How do I prevent baby’s tongue tie from reattaching?

TONGUE TIE REATTACHMENT

How can I prevent reattachment after baby has a tongue tie release? If you’ve had to go down the tongue tie path, you’ve probably heard about reattachment. This is where the frenulum under the tongue regrows, which is normal, but the frenulum can grow back shorter, thicker, or tighter than the original frenulum. This can cause the same or worse symptoms that were experienced prior to the original release. Many release providers will have families do “stretches” under the tongue to help prevent the new frenulum from forming too soon or too tight. Providers should also be recommending manual therapy (like chiropractic, CST, or OT) as well as continued lactation support.

I’ve seen babies, though, who have done bodywork and the tie still reattached. We need to look at the whole infant structure and not just think of manual therapy as a box to check off in the tongue tie process. Manual therapy , but instead a method to help to restore mobility and range of motion to the whole body. I’m an IBCLC, so I only see babies, but I see a lot of babies who don’t have a full range of motion of the head and neck, and tension in a the lower back, that prevents them from moving their spine through the range of motion too. In reality, this tension needed to be addressed BEFORE the release to optimize the body’s function and prepare for the new range of motion the release gives.

None of these things happen in isolation. Tension anywhere causes tension everywhere. If you have tension in you neck and shoulders, your tongue isn’t free to move EITHER. You can try that on yourself....tense up your neck and shoulders and see what happens to how your resting tongue posture feels.

Bodywork isn’t a magic step that prevents reattachment. It’s an critical step that allows for mobility and strength and THAT allows a change in a frenulum as it grows.

Just like not all oral function providers or dentists are equally skilled, not all manual therapy workers are as equally skilled. And, in my experience, the bigger piece of the puzzle is what the parents are doing BETWEEN visits that also has a massive impact on the outcome. If a family sees a chiropractor or osteopath once, and then goes back to using the Snoo for 10 hours a day, mobility can not be restored, because a body has to go through the range of motion to develop the connection to their brain that allows them to continue to go through the full range of motion with ease.

So, a body worker to help with movement is really important, but is not a magician that it seems like some people are hoping for.....that they can prevent reattachment with a cell phone and a credit card, if they get CST one time done before a release. I think *that* is the misunderstanding.

Reflux baby

One of the biggest culprits of reflux, colic and gassiness (which are symptoms not a diagnosis), are actually undiagnosed tongue and lip ties.  True milk allergies are rare (they do exist!!) but so many moms are told to just cut whole food groups out of their diets instead of exploring for ties. The restrictions in the mouth from the ties cause baby to lose the latch and swallow more air (called aerophagia) which contribute to the symptoms (Kotlow, 2011)

Remember ...

Breast milk is NOT made directly from your stomach contents but within the breast itself from your blood. The foods you eat are broken down in your digestive system. Proteins, carbohydrates, nutrients, white blood cells, enzymes, pre- and probiotics, water, fat, and chemicals (alcohol, caffeine, medications) are pulled from your intestines into the blood stream. Blood delivers these nutrients to the milk making glands at the back of the breast. Every nutrient you consume gets used or stored and each type gets cleared from your blood in a certain amount of time. Cow protein, for example, is completely cleared from your blood steam within 8-12 HOURS of absorption. Caffeine clears your blood in 4-7 hours and alcohol within 2. Medications have longer or shorter half lives, which is how long they stay in your body, and larger or smaller molecules. Some can pass into breast milk and some can’t.

🪫MYTH: If the baby is fussy or has colic, don’t eat dairy.

💡FACT: Cow milk protein allergy is only in 2-7% of the population. Fussiness is not a symptom for diagnosing cow milk protein allergy.

🪫MYTH: Spicy food makes spicy breastmilk which will upset the baby’s tummy.

💡FACT: While the foods you eat can change the flavor of your milk, there is no evidence that capsaicin (the compound that makes foods spicy) is ever present in breast milk. Breast milk is actually quite sweet and palatable for babies.

🪫MYTH: Beans, cabbage, broccoli, and cucumber give the baby gas.

💡FACT: The insolvable fiber found in vegetables mixes with your gut bacteria and makes you gassy. Insoluble fiber does not leave the GI tract and cannot reach your milk.

🪫MYTH: Baby will refuse your milk if you eat garlic, onions, and other potent flavors

💡FACT: Research studies have found babies actually  prefer the flavor of garlic in breastmilk and will spent more time at the breast and drink more milk. (Mennella, 1993

🪫MYTH: Carbonated beverages will make the baby gassy

💡FACT: Carbonated drinks don’t carbonate the blood. The bubbles don’t get into your milk.

I know many will not always agree but there are plenty of studies and research if you are interested when it comes to allergies and lactose / dairy intolerance . I feel so many are not educated ates correctly as it is more complex that what meets the eye.

My 2 day old won’t stop crying

Second night syndrome. The word syndrome. It implies something is wrong when in reality everything is going as expected. For nine months your baby has been in your belly and connected in every way. Their existence controlled by the cycles of your body. Then the intensity of labor and delivery propels them into a new world that sounds, smells, and moves differently. The sheer exertion of being born often makes babies as tired as their mothers. On the second night, however, most babies will want to frequently nurse. This helps with two transitions:  meconium to soft, seedy yellow poops and colostrum to mature milk. This cluster feeding catches many parents by surprise and leaves them wondering if baby is starving. Unless baby is not latched well or efficiently feeding, this is normal. It takes 22-24 good latches and feedings to stimulate the breast for making milk. Many babies, though, don’t want to be put down during this process. Each time you put them on the breast they nurses for a little bit, go back to sleep and then cry when placed in the crib.  Many are convinced it is because their milk isn’t “in” yet, and baby is starving.  It isn’t that, baby’s awareness that the most comforting place is at the breast where you body regulates their temperature, heart rate, respiratory rate and blood sugar.  This is pretty universal among babies. When baby drifts off to sleep at the breast after a good feed, break the suction and take your nipple gently out of their mouth.  Don’t try to burp baby, just snuggle baby until they fall into a deep sleep where they won’t be disturbed by being moved. Keep baby in skin to skin contact as much as possible in this transition and trust your body in the process.

Why can’t I lose the baby weight while breastfeeding?

You were probably told breastfeeding would be this incredible biological postpartum weight loss plan. While that may be true for about 1/3 of people, most of us hold on to our weight regardless of how much boob juice we make. When you breastfeed, fat cells stored in your body during pregnancy and calories from your diet fuel milk production. Your body burns about 20 calories for each ounce of milk you make. Which is why you need an extra 300-500 calories a day.

Why are you not losing the baby weight?

🧁 I don’t know about you, but I was hungrier breastfeeding than pregnant. You’re still eating for two only your second party is bigger now than when they were in your belly. Breastfeeding cravings are real

🧁 Lactation cookies? Let’s be honest, a cookie is still a cookie whether or not it helps with your supply. Eating lots of bars, cookies, power drinks and teas with sugar or honey are not going to help with weight

😵‍💫Stress: Research has also found that elevated cortisol levels (the stress hormone) have been associated with weight retention in the first 12 months postpartum

🩸Hormones: Prolactin, your milk making hormone, is also sometimes called the “fat-storing hormone”. High levels of prolactin can result in weight gain. And they are at their highest while breastfeeding. While more research on prolactin is needed, we hypothesize that our bodies undergo metabolic adaptations to hold onto excess fat as “insurance” for making milk

🔑Remember: there is waaaay too much pressure to “bounce back” after having a baby. Your body is epic and lovely and just pushed a tiny human being out. Your body is going through so many changes and there are physiological things at play that can be beyond your control. Trust your body. Trust your baby. Love your body.

Breastfeeding truths

What’s true for most is never true for all. There is a bell curve to human anatomy and physiology. What you are taught is the middle of the curve: what most people do. But there is such a wide variety of normal, the people at either end of the spectrum often are lead to believe that what they experience isn’t normal, when it fact it’s just a variation of normal. Breastfeeding is the same. There is a wide variation of normal. For example:

💦It’s normal to leak milk. It’s also normal to not leak milk at all. Many leak for the first 3-4 months and see the leaking slow when supply regulates around 11-14 weeks. Some stop leaking right away and other leak the whole time the breastfeed

🤱🏾Most breastfed babies (once they’re no longer newborns) want to feed every 2-3 hours and average 8-12 feedings in 24 hours. Some breastfed babies will only do 5-6 feedings and others will seem like boob barnacles who are latched all day. As long as your baby is making enough wet and dirty diapers and gaining weight as expected, let them feed how they want

👼🏼Most breast feeders cannot go more than 6 hours without feeding or pumping and maintain their milk supply. The breast needs emptied frequently to get the signal that more milk needs made. But some can go 8-12 hours and not lose supply. While others can’t go more than 2-3 without the same risk. Breast storage capacity is unique in every breast and what’s true for you won’t be true for someone else

If someone tells you “All breastfeeding does/looks like/should be….”, don’t believe them. While there are general guidelines to how breastfeeding works, there is still such a wide variety of normal. And what works for you won’t necessarily work for someone else. If something is working for you, don’t let comparison to someone else’s journey sabotage your own.

Why do I smell so bad postpartum?

SWEATY AND STICKY

Do you feel hot, sticky, sweaty, sopping wet and a little stinky? Welcome to motherhood. It does get better. There is an actual biological point to leaking from every pore and that weird stench that accompanies it. Not all of our senses are developed at birth. It would overwhelm our littles too much to go from a dark, wet environment to such a bright, crazy world to actually have every sense developed like ours. Their vision isn’t great and they have no depth perception. But they have a fully developed sense of smell. They have been getting to know your odors since their womb days. Your amniotic fluid was constantly changing in its scent based on what you ate and drank and your unique hormone combination. All that leaking you’re doing postpartum has a similar scent which serves to orient your baby back to you. Your body odors are familiar to your baby and it makes them feel safe and secure that they are with their birth person and not someone else. Your leaking smells also stimulate their hunger, which is why baby may constantly root when on your body even if they aren’t hungry. Did you know that the breast secretes an oil from those little bumps on your areolas that smells just like amniotic fluid? This helps baby locate dinner when they are ready to eat. Showering is normal, but avoiding the use of scented products can actually be very helpful and calming for your baby. While you may find your body odor unbecoming, know that to your baby it makes you feel like home.

You may also feel more thirsty than usual, especially during let down. The oxytocin that releases your milk to baby also triggers your thirst. It's your body's way of reminding you to get enough water to produce breast milk. Remember, with breastfeeding, you are losing up to 30 ounces of fluid a day to breast milk. So your body is reminding you to take care of yourself and not just the baby.

Milk blebs/blisters: The white head on your nipple tip

A milk bleb happens when the nipple pore gets blocked/clogged by a piece of skin or a small amount of hardened breast milk. It usually looks like a white dot on the nipple and the pain tends to be focused at that spot and just behind it. The clog might be a tiny, dry clump of hardened milk or a “string” of fattier, semi-solidified milk.

Blebs are often caused by:
👉🏼Shallow latch
👉🏼Tongue tied baby
👉🏼Pumping with too large of a flange
👉🏼Often associated with recurrent mastitis

When the bleb is being caused by skin covering the nipple pore, the duct obstruction will often pop out from the pressure of nursing or manual expression. By changing baby’s position at the breast and focusing on a deep latch, breastfeeding alone will often pop the bleb.

Always figure out the root of why you have one and address that first. Other remedies:
❤️‍🩹Keeping olive or coconut oil on the top to soften the bleb
❤️‍🩹Hand expressing behind the bleb to move milk through
❤️‍🩹Switch nursing positions
❤️‍🩹Taking sunflower lecithin
❤️‍🩹Ice after feeding to reduce inflammation
❤️‍🩹Epsom salt or saline soaks
❤️‍🩹Triamcinolone 0.1% spot applied for 1-3 weeks under direction of an IBCLC
❤️‍🩹If they do not resolve on their own in a few days, seeing a breast specialist for further work up and management

My Breast Milk Won’t Freeze!

You’re happily pumping to your usual routine. You throw that bag of liquid gold in the freezer, proud of what your body can make to feed your baby. But when you come back the next day the bag is still liquid. Puzzled, you hit up google only to find a few dozen other moms asking the same thing with nothing more than some Reddit and mommy group anecdotes and no actual answers.

I had a mom reach out to me with this same question. So I went back to the lactation forums only to learn has puzzled even the most experienced IBCLC lactation consultant. There is only one research study done in Spanish that has attempted to research this phenomenon. Here’s what we know:

🍷It’s not because you’ve had too much alcohol. Yes, alcohol has a lower freezing temperature, but the amount of alcohol you’d have to consume to get that level in your milk would land you in the hospital

🧊Check to make sure your freezer is at the correct temperature.

🥶The quick fix is to take the bag out of the freezer, shake it vigorously and put it back in the freezer in a single layer without it touching other bags

🍦 There are a few theories about this. One PhD chemist says it has to do with the high osmolarity of that particular milk. Basically it has extra nutrients than other milk, extra vitamins and most likely a higher fat content  it’s why it doesn’t happen all the time

🔬Dr. João Aprigio Guerra de Almeida is Coordinator of the Network of Milk Banks of Brazil and of the Ibero-American Network of milk banks. He stated:

“The fact that human milk does not freeze is associated with a phenomenon called gelation, which is autocatalytic, begins even inside the mammillary ducts, continues after extraction, and is accentuated by temperature fluctuations (heating to thaw, pasteurization and cooling) and does not disqualify the milk for consumption. 

How and why does gelation occur?

Aprigio explains:

“The milk accumulated inside the ducts, as in cases of breast engorgement, promotes pressure on the internal walls of the ducts.

On the other hand, by virtue of Isaac Newton's law of action and reaction, the ducts also promote a force on the milk – a pressure on the milk inside the ducts.

Since milk has proteins in its structure, this pressure exerted by the ducts alters the quaternary structure of the proteins, which begin to be “uncoiled or uncoiled”, assuming a more linear structure that is chemically unstable.

In search of a new stability, these proteins establish chemical bonds with the water in the milk through hydrogen bonds.

Thus, the water in human milk becomes progressively linked to the proteins, becoming imprisoned by them and, consequently, even when the temperature of the product is below the freezing point, the product does not freeze, since the water is chemically bound to the protein and for this reason fails to reorient itself to form ice crystals.

Once started, because it is an autocatalytic process, it continues. For this reason, even if the milk is kept at -18ºC in the freezer, it does not freeze, because the proteins form a network that ignites the water molecules, preventing them from coming together to form ice crystals.”

João Aprigio suggests in this situation not to think badly about milk, since it is suitable for consumption. You just have to take it out of the freezer and shake vigorously to undo the protein network that keeps the water trapped.

This may seem strange and a bit confusing, because what we usually say when the milk has been thawed for use and is ready to be fed is to shake gently. Now, when you shake the container or bag of milk it would freeze almost instantly in your hands.”

Have you ever experienced this with your milk?

The discussion by Dr. João Aprigio Guerra de Almeida is translated from Spanish from an original blog post  Click here for the original Spanish version from:

SOS, mi leche materna no se congela.

 

When breast milk smells soapy or rancid: High lipase

Have you heard of high lipase in breast milk? Lipase is an enzyme that helps break down fat in breast milk. The breakdown of the fat in breastmilk by lipase is normal but not noticeable when the baby is feeding directly at the breast. When lipase occurs in excess, this process happens much more rapidly and can make the milk taste off or soapy after a period of time. Milk with excess lipase is safe to drink, but some babies dislike the taste and refuse it.

 

How do you know if you have high lipase?

  • Test prior to freezing – Before freezing large amounts of breast milk, you can test it for odor and taste changes due to lipase. Collect and freeze 1-2 bags or small containers of breast milk for at least 5 days and then evaluate the odor to see if your baby will drink it.

What can you do if you have high lipase?

  • Reduce strong oxidizing agents like iron and copper from your drinking water
    Add antioxidants to your diet
  • Freeze milk as soon as you pump it whenever possible
  • Reduce intake of polyunsaturated fatty acids
  • Consider going on a Whole 30 diet
  • Scald you’re milk prior to freezing 
  • To scald fresh milk: Heat it in a pot until tiny bubbles form around the edges of the pan (approximately 180° F) but don’t boil it. Remove the milk from the stove and allow it to cool before freezing.

Scalding fresh milk will stop the enzymes from breaking down the fat, preventing that soapy smell and taste. Scalding milk does reduce some of the beneficial components in breast milk, however, so give your infant fresh breast milk whenever possible.

Have a ton of freezer milk with high lipase? Some babies don’t mind the flavor and will drink it anyway. If you’re won’t, Before pitching it, consider trying the following:

  • Mix frozen milk with fresh milk to make it more appetizing to baby
  • Some moms find adding a few drops of alcohol free vanilla extract can mask the lipase flavor. 
  • Use it for a milk bath which can help with dry skin

Smoking and breastfeeding

Smoking and breastfeeding. In a nut shell: try to quit or decrease smoking when breastfeeding, but it’s better to breastfeed while smoking than to formula feed and continue to smoke

Smoking can cause low milk supply/milk let-down issues for you and your baby is at increased risk of colic, poor weight gain, respiratory infections, and SIDS (Sudden Infant Death Syndrome). Your milk does not eliminate these risks but does significantly lower them compared to formula. Breastfeeding also helps protect babies from the potential risks of environmental smoke.

The American Academy of Pediatrics (AAP) removed nicotine from its list of “contraindicated” substances during breastfeeding. An AAP statement issued in 2001 says, in part:

“One study reported that, among women who continue to smoke throughout breastfeeding, the incidence of acute respiratory illness is decreased among their infants, compared with infants of mothers who bottle fed. It may be that breastfeeding and smoking is less detrimental to the child than bottle feeding and smoking.”

If you do continue to smoke:

⏱️Wait as much time as possible between smoking and breastfeeding to lower the amount of nicotine in your milk

🧯Smoke right after breastfeeding and away from baby. Change your clothes and wash your hands before coming back to care for your baby’s. Have other smokers do the same

🚬E-cigs and vapes may have the same risks. There is limited research about the safety and health effects of e-cigarettes.

⚖️Monitor baby’s weight gain