Tongue Tie and Breastfeeding

- Julie Matheney

Tongue tie, technically known as ankyloglossia, is a condition present at birth that affects an estimated 2-5% of all babies born. It is characterized by a short, thickened, or abnormally tight lingual frenulum, which is the tissue that connects the tongue to the floor of the mouth. Depending on the severity of the tongue tie, range of motion of the tongue can be restricted. In very severe cases, the tip of the tongue can appear to be heart shaped. Because of this anatomical difference, sometimes tongue tied babies can’t maintain a latch for long enough to take in a full feeding. Others may appear to breastfeed for long periods of time without actually be effectively transferring milk. Some tongue tied babies will successfully breastfeed only during “let-down”, when the milk flows on its own from the breast into the babies’ mouths, but won’t be able to actively express milk out of the breast on their own. Many babies with tongue tie also have a lip tie, an abnormally tight membrane attaching their upper lip to their upper gums. This can be seen by rolling the upper lip upward. Babies with lip tie often have difficulty flanging their lips properly to feed which impacts their ability to latch well. This can cause them to take in excess air during breastfeeding which often makes these babies gassy and fussy.

While many pediatricians do not see tongue tie as an issue, current research and literature suggests that it can have a significant impact on breastfeeding. However, the American Academy of Pediatrics, among others, have documented the negative effects of tongue tie on breastfeeding. The most common complaint of mothers with tongue tied babies is sore nipples, which is due to poor latch and inefficient sucking. Other breastfeeding problems for the mother can include recurrent plugged ducts, mastitis or thrush, vasospasm, and supply difficulties. Babies with tongue ties typically have difficulty latching, make click sounds while nursing, may be gassy and fussy during feedings, and have slow weight gain despite having mothers who use correct positioning and nurse frequently.

Some babies with very short or thick lingual frenulums are able to compensate well and breastfeed without difficulty. Tongue tie needs to be diagnosed by function and not just appearance, so what the baby’s tongue looks like is not as important than what it can do. According to one study, simple inspection of a tongue-tie is not enough to determine which infants will need medical intervention. However skilled professionals will complete a clinical assessment which includes observation and measurement of the effectiveness of feeding to help determine appropriate action to improve breastfeeding skills. This is not a comprehensive list for tongue function, but it may give you an idea for why your baby is having breastfeeding difficulties:

  • Does the tongue elevate? When the baby cries the front edge of the tongue should come up at least as high as the corners of the baby’s mouth.
  • Does the tongue extend? The baby’s tongue should be able to protrude or stick out at least past the lower gum  if not to the border of the lower lip
  • Does the tongue lateralize, or move side to side? Tracing the baby’s bottom gums triggers a reflex for the tongue to follow the finger..
  • The baby’s tongue should be able to lift towards the roof of the mouth and touch behind where the upper teeth will come in. Is there a membrane there that prevents the tongue from lifting? When very tight from tension, the membrane may appear white.

If it is determined that the tongue tie is indeed the culprit for breastfeeding difficulties, some pediatricians, ENTs and dentists can perform a frenotomy or frenectomy. This is a quick procedure to cut the frenulum which returns the full range of motion of the tongue and upper lip. Specialized scissors may be use to simply cut the tongue or lip tie. Some prefer to use lasers, which have the benefit of minimizing the amount of bleeding during and after the procedure and decrease the chance that the frenulum will grow back. Many practitioners use a local topical anesthetic to numb the area before the procedure and some use an injection of anesthetic as well. Babies can breastfeed as soon as the procedure is done. Post-procedure care should be done to minimize the frenulum from growing back. Current research shows this is a safe, easy procedure with minimal risk to the baby. The majority of mothers notice an immediate difference in breastfeeding effectiveness and a significant reduction in nipple pain.

When should the frenotomy be done? Current research shown between 2-6 days after birth to establish proper breastfeeding patterns. This same study showed that waiting more than four weeks for frenotomy drastically increased the likelihood that mothers would abandon breastfeeding all together.

If you suspect your baby has a tongue or lip tie, set up a consultation for a full assessment of your baby’s oral motor skills.

For more resources and articles, see Breastfeeding a Baby with Tongue-Tie or Lip-Tie at kellymom.com

  1. Lalakea, M. Lauren; Messner, Anna H. (2002). “Frenotomy and frenuloplasty: If, when, and how”. Operative Techniques in Otolaryngology-Head and Neck Surgery. 13: 93. doi:10.1053/otot.2002.32157. 
  2. Wallace, Helen; Clarke, Susan (2006). “Tongue tie division in infants with breast feeding difficulties”. International journal of pediatric otorhinolaryngology. 70 (7): 1257–61. doi:10.1016/j.ijporl.2006.01.004. PMID 16527363.
  3.  Emond A1, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, Sutcliffe A. “Randomized controlled trial of early frenotomy in breastfed infants with mild to moderate tongue-tie.” Arch Dis Child Fetal Neonatal Ed. 2014 May;99(3):F189-95.
  4. Jack Donati-Bourne, Zainab Batool, Charles Hendrickse, Douglas Bowley “Tongue-Tie Assessment and Division: A Time-Critical Intervention to Optimise Breastfeeding/” Journal of Neonatal Surgery 2015; 4(1):3
  5. Nicholson WL. Tongue-tie (ankyloglossia) associated with breastfeeding problems. J Hum Lact.1991;7 :82– 84
  6. Lawrence R. Breastfeeding: A Guide for the Medical Profession. 5th ed. St Louis, MO: Mosby-Year Book; 1999
  7.  Jain E. Tongue-tie: its impact on breastfeeding. AARN News Lett.1995;51 :18
  8. Huggins K. Ankyloglossia: one lactation consultant’s personal experience. J Hum Lact.1990;6 :123– 124
  9. Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol.2000;54 :123– 131
  10. Messner, Anna H.; Lalakea, M. Lauren; Aby, Janelle; Macmahon, James; Bair, Ellen (2000). “Ankyloglossia: Incidence and associated feeding difficulties”. Archives of otolaryngology—head & neck surgery. 126 (1): 36–9. doi:10.1001/archotol.126.1.36. PMID 10628708. 
  11. Tongue Tie – What Do Parents Need To Know? Submitted by jessicabarton on
  12.  Rosegger H, Rollett HR, Arrunategui M. [Routine examination of the mature newborn infant. Incidence of frequent “minor findings”]. Wien Klin Wochenschr.1990;102 :294– 299
  13. Wright JE. Tongue-tie. J Paediatr Child Health.1995;31 :276– 278
     

Nursing Bras

- Julie Matheney

Many moms need to breast pump for a variety of reasons, from going back to work, to increasing milk supply, to feeding a preemie in the NICU. I think it’s pretty safe to say these models have never seen a breast pump in their life. And if they have, I think they may need to see a plastic surgeon to help with their nipple placement! For help with fitting your breast pump, nipple shield, or nursing bra, feel free to set up an appointment with me!

Pumping Log #2

- Julie Matheney

What’s in my pumping bag. A well stocked pumping bag is the most essential item you will need when you go back to work. Packing the bag efficiently and with necessities can help eliminate stress and worry while pumping at work. Here are a few of the things in my pumping bag. Obviously the pump is the most important piece. Make sure to check that you have all the pieces and parts in the morning before you leave for work. I had forgotten one or two pieces several times. I actually now keep a spare pump in my car that is always ready to go in the event that I forget something. I always keep instant oatmeal, mothers milk tea, and honey sticks ready for a quick snack on the go. When I know I am going to work the next day, I bring empty bottles to put my milk in. That way I can keep it in the fridge and handy for the next days feedings. If I know I am going to be home the next day, I use disposable milk storage bags. I’ve tried several brands and really like the Dr. DuDu. They’re sturdy and have a double zipper. Plus they come in a handy 8oz size for streamlining in the freezer. I can put my pumped milk in the freezer and it will be ready to go the next time I’m at work. I always keep extra nursing bra pads. I wear washable ones made of bamboo fiber. But you never know when you might need to change them. I keep it small stash of disposable ones in my bag at all times. Another necessity is my stash of essential oil’s. I use fennel to help keep my supply up. Serenity, lavender, balance, and citrus bliss help elevate my mood when I’m feeling down at work. What’s in your bag?

 

 

Pumping Log #1

- Julie Matheney

Not only am I a lactation consultant, I am also a full time working mom with an 8-month-old at home. I’m gone around 40-50 hours a week for work and am pumping on the go. At the hospital where I work there is an employee lactation room. Half the time I’m in here by myself and the other half there is another mother behind a curtain pumping with me. It is amazing to see how universal our concerns are with breast-feeding.The number one complaint I hear about from the other side of the curtain is that the mom is not pumping enough. I have never been a super pumper and have always had to really work on my supply. It is amazing to me how from day today, pumping to pumping, I can get varying amounts of milk. It’s depends on my stress level, what I’ve eaten, how much water I’ve been able to get in, and how often I can get away to pump during my shift. Pumping is also very psychological. It’s honestly hard to “feed a machine” instead of my baby, but the more I look at pictures and videos of her or FaceTime with her while pumping, the more I tend to make. Here are the top tips I give to the other moms pumping at work:

1. Shake the girls. Give your breasts a good shake before each pumping session. This wakes up the breast and helps release hind milk from the back of the breast.
2. Use the stimulation and let down modes on your pump more often. Use the stimulation mode for 2 minutes followed by the let down mode for 4 minutes. Go back to the stimulation mode for another 2 minutes followed by the let down mode for another 4. Do this up to 4 times in your pumping session to see an increase in your milk. Massaging your breast from top to bottom in a clock wise motion will also help empty the breast. End your pumping session with a few minutes of hand expression.
3. Keep well hydrated. Water water water!!!
4. If you feel like you did not pump enough during the day at work, add in an extra pumping at night before you go to bed. Keep this extra pumping going even if your home with your baby for the weekend. You can stock up this milk in your freezer for those occasional days where you don’t pump enough on your shift.

For more tips and tricks, feel free to give me a call, attend one of my working mother classes, or schedule a personalized consultation!

Food for Thought

- Julie Matheney

How long should I breastfeed my baby?

The American Academy of Pediatrics recommends that babies be EXCLUSIVELY breastfed for about the first six months of life. This means that your baby needs no additional food (except Vitamin D) or fluids unless medically necessary. Babies should continue to breastfeed for one to two years or for as long as is mutually desired by the mother and baby.

When should I start solid foods with my baby?

How do you know when your baby is ready for solid food? After six months of age, they should be able to do these three things:

  1. They sit unsupported for an extended length of time
  2. They are starting to use a pincher grasp (thumb and forefinger together to grab little objects)
  3. They start to have eye-hand coordination to bring their hands to their mouth

 

Myths and Old Wive’s Tales

- Julie Matheney

We all have questions about what “normal” and “typical” feeding looks like for our babies. We also have lots of questions about when things go different than we anticipated or we run into problems with breastfeeding. So often we turn to other mom’s experiences that we find on social media or internet blogs. We think we’re doing something wrong or we inadvertently pick up the bad habits of others. Some of us learn fact from fiction by trial and error. Others turn to family and friends for help, but they each may have a very different answer and it can be extremely confusing. How do you make the right decision? By getting your information from the right, trusted source, you can save yourself from experimenting with things that may work in the moment but will set you up for feeding failure in the future. Here are common breastfeeding myths.

Myth #1: Breastfeeding is supposed to be the most natural thing in the world, so it should come naturally to me and my baby, right?

There are many reasons why you or your baby could experience difficulties breastfeeding, from anatomical differences to coordination issues. Babies are just as brand new to feeding as you are and it can take some time to learn the skills needed to effectively eat. Many moms see happily breastfeeding infants with their smiling mothers and just assume it will be easy. Due to poor education and lack of support, they can become easily frustrated or discouraged when challenges arise.

Take time before your baby comes to learn how to breastfeed and all that accompanies. Don’t wait to ask for help. As soon as you notice any problems with feeding, call for help. There is no stupid question. Even if you took a class before birth, you aren’t expected to know everything. We are here to help!
Myth #2: My body knows how much milk to make

Actually, you have to tell you body how much milk to make, which is why it is so important to stimulate milk production in the first 24 hours. The more you breastfeed, the more milk your body produces. The less you feed, the faster your milk decreases. Frequent breast stimulation tells your body that milk needs to be produced.

If baby is having difficulty latching and nursing early on, your baby has difficulties staying awake during feedings, or your baby sleeps for a long time, pumping or hand expressing will continue to facilitate milk production until your baby gets the hang of feeding and gets into a more regulated sleep/wake cycle.

As I always tell moms with babies in the NICU, if you’re away from your baby and your goal is to breastfeed, you still need to feed something or you will see a decrease in milk supply. If you can’t feed your baby because you are at work or your baby is in the NICU, feed your pump until you can feed your baby.

Myth # 3: Breastfeeding will be painful

Many new mamas try to muscle through nipple pain, cracks, blisters, and bleeding because they think it’s all part of the process. This is one of the biggest and worst myths out there!  While this is the experience of many women, it doesn’t have to be yours! Pain is not normal!

In my classes and consultations, I will teach you how to differentiate between the pressure and sensation of a proper latch and the pain associated with an improper one. What you should feel is something moms describe as a “tugging and pulling”. What you should not feel is pinching or sharp pain. Pain is always a good indication that something isn’t right! This is most likely a signal of a poor latch and you need to break the latch (you can slide your pinky finger in the corner of the baby’s lip between his lip and your areola to break the latch) and start over, repositioning the baby to improve the latch.

Myth #4 I can just get all the information I need at the hospital

Giving birth is one of the most emotionally and physically exhausting experiences you can have as a woman. If you give birth in a hospital, there is actually little time to rest. Nurses will come in every two to three hours to check on you and your baby. Then they will go over a whole laundry list of information, from umbilical cord care and monitoring poops, to symptoms you and your lady bits might experience and what to do about it. They will talk about car seat safety, birth certificate information, diaper care and follow up appointments with your physician. Do you really want to try to squeeze in even more information about the essential task of feeding your baby? Being prepared ahead of time will lighten the load your brain will have to process and let you focus more on just enjoying your new baby.

Myth #5: I don’t want to bother anyone with my problems, I’ll just figure it out

No mama is an island. We all need support, and this especially true for breastfeeding. Research shows that the opinions about breastfeeding of those close to you (including the baby’s father and your mother) affect the duration of breastfeeding overall. It is so important to have support when it comes to breastfeeding. Without it, many mothers wean within a week of giving birth!

Successful breast feeders typically have at least two people they know they can turn to for breastfeeding support, be it a friend, aunt, or cousin. Bring your spouse with you to a breastfeeding class. Talk to those around you about your breastfeeding goals. Join a Facebook breastfeeding support group. Hearing about other moms’ obstacles and how they overcame them can be so encouraging. Find another mom whose baby is a few months older than yours that you can talk to about each stage you’re in and what’s to come. Let me help connect you to other moms in your area.

Myth #6: I’ll just use formula since it’s just as nutritious and so much easier

This one’s a big myth that many people believe! While formula companies would like you to believe they are as nutritious and convenient as breast milk, the truth is actually quite the opposite! The American Academy of Pediatrics, the American Medical Association, the American Dietetic Association and the World Health Organization call recommend that breastfeeding is best for babies up through one year of age, as it helps defend against infections, prevent allergies, and protect against a number of chronic conditions. Breast milk contains antibodies that can lower the occurrence of ear infections, diarrhea, respiratory infections and meningitis. It contains the correct proportions of lactose, protein and fat, which are easily digested by a newborn baby. Babies that are formula fed are more likely to suffer from digestive problems, have a higher risk of childhood obesity and more likely to develop allergies and illnesses. They also do not receive antibodies from their mothers, which means they are less protected against infection and illness.

Not to mention formula is expensive. Feeding a baby exclusively formula can cost up to $3000 for the first year. There’s also the cost of time. Time to wash bottles, time to prepare bottles (especially at 2am this becomes a tedious task), time to buy formula ahead of time so you don’t run out (running out at 2am is the WORST!). And if you want to leave the house you have to consider carrying, storing, and preparing formula away from a full kitchen.

Myth #7: My baby has nipple confusion

The scenario is all too common. Mom has to go back to work or wants a night out so she offers the baby a bottle for the first time. The baby gets fussy, starts pulling off the bottle nipple and screams, spits our milk and gags or vomits. Mom tries fifteen different bottle systems and none of them seem to work. Both mom and baby are super frustrated. Let’s start with the truth. There is no such thing as nipple confusion. Your baby is not confused about what a nipple is. But she is confused about the rate that the liquid is flowing at from the nipple. The rate at which milk flows from the breast, in most moms, is significantly slower than a bottle nipple. Breastmilk flow is stimulated by the baby sucking, and goes through various rates depending on if the baby is just starting a feeding versus in the let down phase of feeding. Bottle nipples, however, are on demand and constant. As soon as that baby starts sucking there is milk available. And it’s always available as long as the baby is sucking. When babies are just born and/or exclusively breastfed, they can easily get overwhelmed by the high flow rate of the standard nipple that comes on most bottles. Signs of being overwhelmed by flow rate include pulling off the nipple, crying, arching the back, turning the head away, refusing to latch, hiccupping, coughing, gagging or choking, Starting with a slower flow bottle nipple, using positioning and pacing can all help the transition from breast to bottle. You can also learn other tips and tricks of the trade in my special breast to bottle feeding consultation.

Feeding Amounts

- Julie Matheney

Feeding amounts:
Did you know that when a baby is born her stomach is only the size of her own fist? That’s only ⅙th of an ounce! At one month her stomach is still only the size of her own fist! In other words, her stomach grows at the same rate she does. Her stomach does have the capacity to stretch and fill with the right amount of milk she needs at each feeding.

Proper feeding amounts ensures your baby’s optimal health. How can you tell your baby is hungry and how much should you give her? Hunger cues include lip smacking and tongue licking, rooting with the lips to find a nipple, hands up by the face, and becoming awake but still quiet. Late hunger cues include crying or fussing, arching of the back, and a decreased ability to latch onto a nipple. You can tell if a baby is eating well by achieving a good latch, listening for audible swallows, and making sure baby is given plenty of time at both breasts. A baby is getting enough milk if they are making enough wet and poopy diapers and gaining weight at each pediatrician appointment. For more information on achieving a good latch, knowing what a swallow sounds like, and other strategies for knowing if you’re making enough milk, sign up for one of my classes or personal consultations.

Frequency breakdown:
In the first few weeks after birth you will want to feed every 2-3 hours or sooner if baby is exhibiting hunger cues.
10+ feedings every 24 hours.
Alternate breasts each feeding.

 

Welcome to LA Lactation!

- Julie Matheney

Hello, mama!
Welcome to LA Lactation. Congratulations on the newest arrival to your family!
LA Lactation’s blog is meant to provide you with quick and simple strategies to ensure successful (fun and hopefully enjoyable) breastfeeding.

People unwittingly tell new moms that breastfeeding should come naturally and easily, but honestly, breastfeeding can be tricky! Babies come into the world ready to learn, but feeding still takes practice!!!

The posts on this blog are packed with helpful information designed to walk you through the breastfeeding experience so that when baby comes, you will feel confidence in your own abilities and skills to feed your baby.
Breastfeeding beginnings:
Of course, putting your baby to your breast immediately after birth is the first step toward breastfeeding. But what next? What if your baby won’t latch? What if his hands are constantly in the way? What if your milk is slow to come in? There are many questions new mothers have and you can find all your answers in the content of this blog.

The first feeding:
Baby’s first feeding should happen within the first 60 minutes of birth. Skin to skin contact is essential for starting the bond between mother and baby and is a catalyst to the first feeding. It stimulates hormones in the mother’s body to begin the production of colostrum, the first milk often called “liquid gold”. Colostrum is packed with immune boosting antibodies, all the essential vitamins and minerals your baby needs, and perfectly balanced nutrition for growth and development. When infants are placed on their mothers chests at birth, their feeding instincts kick in. They will begin to army crawl to the breast and root around for mama’s nipple. You can facilitate this by laying your baby on your belly when he is born and watching the magic happen. After the first latch, you can position baby for feeding. While there are several breastfeeding positions for your infant, which will be in another blog post, you’ll want to keep skin-to-skin contact while feeding.

Proper latch:
It’s not immediately obvious, but a proper latch means baby has not only the nipple in her mouth, but a good bit of breast tissue from the areola as well. The areola is the colored area around the nipple. If the baby has a shallow latch just on the nipple, their tongue movement will cause chaffing which will lead to unnecessary cracking, bleeding, and pain. A deep, wide latch and will help prevent nipple soreness and discomfort, as well as allowing for a good flow of breastmilk.

  • If you need to break suction to reposition baby for a proper latch, be careful not to pull baby off your nipple, which will cause painful shearing over time. Instead, insert a finger between the gums to gently pop the suction, or use a finger to raise baby’s top lip toward her nose.
  • You should not feel pain in the nipple or breast when feeding. Women experience different sensations when nursing, like tugging or pulling. If there is any pain, your baby is most likely not latched correctly. Try breaking the seal and repositioning.
  • If you notice drying or cracking starting on the nipple, take immediate action. Nipple creams can help, but so can breast milk. Breast milk has been known to heal sore or cracked nipples faster than over the counter creams! Using a reusable/washable nursing pad made from natural bamboo fibers can help keep the nipple dry, which will also help with healing. If you use disposable nursing pads, make sure to change them frequently.