and I was able to pump my milk and set it aside until the morning. He would take the milk downstairs when he went to make breaskfast, bag the milk, and wash the pieces so everything was ready for a new day. I was able to use that station the whole day. Sometimes I would move it downstairs to a table next to my favorite chair. Having everything together shaved a few minutes off the routine which really adds up during the day. It also just helped me feel slightly more put together which was good for my mental health.

More is better.

Once you figure out your preferred pump part set-up go ahead and get yourself a few extra sets. It really helps take some of the urgency out of cleaning parts when you have a few clean sets ready to go. While we are talking about it, there are a ton of size and shape options for pump flanges that can be found online. If your current setup isn’t working for you then talk to your IBCLC about other options.

Organize where you can.

I picked up a plastic basket at Target that I kept next to the sink. All of the clean pump pieces and feeding tools would go into that. It helped declutter my counter and pleased my structure craving brain.

Build a team that respects and supports your goals.

You don’t have time and energy to waste on people who aren’t on your team. If you are not feeling respected and heard from your healthcare team then it is completely within your rights to change it up. Also keep in mind that your goals may change. They may change many times. That’s okay.

Use the plan that works for you.

It’s really important that your path forward be one that you can navigate. An example in my journey was that ideally I would have wanted to use an breast supplemental nursing system to supplement our breastfeeds. It would have been the ideal choice in an ideal, magical world. It turns out that my son HATED that damn supplemental nursing system. It was a nightmare trying to feed him with that thing. One time I was so frustrated I threw that damn SNS across the room and it smashed against the window, spraying milk everywhere. We used a special needs feeder instead. It worked for us. We had to make a change that was feasible for our situation. If something in your plan isn’t working out then reach out to your care team and talk to them about it. Find out if there are alternative ways to accomplish the same goal.

A Hard Start: Part II

I was recently with a client of mine who also happens to be a friend. While we were waiting for her baby to finish breastfeeding we were chatting and catching up. When conversation turned to my recent crazy breastfeeding experiences I found myself having a hard time coming up with a cliff notes version.

Our issues were layered.

They got worse before they got better.

They got better slowly.

It started out so normal. At first everything seemed to be relatively smooth sailing. My birth was very fast and intense but also powerful and healing. I had the intervention free natural birth that I had always hoped for. He breastfed right away and within five hours of his first time in my arms I was home in bed with my husband and son. We spent our time skin to skin, snuggling, watching movies with my older kids, and feeding on demand.

Image by Rachael Anastasio Collins

Image by Rachael Anastasio Collins

I wasn’t alarmed about the tongue and lip ties that I saw. I was expecting them after my experiences with my other kids. I saw them as a minor inconvenience that I would just take care of and move on. My latch was a tad uncomfortable but not terrible and he was happy and growing. I also noticed pretty early on that he kept his head turned to one side with even his gaze was stuck with his sweet eyes looking mostly in one direction. This congenital torticollis didn’t surprise me that much either. I frequently commented during my pregnancy that he stayed in the same spot all the time, he kicked around but never really rolled side to side.

I figured it wouldn’t be a huge deal. I am a professional, after all. I did the things I know to do. I made the appointments I needed to make and expected things to go according to plan. A wonderful friend of mine happens to be a pretty fabulous chiropractor and she gifted us with a meal and an adjustment for my guy soon after his birth. I made an appointment with a Craniosacral Therapist that I respect in town. I planned to start bodywork and then make an appointment for his lip and tongue tie release. I had it covered.

At three weeks old his lip and tongue ties were released by a great provider in my town and my boy handled the procedure surprisingly well. I did my aftercare, nursed my baby, and took him to his appointments with a physical therapist and then an occupational therapist to tackle the torticollis.

Do the things. It will be good.

But, it wasn’t. 

He wanted to feed constantly but would quickly fall asleep at the breast. Every time I would go to move him he would root around hungrily and cry, latch back on, suck a little, and then fall asleep again. This was not simply cluster feeding. This was all day long. His weight gain each week kept slowing and there was a period of a few days where he didn’t poop at all. I started to get more and more concerned. I kept doing all the right things—aftercare, sucking exercises, physical therapy, occupational therapy, CST, and chiro—but it was getting worse. He seemed to become more lethargic at the breast, sucking weakly and ineffectively. His tongue was not moving correctly. It was just bunching in the back of his mouth. For some reason, I decided to dig out my stethoscope and listen to his heartbeat. There was a heart murmur. Something that isn’t all that strange in a new baby but my panicked mind was connecting random dots thinking that maybe he had a heart defect causing him to feed poorly. Cue anxiety overload and a call to our pediatrician. An echocardiogram ruled out that worry when it confirmed that the murmur (small pat on the back for still having those nurse assessment skills) was actually caused by two small holes that will most likely close without issues but that wouldn’t contribute to feeding problems or cause fatigue in my boy.

What the hell was going on? The more his tensions unwound the more he seemed to fall apart. What kind of horrible lactation consultant was I that I was struggling to fix him?

I called up an IBCLC friend of mine just to see if she was seeing what I was seeing. She did and cofirmed what I was thinking — he needed more to eat because he wasn’t able to pull enough milk from my breasts on his own. I had to start supplementing with my expressed milk. 

I started pumping to increase my supply because it was wrecked after weeks of sub par nursing. He was so ineffective at pulling milk from my breasts that my supply started drying up. My mom came into town and my husband worked from home one day so that I could get it back. I rented a hospital-grade pump and for four days I pumped 10-12 times a day in addition to breastfeeding and supplementing my baby with my milk. I filled my freezer with 60 ounces of breastmilk donated from a friend because I wasn’t producing a full supply.

Image by Rachael Anastasio Collins

Image by Rachael Anastasio Collins

My professional brain was trying to do its job while my tired, emotional, and freshly postpartum mom brain was going crazy. Finally I waved the white flag and called a colleague. I surrendered to her expertise and treatment plans. My IBCLC hat came off and I embraced being the mom. I told her to just tell me what to do and I would do it.

I got to experience the other side of the relationship that I form with people in the course of my work.

She assessed, helped, made suggestions and treatment plans. She supported and encouraged and taught me new tricks. She answered my texts and calls. Many, many calls. She made gentle suggestions and supported me. She made firm suggestions and bolstered me. She collaborated with others to find the best tools for my silly baby boy who hated some of our typical devices. I followed instructions and did the work.

I triple fed my baby for weeks where I would put him to the breast first, then feeding him expressed milk from different devices, and finally I would pump to protect my supply and collect the milk he would eat later. We tried every breastfeeding aid and tool we could think of— different bottles, different techniques, different exercises, so much patience, different pumps and types of flanges to find the most comfortable fit, craniosacral therapy, craniofascial therapy, chiropractic treatment, physical therapy, occupational therapy, a second trip to the pediatric dentist for a buccal tie release, rebirthing in the tub, supplemental nursing systems, special needs feeders, tubes, and syringes. My husband and I washed pump parts constantly. I started an SSRI to treat my postpartum anxiety that was not being helped by the feeding struggles.

All of the equipment we used on our journey to successful breastfeeding. Image by Rachael Anastasio Collins.

All of the equipment we used on our journey to successful breastfeeding. Image by Rachael Anastasio Collins.

I cried a lot. I smiled too. I remember one particular moment when I was going through the motions of bottle feeding and happened to look down at my boy who locked eyes with me and gave me a gummy grin. It was like he was telling me that even through all of the crap we were going through that he was happy and loved me and we were in it together. I messaged with friends that had hard starts too, received a beautiful note of encouragement from my mother in law, a hilarious card from my cousin that made me laugh and served as a reminder to keep going, and made daily calls to my own mother. I spent my time rocking my baby, feeding my baby, smelling my baby, and wearing my baby close to me every chance I could because I had to put him down so much to pump out his food. My older kiddos watched way too much TV most of the time. Some nights I would miss then so much that I would hand the baby to my husband so I could cuddle my girls for a few minutes at bedtime. Some days were extra hard when I felt like a terrible mother to my big girls for being so distracted with feeding their brother. I pumped at dance class and in the car and at occupational therapy appointments and in the Target parking lot and in the car pool line at preschool.

MF'ing seagull

When I couldn’t see the progress through all the stress and despair there was my IBCLC, my friends, and my family reminding me of the incremental steps we were making and encouraging me to keep going.

Slowly, slowly, slowly there was progress.

Tensions unwound, muscles strengthened, and a baby grew.

One day in early December I was chatting with my IBCLC and giving her a status update. A few weeks prior I had returned to the pediatric dentist for the buccal release that we suspected was keeping our progress stalled. After that release it seemed that he started making a big jump in feeding ability. Our OT had discharged us from therapy because the torticollis was resolved and he was feeding well on the special needs feeder we had been using moving from the easiest milk flow to the hardest. I had this gut feeling that he was ready to fly solo. I talked over my ideas with my IBCLC and pediatrician and both of them felt like it was time to try. 

We made a plan to do a three week trial of exclusive breastfeeding over the Christmas holiday. At the end of the three weeks I would go back to my pediatrician and we would do a weight check to see how he did. I was forbidden from weighing him at home on my scale. I spent spent a few anxiety riddled days mentally preparing for our next and hopefully last hurdle and on a Saturday morning I woke up and breastfed my son.

Afterwards, I didn’t give him a bottle.

A Hard Start: Part I

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He is sitting on the floor of my bedroom happily grabbing for everything within reach and cramming his prizes into his mouth; the play kitchen food, his sisters discarded socks, the inserts for his diapers that were washed a few days ago but have not yet been assembled.  His seriously precious chubby cheeks and double chin are slick with drool. At six-months old he is cutting his first tooth. He is thriving and happy. 

His efforts to reach his sisters hairbrush result in a face plant onto the carpet. He lets out an angry yowl and I pick him up turning him into my body. He’s tired and his face hurts. I move him to my breast and he latches on deeply drinking in nutrition and comfort. His eyes are heavy and he throws his hand up over his face. Oh, good. He’s going to take a nap and I can get some of these chores done. The cat walks by and he’s wiggling to get down again so he can try and grab a tail. The nap will have to wait. 

Image by Rachael Anastasio Collins.

Image by Rachael Anastasio Collins.

This scene has played out in some form over the last six-years as I’ve been nursing my kids. What is just normal life today was a few months ago a much different bath time scene. It was rushed and stressful and included pump equipment and special bottles. There was no moment to relax and take in the quiet moments of my girls playing happily in the tub and my little dude experiencing his world.  

The stress and worry of those times still sneak in and nag at me sometimes. I have these fleeting questions flash in my brain,

“Is he okay? Is he growing? Does he look thinner?”

It takes a conscious effort to shove them away. Get out of here. You don’t belong here anymore.  

 I hand my boy an orange silicone water bottle brush that he is obsessed with and turn back to the computer. Sneaking back into my thoughts, a little voice wonders if I should even be writing about this topic as if acknowledging that we made it will somehow set us up for it to go all wrong again. Shut up. I shove it away again. 

Image by Rachael Anastasio Collins

Image by Rachael Anastasio Collins

My reasons for sharing this part of our breastfeeding journey are twofold.  

 

The first is to help me process the first sixteen weeks of my son's life. There was so much happening that is seems like a huge blur now. For weeks I lived my life in three hour increments with everything clouded by stress. I want to process all of the feelings from that part of my journey that were trapped within the net of despair and anxiety and determination.  

The second intention is to shed light on something many parents and IBCLCs alike have learned. Even though baby humans have evolved to grow best on species specific human milk that doesn’t mean that breastfeeding is easy.  Even when things progress as expected there is a learning curve and when it doesn’t go the way it is supposed to go then it can be downright hard and the path bumpy and sometimes with detours and roadblocks. Sometimes, the map has to change. This journey has helped me to understand even more than I did before that we need to be honest about that. It’s not always rainbows and unicorns. 

As advocates and supporters we mostly talk of the positives and benefits but we can teach all the positives while still discussing that sometimes it’s a challenging act. In fact, I think hearing the stories of the times that things don’t go to plan; the times when it is downright awful and hard is helpful. Hearing these experiences helps remove some of the isolation and despair that can be felt when its really hard. And it can be really, really hard. I want to let people know that struggles happen, sometimes things suck, and you’re not alone or at fault. Your story can have a hard start and still have a happy ending—one where the experience becomes joyful and fulfilling, whatever form that takes. 

I hope after sharing this three part series on my journey with my son that I will be able to share stories from other parents and that those reading might find something useful in them.  

Image by Rachael Anastasio Collins

Image by Rachael Anastasio Collins