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.

This is the first generation that has had the luxury of having a freezer milk stash. No other generation had the ease and technology to be able to go back to work and still maintain the breastfeeding relationship while parent and child are separated for 8+ hours a day. In our grandparents generation, you either stayed home and breastfed your baby or formula fed by bottle. There really weren’t other options and breast pumps were not readily available. It was only in 2010 that the Affordable Care Act laws were passed to require insurance companies to cover the cost of breast pumps as part of preventative medicine. With those laws, new breast pumps flooded the market. Before that, there were only a few choices for pumps and people had to buy them out of pocket. Because we have been raised around technology, we still take for granted what our not so ancient ancestors went through. Historically, if weren’t successful at breastfeeding, either some one else breastfed your baby or your baby died.

You don’t have to have a freezer stash to successfully breastfed your baby. If you need a freezer stash because of your circumstances, what an amazing time to be a parent!!! New and better technology is available every day to continue to make the process easier and more efficient. The freezer stash can mean reaching your personal goals as a family. If you have an abundant supply, consider milk donation to help other families reach their goals. What a gift to be able to give back to others.

Do I need to do stretches on my baby’s tongue after a tongue tie release? There are many conflicting answers, and it seems like every dental job or ENT practice has a different answer, which gets really confusing for parents. The biggest concern is tongue reattachment after it’s been released, defeating the purpose of release. For some babies it means needing it released again.

From my speech pathology/IBCLC background, to give one answer to all families is a disservice to the unique nature of each tongue that is released and how each body heals (which is as distinct as the individual). We have to consider that this is wound care and we need to understand what that specific tongue did before and after the revision. When you have a tongue that is strong (good muscle tone) with good range of motion, but was only limited because of the frenulum, the stretches, exercises and wound care management are different than a tongue that is super weak and with disorganized movement. I have found in my practice that tongues that are super strong pre-release do much better post release and tend to need much less wound care management to keep the tongue from reattaching. They also need fewer oral motor exercises to get baby back to breast. The tongue was already functioning as it should, it was just anchored by the frenulum. When you have a weak tongue where range of motion was poor to begin with, they tend to need much more suck training/exercises, and without stretching, the tongue will reattach because of how the tongue rests on the floor of the mouth instead of up on the palate during healing. Body work is essential for these babes as the tension and weakness is usually though the whole system. When prescribing wound care management we need to consider what does the tongue do.
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Here’s a phenomenal video of Dr Chelsea Pinto teaching stretches after frenectomy CLICK HERE

For more information on wound care after tongue tie release, Dr Ghaheri has amazing information and videos. CLICK HERE

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

Pacifiers are a tool, like any other tool in the parenting bag of tricks. Using the right tool at the appropriate time can be very handy. Using the wrong tool can be problematic.

Good uses for a pacifier:
🚗 When in the car and you can’t feed baby
🛀🏽 If you need a few minutes to use the bathroom or shower
😴 Baby just fed and is trying to transition to sleep. Remove once baby is asleep
👶🏼 Suck training for a premature baby or used specifically during suck training exercises under the guidance of a feeding therapist
🤮 Help with reflux (swallowing helps prevent pain and keeps food in the stomach. Babies with moderate to severe reflux often get over fed because they want to suck so often to sooth the reflux. If a baby has had a full feeding but is still wanting to suck, it can help reduce reflux and keep baby from being overfeed)

When looking for a pacifier, we want one that optimizes the same oral skills that are needed for the breast. Your nipple should go in baby’s mouth round and come out round, not pinched or flat. Look for a pacifier that is also round. This promotes the same tongue cupping baby does at the breast. An orthodontic pacifier, the one with a big bulb on top and a flat spot on the bottom, can promote a high roof of the mouth and incorrect tongue resting posture as well as have long term impacts on how teeth come in with prolonged use.

When possible, limit pacifier use so baby’s mouth is closed with the tongue resting on the roof of baby’s mouth to promote correct mouth development. There is no developmental age when baby needs to take a pacifier and it’s OK if your baby never does. They are a handy tool, but not a necessary one.

🦷 One concern when breastfeeding longer than 6 months is teeth for the fear of biting. When a baby is latched well, they physically cannot bite. The tongue covers the lower teeth while breastfeeding. Biting usually happens toward the end of the feeding as baby slides down the nipple, when falling asleep at the breast, or occasionally intentionally either from exploration, trying to change flow rate of milk, or behaviorally to Get a reaction out of you. Here’s some tips and tricks to navigate that time:

🦷 Most first bites can be combination of baby discovering they have a mouth as well as seeking comfort during teething
🦷 How you react that first time can really help to dictate baby’s reaction and if they’ll do it again.
😬Instead of yelling, overreacting or doing anything that baby may mistake for a game, unlatch, make eye contact and calmly tell baby how that hurt. Your baby will understand. Keep your tone neutral but firm
😬 If baby does it again, stop feeding. Just for a couple minutes. Try distracting them with a toy or play and then try again.
🦷 If you think baby is actively teething, give plenty of opportunity to chew on toys between feedings. Stay on top of pain management so they don’t use you as a teether
🩹Camilla and arnica are great natural pain remedies, as are products like Gum-Omile which is clove oil based. It is natural and can be used frequently and does a great job of numbing the gums
🦷 If baby shark gets to be too much, offer a bottle and see if baby will behave the next feeding
🦷 A nipple shield can protect your nipple and heal any damage if your little is ok nursing with one

Usually baby won’t intentionally bite to hurt you. Figure out when your baby is biting (usually at the end of the feeding when falling asleep or when in pain from teething) and try to unlatch before they bite. You’ve got this.

It is safe to drink coffee while breastfeeding
☕️Research says it’s safe to drink approximately 300-500mg of caffeine a day as only about 1% of caffeine reaches your breast milk. ♨️Not all coffee is created equally. That Folgers your grandparents used to make at home has about 150mg in an 8oz cup. But that exact same size from Starbucks has 250mg! A 16oz cup from Starbucks has 500mg which is the max daily recommended amount!

👼🏼Younger babies (under six months), preterm and medically challenged babies process caffeine slower in their bloodstream and they may be much more sensitive to it. If you consistently drank coffee during pregnancy you baby is already used to caffeine.

🔬It takes 15-20 minutes for coffee to hit your bloodstream and is usually completely gone by 4-7 hours. So if you’re concerned or having it for the first time after birth, either breastfeed your baby first and then have your cup of coffee or have your coffee while breastfeeding.

😿😾🙀Watch for signs of irritability, extra fussiness and inability to sleep in your baby when drinking coffee and consider cutting back if you see them. So what feels right for your body by being in tune with your body and your limits. What is right for you may not be the same as another mother.

TWIN MOMS
👩🏽‍🦳University of Utah researchers looked at 59,000 birth records from 1800-1979 and found that moms of twins tend to live longer than moms without twins.
👥Fraternal and identical twins are the most common types of twins. Other rare twin types include “half identical twins” (when the egg splits first and then each half is fertilized) and mirror image twins (Meaning they are exact reflections of one another. For example, if one has a freckle under the left eye, the other’s freckle will be under the right eye.).
🫂You can also have twins with two different fathers. Known as heteropaternal superfecundation, occasionally two eggs are released during ovulation and then the woman gets impregnated by two different men at the same time. About 1 to 2% of all fraternal twins have different dads
🖐🏿Identical twins don’t have identical fingerprints.
🍔When breastfeeding, you normally need to eat an extra 300-500 calories. It takes captures to make calories. Twin moms need to consume an extra 600-1000 calories per day!!
Twins share a unique bond that starts in utero. 👭Twins have been shown to interact with each other as early as 14 weeks gestation during ultrasounds.
🔄When breastfeeding twins it’s important to remember to switch which breast you offer each baby. Each breast has its own flow, flavor, and milk supply. Switching which one you start with helps keep breasts balanced and gives each baby equal opportunity if there is a more robust supply on one side than the other
🏈 There are many breastfeeding positions that still work for twins. Football and koala tend to be the easiest when babies are small to get a deep latch when feeding tandem. You can also practice with one baby at a time to make sure they learn how to properly latch before attempting tandem.
🛌 There are twin breastfeeding pillows that can make positioning and feeding easier.

Information on toddler nutrition seems to assume your toddler is no longer breastfeeding. Breast milk does not magically lose nutritional value after the first birthday. In fact, the US is one of the only countries to recommend stopping breastfeeding at 1. The WHO recommends continuing until 2!

Toddler breastfeeding key points:

🤱🏾Breastfeed as often as you want. There is no “recommended number of times per day” for breastfeeding. Find what works for your routine and your family. Human milk will continue to fill nutritional gaps as toddler eats more solids
👩🏻‍🍼Depending on your situation, you may be able to stop pumping while at work and still maintain a good supply when you’re home with your toddler
🚰Slowly add in more water by cup during meals
🍎Offer foods BEFORE toddler breastfeeds. Human milk still had nutritional, immunological and emotional benefits
3️⃣In general, nursing 3-4 times a day will give your toddler all of the milk nutrition they need
🥛 Research shows between 12 and 24 months toddlers average 14-19 oz of human milk per day. Between 24 and 36 months typical amounts of human milk are 10-12 oz per day
🍦Your milk IS whole milk. It has a higher fat content with more bio available nutrients than whole cow’s milk. The more human milk toddler gets, the less additional fat from whole milk or other sources is needed
🐮 Cow’s milk is a convenient source of calcium, protein, fats, vitamin D, etc. – it’s not necessary in our diets
🥩 Sources of protein: meats, eggs, fish, peas & beans, tofu and other soy products, peanut & other nut butters
🐠 Sources of fats: oils like soy, safflower flax and fish; flax seed, fish & avocado
🥬Calcium sources: dark greens: broccoli, spinach, collards, kale, turnips, bok choy, parsley, tofu & other soy products, beans: chickpeas/garbanzo beans, navy beans, pinto beans, nuts & seeds: sesame seeds, sunflower seeds, almonds, cashews, nut butters, tahini, fortified orange juice
🐄 Limit cow’s milk to 2-3 cups (16-24 ounces) per day. Too much cow’s milk increases the risk for iron-deficiency anemia