WHAT TO EXPECT POST TONGUE TIE RELEASE  

My baby had their tongue tie released, what should I expect? First, having a tongue tie released isn’t always a magix fix to breastfeeding issues. While 80% of mothers do report a significant decrease in reported nipple pain after the procedure, there is still a recovery and healing proceess that needs to take place. That tongue has been like that since 8 weeks gestation and depending on how baby has learned to use their tongue, some relearning is necessary. 

Do I need to do stretches on my baby’s tongue after a release? There are conflicting answers, and it seems like every provider has a different one, which gets really confusing. The biggest concern is reattachment, which defeats the purpose of the release and for some, reattachment means re-release. 

Every baby is unique, as is their healing post release. When you have a tongue that is strong and coordinated but range of motion is limited because of the frenulum, the stretches, exercises and wound care management are different than a tongue that is super weak and disorganized. 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. Bodywork, suck training and lactation support are still crucial for the few days to weeks after the release is done. 

But what should you expect as a parent.

Day 1-3 your baby will feel sore and tender. They may be fussier than usual. A white patch will form where the surgery was done. Baby may have difficulty latching to bottle or breast, so have an alternative feeding plan ready such as cup or finger feeding. 

For the first week, baby is relearning how to use their tongue. Your provider should talk to you about stretches to do several times a day to help prevent the tongue from reattching. Our body likes to heal together so this is very important. Some minor bleeding may occur, but if you see lots of blood notify your provier right away. Pain management is often needed for the first few days, but many babies can taper off of this. 

From week 2-4, the white patch will shrink and may turn yellow as it heals. Some babies will see a small to drastic reduction in their symptoms at this point. Many babies will still need bodywork or lactation suppot. 

Natural remedies can include frozen breast milk chips that you can use to numb the area. This is especially helpful for very small babies when you don’t want to use an OTC rememfdy. 

Coconut oil is often recommended to lubricate the wound and for use during the stretches. A little goes a long way.

There are natural remedies that some parents find helpful such as arnica or camellia. And infant’s children tylenol can also be helpful. Mae sure to talk to your provider and your pediatrician for the correct dosage which is done by age and weight. 

Lots of snuggles, skin to skin time, and baby wearing can be helpful. Keep time at the breast pleasant and if you’re having trouble feeding, make sure to reach out as soon as possible for help.

Most parents are very aware of the AAP guidelines for safe sleep for babies, which includes having babies sleep in the same room as their parents for the first 6-12 months. Did you know having baby sleep in the same room as you also applies to naps during the day? Research shows babies who sleep in a separate room from their parents are at a greater risk of SIDS for both daytime and night sleeps. While 83% of SIDS deaths occur at night, the risk during the day is still there. The safest option is to keep your baby near you while they sleep for the first few months of life.

Here’s three ways to have baby sleep close to you:
👼🏼 Baby Wear: This ancient practice has baby riding on your body like a baby monkey. They may be worn on your chest facing you, on your chest facing out, on your hip or back. Ring slings, soft wraps, structured carriers or baby back packs all work. The movement of your body helps baby be swayed to sleep and the rhythm of your heart and body heat help them stay comfortable and calm. You can still move around and get chores like vacuuming and washing dishes done

🛌 Co-nap: Every new parent I know is sleep deprived to some extent. As they say: eat when baby eats, sleep when baby sleeps, and vacuum when baby vacuums (which means it’s ok to stall a bit on those chores to enjoy those baby snuggles). If you are breastfeeding and bed-sharing, learning side lying breastfeeding can be a game changer. Never co-sleep with baby on a couch or chair. If you plan to sleep at the same time as baby, or fear you might accidentally fall asleep, always lay down on a firm, flat mattress and make sure there are no blankets or pillows around that could cover baby. Those who are not breastfeeding, smokers and others who fall outside the guidelines for safe bed-sharing can put baby to sleep in a bassinet or crib, then lay down in their own bed in the same room.

😴Contact Nap: It’s a term coined by Sarah Ockwell-Smith, author of The Gentle Sleep Book. It means having all or part of one body in contact with another body while one or both sleeps. Skin to skin contact releases oxytocin, the cuddle hormone, to help you bond. And when you’re breastfeeding, this contact also helps naturally boost your milk supply. Its OK to contact nap as long as you mutually want and it WON’T create a dependency to sleep on you in the future.

This stage in parenting is short and babies will eventually stop napping. Make the most of it by keeping it safe (and snuggly).

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.