Most lip blisters in newborns are caused by all the sucking they’re doing to get their milk. They’re often caused by friction on their sensitive lips. The skin of the lip had 3-5 cellular layers, very thin compared to typical face skin, which has up to 16 layers. The lip skin is doesn’t have sweat glands, so it lacks the protective layer of sweat and body oils which keep the skin smooth and moist. This makes the lips dry out faster and become easily chapped.

Lip blisters, AKA:

• Friction blisters
• Suck blisters
• Suck callouses

The sucking reflex starts around week 32 in the womb and is fully developed around 36 weeks. Occasionally a baby may be born with these blisters if they were super active at sucking in the womb.

Babies should latch by cupping their tongue around the breast and creating a vacuum seal in their mouth. The tongue then pumps up to compress the breast to squeeze out milk and then pumps down to generate negative pressure in the mouth to draw milk in like a syringe. The tongue is the dominant organ in effective breastfeeding. The lips actually play a passive role in feeding and should stay soft without the muscles engaged. They are only meant to prevent milk from leaking out of the mouth. Babies get suck blisters/two tone lips from overusing their lip muscles, specifically the one that rounds and closes the lips, called the orbicularis oris.

Think of it like this: try drinking from a straw. You usually put the straw in about 1-2 inches so your tongue and teeth help support it. This gives the straw stability so you can direct the flow of liquid in your mouth. If the straw is only touching the border of your lips, you need to use more of your lip muscles to keep the straw in place and from falling out of your mouth. Your tongue, cheeks, and teeth/gums provide needed support to keep the straw in without over working your lips. Same with the breast or a bottle nipple. The baby’s tongue is supposed to be the dominant muscle in maintaining the latch, with the cheeks and lips playing a passive, supportive role.

Very small blisters that go away in a few days are normal for newborns as they’re learning to latch and suck. Blisters that don’t disappear in the first week or two or that are extensive across the lips are a sign something is going on.

Reasons for lip blisters:

👄 Baby’s in a shallow latch (to breast or bottle) use their lips to hold on to prevent losing the latch. This is the simplest to fix. Fix the latch, the blisters go away. Usually baby is in a shallow latch because of how they’re positioned. Make sure baby is completely touching your body, tummy time tummy with their belly button touching you and not on their back. Baby’s face should be coming straight to your breast instead of turned toward one shoulder.

👄 Lip blisters are a classic sign of tongue/lip tie where the lips are compensating for the lack of range of motion/strength/coordination of the tongue because it’s being tethered to the floor of the mouth.

👄 Premature babies may also get lip blisters as they should still be practicing swallowing in the womb with no expectations. Babies born 34.0-38.6 weeks gestation may look like fully formed babies, but have a lot of maturing and growth to do outside the womb. Their brains would rather be sleeping than eating, and they can fatigue quickly at the breast. They also use those later weeks in utero to practice sucking and swallowing while being fed through the umbilical cord. Premies Also have under developer fat pads in their cheeks. The last weeks of pregnancy help fattening these up. The fat pads support the tongue to make sucking more efficient while decreasing the amount of space in the mouth, this means less suction is needed to draw milk into their mouth. Without the fat pads, babies use alternative muscles to maintain a latch, hence the lip blisters as they’re using their lips more than needed.

👄 When babies are born, there is a lot of pressure on their head and neck. Babies are also supposed to move their head and body around in the womb and again during delivery to help themselves be born. Sometimes they get stuck in a certain position and this can put extra pressure on the baby’s body. If they sat low in pregnancy, we’re always positioned in a certain way, or have little room to move around, we can some times see cranial nerve dysfunction. This can also happen when a baby is pulled out (cesarean, vacuum, forceps). Proper nerve function allows correct muscle movement. If a nerve involved in sucking is temporarily squished, pinched, or strained, certain muscles (tongue, cheeks) can’t function properly which can lead to compensations. See the videos on my YouTube channel for stretches to help baby move their muscles better. If you think baby may have a stretched nerve, chiropractic care, craniosacral therapy, physical or occupational therapy can definitely help.

Did you know that many of us will notice a supply drop right before our period is going to start and lasts through the period? This is caused by hormone shifts in your body. During this time, as supply dips, the milk flow slows and the milk can taste saltier than normal. Some babies become frustrated with this change. They may grab the nipple with their mouth and shake their head back and forth. Pop on and off the breast. Knead or beat the breast with their hands or become extra fussy at the breast. They may even cluster feed and act as if they’re still hungry. They’re trying all the strategies to get your milk to flow how they prefer. This is a temporary dip but can be surprising the first time it happens. Remember: this dip can happen once or twice before you actually have a period as your hormones are shifting back into baby making mode. If your baby is older than 6 months and eating lots of solids, you may not notice a difference. The strongest behaviors are seen under 6 months when babies need an exclusive milk diet. You may also notice the dip if you’re a pumper.
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What can you do about it? Knowing it can happen is the first step. Stay well hydrated and eat quality nutrition. Many find adding in a calcium/magnesium supplement (1000mg of calcium/500mg magnesium per day split into 3-4 “doses”) can help combat the drop. Others find adding in lactation specific herbs or supportive foods help. Iron rich foods like dark leafy greens and red meat and milk making foods like oatmeal, almonds and fennel can really help. Keep offering the breast or pumping frequently. It will get better and your supply will come back up as soon as your hormones shift again after your period. It usually only lasts a few days.
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When did your period come back? Did you notice a supply dip?

Tandem breastfeeding is when two or more children breast/chestfeed or receive expressed milk at the same time.

It is possible to continue to breastfeed throughout pregnancy; however, there are some important things to know. Some may experience nipple sensitivity or a feeding aversion to the point that they want to stop feeding the older. About 1/2 report their milk supply drops, sometimes significantly. This is from hormonal changes and there is little that can be done to prevent this. If the first baby is less than one year old, supplementation may be required until after the birth of the baby. Milk can transition back to colostrum as early as the end of the first trimester. Colostrum is salty and some toddlers not drink it. Colostrum also acts as a laxative to help newborns poop meconium. It may have the same laxative effect on your toddler, so be warned!

Once the new baby comes, some will feed both children together at the same time, rotating which side they start on each time. Others may take turns to feed one child at a time. If the babies are of different ages, they’ll usually feed the newborn first to optimize milk supply. Many tandem feeders say that breastfeeding their toddler helps with the transition of having a newborn.

Removing more milk from the breasts

One easy way to increase your milk output with pumping is by breast massage and compression while pumping. One study found when mothers used their hands while pumping they were able to get 48% more milk than without using their hands! Their milk also had more fat in it

Steps to hands on pumping:

1. Massage both breasts. Massage both breasts using small circles in a spiral pattern (similar to a self-breast exam). Milk is made at the back of the breast, so focus on the back and sides of the breast. Stroke the breasts from the chest wall down toward the nipples. Use a light touch to help you relax and to help stimulate your let down.

2. Pump both breasts at the same time (double pump). Start in the stimulation (fast/light suction) mode of your pump. Gently compressing your breasts while pumping. Pay special attention to areas where you feel lumps (these are full milk ducts). Using medium pressure, stroke your breast from the outer margin in toward the pump to empty the ducts. After 1-2 minutes switch to the express (slow/higher suction) mode for 4-6 minutes. Switch back to the stimulation mode for another 1-2 minutes and then back to the expression mode for another 4-6. Keep alternating settings until milk flow slows to a trickle.

3. Massage your breasts again, concentrating on areas that still feel full.

4. Finish by either hand expressing your milk into the pump’s nipple tunnel or single pumping (one breast at a time) whichever yields the most milk. Either way, during this step, continue to compress the breast from chest to nipple on each breast, moving back and forth from breast to breast several times until you’ve drained both breasts as fully as possible.

The breast is a gland made up of connective and fatty tissues. There are small clusters of milk making cells in the back of the breast called alveoli. A hormone made in your pituitary gland called Prolactin causes your alveoli to take nutrients (proteins, sugars) from your blood supply and turn them into breast milk. Oxytocin causes the cells around the alveoli to contract and eject your milk down the milk ducts. This passing of the milk down the ducts is called the “let-down” (milk ejection) reflex. Most of us will have multiple let downs in a single feeding/pumping session but in general only feel the first one, which is the strongest.

Let down is usually triggered by stimulation of the nipple, either from baby’s mouth or a breast pump. Some people feel their let down like:
🔥Burning
📌Pins and needles
⚡️An electric shock
☀️Warmth

Some people never feel their let down. They know they’re in let down when:
🥛Leaking milk from the other breast
🤱🏽Baby audibly swallowing milk

Others may let down just fine for their baby and struggle to let down for their pump. The let-down reflex also may occur if a feeding is overdue, if you hear a baby cry, or if you think about your baby. You can teach yourselfg to let down by training your body to respond to a sound, smell, or event. You can also trigger more let downs when pumping by alternating between the stimulation and expression modes on the pump.

In the early weeks after delivery, babies rely on instinct and reflex. They are in tune to what their body needs and respond in the only way they knew know how, through crying or cueing. Babies are also born with an underdeveloped biological clock and circadian rhythm that takes months to mature. Being on your body and at the breast actually helps regulate and develop those systems.

Breast milk digests very quickly compared to formula (in about 90 minutes) and exclusively breast-fed newborns will feed 10 to 12+ times in 24 hours as that milk digests quickly. Most babies want to take 2-4oz per feeding For most parents, their body makes this exact amount, which is a perfect match to their babies. It’s unrealistic for most to either make or want to eat 5-6oz feedings. Obviously there are ALWAYS exceptions to this. It’s just not the majority. Your body naturally has higher milk making hormones at night, so supply is at its highest between 2-6am, helping babies take shorter feedings to help them transition back to sleep sooner. Did you know that night milk also has hormones in it to help set up baby’s circadian rhythm?

Some times babies come out with a preference to turn their head to one side. This may simply be from how they were positioned in utero. Babies who sat really low in the pelvis or who have short moms with no space in the belly tend to be much more cramped and you can often see how they were positioned inside when they’re on the outside. A head turn preference or tilt can also be caused from birth trauma, like from a forceps/vacuum delivery or a really long pushing stage where baby was in the birth canal at a certain angle for a long time.

A mild head turn preference usually works itself out with lots of tummy time and the natural stretching that occurs outside the womb with position changes. It’s why rotating breasts is important to get baby moving in all directions. When baby is sleeping on their back, be sure to rotate which direction their head is laying to naturally help stretch out those neck muscles.

If you notice a consistent head tilt or turn that doesn’t go away in a few weeks or if it’s impacting feeding, there are multiple professionals that have additional training to help: specialized occupational and physical therapists, pediatric chiropractors, osteopaths and craniosacral therapists can work with your baby to help bring symmetry back to the body and release tension in baby’s muscles. If left unaddressed, it can potentially contribute to colic, increase flat spots on the head, or lead to torticolis.

Growth charts are used to compare the growth of your child compared to thousands of other children of the same age and gender to track their growth OVER TIME. If you took 100 babies and lined them up by weight, where would your baby fall in line? If they fall in the 36th percentile, for example, they weigh more than 36 babies but less than 64 babies. The goal isn’t for every baby to be in a top percentile, like a grade. The goal is for baby to stay around their percentile while they grow over time.

Growth patterns differ between breastfed and formula-fed babies and there are different growth charts to track growth depending on how baby is being fed. Beginning around 3 months of age weight gain is generally lower for breastfed babies than for that of formula-fed babies. For the first 3 months of age, the WHO growth charts show a somewhat faster rate of weight gain than the CDC charts. After about 3 months of age, WHO growth charts show a slower rate of growth than the CDC growth charts. Because formula-fed infants tend to gain weight more rapidly after age 3 months, they may be more likely to cross upward in percentiles on the WHO growth charts. In general, we like to see a baby staying on their growth curve.

Growth charts are not intended to be used as a sole diagnostic instrument. Instead, growth charts are tools that contribute to forming an overall clinical impression for the baby being measured. This does help guide us to determine if feeding is in general going well and if adjustments need made. If your baby is losing percentiles or significantly dropping off their curve, and your goal is breastfeeding, a good pediatrician won’t just tell you to supplement. They’ll also refer you to a lactation consultant to help figure out why. Is it a supply issue, a feeding issue or both?!

Full movement of the tongue is needed for normal feeding, swallowing, chewing, speech, and breathing. The tongue needs to be able to move:

👅 In and out (and stay out for an extended period of time when breast or bottle feeding). The tongue should be able to protrude past the lower lip without any tension on the tongue. The tongue tip should be round or square and not notched or heart shaped.

👅 Side to side (enough to eventually clear food from the back molars). The ability to move the tongue side to side helps move food to the teeth for chewing.

👅 Up and down (the MIDDLE of the tongue being able to move up and down is actually what is needed for a baby to be successful at the breast). If your pediatrician told you your baby could stick their tongue out so there was no tie but didn’t check how the middle of the tongue moves didn’t actually assess your baby for a tie and doesn’t understand how the tongue needs to move for your baby to feed.

If the tongue cannot do these movements, it can have a chain reaction to limit or negatively impact other systems, including the respiratory system. Snoring in a baby is never normal. Open mouth posture except for when baby is sick is not normal.

Having a visible frenulum does not necessarily mean the tongue is tied. If the tongue has a frenulum but it still allows the tongue to move in all directions, it is not tied. A visual inspection from a picture or video is not enough to diagnose a tie. Only a hands on assessment where the tongue movement is challenged in all directions is enough to tell us whether or not the tongue is tied.

Once a tongue tie has been identified it’s often recommended that the tissue forming the frenulum be clipped, revised, or released. This it’s not always a magic wand to fixing all of the breast-feeding or bottlefeeding issues that a baby is experiencing. There are three components that need to happen for a baby to be able to effectively feed: strength, range of motion, and coordination of the muscles of the lips, tongue, and cheeks. For a baby that has good strength and range of motion of the tongue but the tie is restricting the ability for the tongue to move in all directions, having the time released often is an overnight miracle cure to many of the issues seen with feeding.

However, for those babies that also have a head turn preferences, low tone or high tension in the body, reduced strength and difficulties coordinating their mouth muscles, just having the ties released alone is not an instant fix. Some may even find that feeding gets worse before it gets better. Other therapies and specialists may need to be seen in order to be able to get feeding back on track and optimal. This may include chiropractors, cranial sacral therapist, physical and occupational or speech therapist as well suck training or oral motor exercises. Make sure whoever you are seeing who feels like you baby is tied is making the appropriate referrals and setting up realistic expectations based on what your baby can and cannot do.