Nipple shield weaning

Did you use a nipple shield to help your baby latch? Want to transition baby off the shield? First, weaning from the shield is your choice. If you like it and it’s comfortable for you, don’t feel pressured to get rid of it before you and your baby are ready. There are risks associated with shield use, like the potential for decreased milk supply. But if that’s the only way your baby will latch right now, give yourselves time and grace to keep trying as baby gets older and more proficient at the breast. As always, if you’re really struggling to get off the shield, find a knowledgeable lactation consultant to help you with the process to make sure something else isn’t going on with baby’s latch.

💡You can always start with the shield on and take it off after your first let down once baby is not as hungry or use it on the first side and offer the second side without it

💡Start by trying without the shield once a day during daylight hours when baby is happy and not too hungry. Catching baby with early hunger cues is imperative. If they’re crying and really hungry, try a different time

💡Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible

💡Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch

💡Help baby latch with laid back nursing, supporting the breast in a “C” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible. A baby that can’t feel the breast can’t latch to the breast.

💡Hand express to get your milk flowing so baby gets instant satisfaction and reduce the work

💡Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby

💡Try a nipple shield weaning system like this one from Back to Mom (24mm) or Lacteck (small/20mm).

Lip Tie vs Normal Lip Frenulum: An SLP/IBCLC Perspective

Lip ties (and their pictures on social media) drive me clinically nuts, because is so much confusion and misinformation about who actually has one. Too often medical professionals and lactation consultants say:

“All babies have lip ties”
“All babies have a band under there, there’s no such thing as a lip tie”
“That tissue will stretch with time/migrate up as they get older”
“They’ll eventually fall and break it on their own. No need to intervene”
“It doesn’t cause any problems, so just leave it alone”

On the flip side, some providers (and other random parents on social media forums) will say:

“See how the band of tissue is really low on the gums? That’s a lip tie”
“See how thick that band is? That lip is definitely tied”
“Lip ties are causing of all your nursing issues, cut it ASAP”
“Lip ties will cause all kinds of issues in the future, even if you don’t have symptoms now, better to cut it sooner rather than later”
“Where there’s a lip tie, there’s a tongue tie, your baby must be tied if they have any symptoms if a frenulum is visible”

Lip tie

I am the first to refer to the appropriate health care provider (ENT or pediatric dentist) when a true lip tie is not allowing proper function of the lips and is impacting the success of digestion or breastfeeding. But let’s understand a few things:

✏️According to a 1994 study by Flinck, who looked at >1000 babies, 77% of them had a frenulum that inserted “low” on to the gumline. A further 17% had a frenulum that inserted into the palate. So 94% of babies have a really low gum insertion – that is NOT the definition of a lip tie. Having a low set frenulum cannot be the only criteria used for release.

✏️There is currently no published criteria defining a normal frenulum vs a lip tie. That does not mean a lip shouldn’t be addressed when function is being impacted by anatomy. But that band between lip and gums is supposed to be there to some extent to help anchor your lips to your face for proper movement and facial development.

✏️Lip tie, when it is present, can certainly get in the way of a normal latch. A lip tie may cause increased air intake (contributing to reflux and gas), breast pain from the lips gripping too tightly to the breast, contribute to lip blisters muscle compensations, or not allow the baby to be able to maintain the latch through the whole feeding. While the lips are important for feeding, I’m more concerned about the tongue for obtaining a normal latch. Many compensations baby does to overcome a tongue tie may be mimicking issues seen with lip tie. Baby needs assessed for both.

✏️ It is rare for there to only be a lip tie. In the vast majority of cases, where there is a true lip tie there is also a tongue tie. The tongue is usually the reason for the symptoms as the tongue plays the major active role in breastfeeding. If the lip tie is released and symptoms persist, it is worth further evaluation of the tongue. I have had a few cases where a lip tie release only has resolved the breastfeeding issue, usually areola pain or popping on and off the breast from not being able to make a tight seal with the lips.

No lip tie

True diagnosis of lip tie is all about anatomy (what does it look like), physiology (what does it do), and symptoms (what is it causing). A lip tie will always impact function of the lip by restricting its expected movement. The upper lip should be soft and move to spread and pucker the lips without difficulty. The upper lip should play a passive role when breastfeeding, gently rounding to maintain the seal at the breast so milk doesn’t leak out and not gripping the breast.

An evaluation by an IBCLC should be mandatory before any baby is sent for oral surgery. Are the symptoms and behaviors at the breast being caused by poor position and latch? By tension in the body from birth trauma? Is tongue tie the actual culprit to the issues going on?

👄 The movement of the lip must be physically challenged to determine its full range of motion. If the lip is lifted up toward the nose, the center of the lip should move up toward the nose with the rest of the lip. If the center of the lip stays down against the gum line, it is most likely a tie. If no one physically flipped the lip up toward the nose, lip tie was not assessed.

👄 When you lift the lip, if the gums where the frenulum inserts turns white (blanches) OR the lip skin/frenulum turns white (blanches ) when you lift the lip up with reasonable amounts of pressure, the lip is tied.

👄 A notch in the bone of the gums where the frenulum attaches means the lip is tied. It indicates the tissue is so tight it’s now impacting the bone. This kind of lip tie needs immediately assessed and addressed as it most likely will impact dentition and dental hygiene.

👄 My baby has lip blisters. Does that mean they have a lip tie? Not necessarily. They may have a tongue tie and the lips are compensating for it. They may be constantly in a shallow latch at the breast or bottle and be using their lips to hang on. Lip blisters are a sign of shallow or dysfunctional latch and feeding should be observed to maximize latch.

👄 My baby always tucks their upper lip when nursing. Does that mean they have a lip tie? If the lip is still soft and can easily be flanges out, no, it’s not tied. Some babies like to tuck the upper lip or it gets accidentally tucked when latching and it’s not a problem. Tucking the upper lip can also happen when the tongue is tied- if the tongue can’t hold the seal (which is its job), then the lips have to. If the lips hold the seal, the lips have to be tucked in or milk will leak.

👄 The upper lip frenulum is one that can stretch and migrate up with time. As more teeth come in, the teeth may naturally help close the gap caused by some frenulum. If that is normal, why should it be released? An upper lip frenulum can migrate up over years, but if the restriction of the lip is affecting baby and mom NOW, then it should be treated NOW. Nipple pain and damage may have been normalized by the general public, but that does not mean it is normal. If you’re having symptoms associated with lip tie, have the lip and tongue assessed by someone who can properly evaluate and manage it.

A lot of emphasis is being put on lip ties right now, especially by well meaning parents on social media. Remember: you usually cannot tell if a lip is tied from a picture alone. A full, dynamic assessment is needed. If a health care provider looked at the lip without actually completing a full inner mouth assessment in the lips, cheeks and tongue, and observing a feeding, a full assessment wasn’t made. While a lip tie alone can get in the way of feeding and cause some pretty intense symptoms in some babies, the main focus should be on good position and deep latch with normal tongue mobility.

Normal frenulum. No blanching and lip flips without difficulty

If you’re struggling with breastfeeding, seek out a qualified IBCLC or schedule your consultation with me ASAP to determine your next steps.

Weaning schedule

There are many ways to wean and you get to decide how you’d like to wean for your family. I recently had a client who wanted to gradually wean her 6 month old and needed a structured plan to help navigate the process. This is by no means meant to be for everyone, but I thought some one else may find it helpful if it sounds similar to your pumping or feeding experience and you’re looking for some guidance. You can always reach out for a consultation and we can work on a plan that’s individualized to work for you!

Week one: Monday to Thursday:

6:30am – Breastfeed (about 15 mins)
7:00am – Pump 15 minutes
10:00am – Pump 15 minutes
1:00pm – Pump 15 minutes
4:00pm – Pump 15 minutes
6:30pm – Breastfeed (5-10 mins)
8:30pm – Pump 15 minutes

Week one Friday to Sunday:

6:30am – Breastfeed (about 15 mins)
7:00am – Pump 12 minutes
10:00am – Pump 12 minutes
1:00pm – Pump 12 minutes
4:00pm – Pump 12 minutes
6:30pm – Breastfeed (5-10 mins)
8:30pm – Pump 12 minutes

Week two Monday to Thursday

6:30am – Breastfeed (about 15 mins)
8:00am – Pump 10 minutes
11:00am – Pump 10 minutes
3:00pm – Pump 10 minutes
6:30pm – Breastfeed (5-10 mins)
9:00pm – Pump 10 minutes

Week two Friday to Sunday 6:30am – Breastfeed (about 15 mins)
9:00am – Pump 10 minutes
12:30pm – Pump 10 minutes
3:30pm – Pump 10 minutes
6:30pm – Breastfeed (5-10 mins)
9:00pm – Pump 10 minutes

Week three Monday to Thursday
6:30am – Breastfeed (about 15 mins)
9:00am – Pump 5 minutes
12:30pm – Pump 5 minutes
3:30pm – Pump 5 minutes
6:30pm – Breastfeed (5-10 mins)
9:00pm – Pump 5 minutes

Week three Friday to Sunday
6:30am – Breastfeed (about 15 mins)
10:00am – Pump 5 minutes
2:00pm – Pump 5 minutes
6:30pm – Breastfeed (5-10 mins)
9:00pm – Pump 5 minutes

Week four Monday to Thursday 6:30am – Breastfeed (about 15 mins)
10:00am – Pump only to relieve discomfort
3:00pm – Pump only to relieve discomfort
6:30pm – Breastfeed (5-10 mins)
9:00pm – Pump only to relieve discomfort

Week four Friday to Sunday. 6:30am – Breastfeed (about 15 mins)
11:00am – Pump only to relieve discomfort
Afternoon – Pump only to relieve discomfort
6:30pm – Breastfeed (5-10 mins)
9:00pm – Pump only to relieve discomfort

Week five
6:30am breastfeed if desired
Pump once or twice only to relieve comfort
6:30pm breastfeed if desired

Slacker boob

Did you know? Around 70% of women produce more milk in the right breast. Which means 30% make more in the left. It is VERY common for one side to produce more than the other. Some times double on one side. We don’t know why. This is not a reason to neglect one side. You want to make sure you rotate which breast you offer first. Babies may prefer one side over the other for various reasons:

👶🏽They like to lay with their head in a certain direction or their body is uncomfortable in the opposite position

👶🏿They prefer the flow (one side may flow faster or slower than the other)

👶🏼They may prefer the flavor (YES!! Milk can taste different form each breast during the same feeding!!)

If you want to help balance out a slacker boob:

🔆Offer the slacker first more often. 

🔆End on the slacker can also help, especially if baby just wants to use you like a pacifier. 

🔆Pump the slacker side during or after feedings can also help stimulate more milk production

🔆Make sure you have the correct sized pump flange on the slacker side. Our nipples can often be different sizes and using the wrong sized flange can drop supply on that side

🔆Hand expression on that side at random times of the day even for a few minutes will jump start increased production. 

🔆If it’s positional from your baby (they only want to lay cross cradle to the right and not the left, experiment with other positions like football or side lying to help baby compensate for their body. If your baby prefers one side of the other from a positional perspective, consider taking your baby for some infant bodywork like chiropractic or craniosacral therapy.