Why is my breastfed baby losing weight?

While maternal nipple pain and damage are classic signs of tongue tie in baby, I have seen many cases where the mother reports absolutely no pain with breast-feeding. These babies tend to have very high palates and some times a weak suck (not always). The actual nipple in most cases is large and long and goes up into the palate where the tongue tends not to be able to pinch it as much. There may be creasing of the nipple, but usually not the classic damage seen with other presentations of tongue tie. These mother‘s bodies often compensate with a fast let down and over supply of milk. These babies trigger let down easily and the mothers body responds with freely flowing milk. Baby drinks from the fountain without learning how to stimulate the breast and empty it on their or or learning how to trigger new let downs. These babies often gain weight well or even faster than expected until around 3-4 months when they unexpectedly drop off the growth curve and mom feels like her supply suddenly drops. Symptoms often include clicking at the breast (caused by that high palate and the fast flow of milk) which in turn increases the risk of reflux, colic and gassiness. Moms also complain that they need to constantly hold or shape the breast or baby loses the latch. These ties often go undiagnosed and many of these babies are switched to bottles and formula as the supply continues to decrease from the baby inefficiently moving milk from the breast which can also coincide with mother going back to work. If she is using a poor quality pump or the wrong size flanges and not moving milk well with the pump, she’ll often blame herself for the low supply.

Breast changes

Breasts are made of a network of ducts, covered by a layer of fatty tissue. During pregnancy, estrogen and progesterone enlarge the milk ducts and multiply the glandular tissue that produces milk. After birth, estrogen and progesterone drop and prolactin and oxytocin rise. Prolactin makes milk production and oxytocin releases it into the ducts. Extra blood and fluid fill the breast just after birth to supoort your body adding hormone receptors in the breast to make milk. The blood and fluid surrounds the ducts and this extra pressure is what makes your breasts feel full between feeding. This blood and fluid reabsorb around 6-8 weeks once supply is established and you won’t feel that full/soft feeling except when you go a really long time between feeding or pumping. Breasts go back to prepregnancy size when supply regulates around 11-14 weeks but continue to make milk. When you wean from breastfeeding, it can take several months for prolactin levels to return to baseline (which is why you may still see milk for months after weaning). Once you stop breastfeeding, the milk making structures actually self-destruct – a process that involves massive cellular suicide, and the removal of the debris. Around 6 months after weaning, the milk-producing tissue is replaced with fatty tissue. If you return to your pre-pregnancy weight, your breasts most likely will return to the same size. They may not be as “perky” because the skin is a bit more stretched and the connective and fatty tissues in the breasts often shifts during pregnancy and breastfeeding. While they may look smaller after weaning most of us can expect that our breasts will return to a similar size as they were pre-pregnancy. They’re just a little more lived in and well loved.

Tricky Posterior Tongue Ties

Some times even the best lactation consultants and feeding therapists can miss a posterior tongue tie in the immediate days or weeks after birth. Having a frenulum under the tongue doesn’t automatically mean it’s tied. A long, stretchy frenulum that allows full movement of the tongue is normal and not something that needs released. However, sometimes a frenulum can allow the front of the tongue to do what it needs to, but still be tied at the back. These are what I can tricky posterior ties. Mom may have lots of milk and baby transfers well from the breast in the early days or weeks post delivery. Mom may have no nipple pain or damage whatsoever. Only they come back a month later with new symptoms like slow weight gain or feeling like there breast isn’t emptying. Why is that?

Mom’s body often compensates well during the early weeks post delivery. The uterus doesn’t tell the breasts how many babies came out. So her body goes into overdrive to make more milk than needed from the start. As time moves on, the body figures out how much milk to make and drops supply to just what is being emptied. A baby that rode on mom’s robust post delivery flow may all of a sudden start to struggle at the breast as supply regulates. Based on how the anatomy is, there may never have been nipple pain or damage. If the baby has a high palate where the front of the tongue can still move well and mom has a large nipple that fills baby’s mouth well, the nipple may come out creased or pinched, but without pain. The anatomy on one or both sides masked the tie while baby was small. 


If breastfeeding was going well in the beginning, but symptoms start to pop up later, working with a qualified lactation consultant can help figure out what’s going on. And some times that means finding a posterior tie that was originally missed where a release is necessary to get feeding back on track. 

Causes for mastitis

Did you know mastitis may be related to your posture?

Fluid dynamics is the science of how fluids move in our bodies. All of put bodily fluids are supposed to be free-flowing and unobstructed for optimal health. Milk is a fluid that flows through ever narrowing ducts and pores. Lymph is a fluid throughout your body (and breasts) that helps transport waste from cells and tissues in your body to help flush it from your system. It also helps reabsorb milk that doesn’t get emptied to baby/pump. Anything that increases resistance of the movement of these fluids increases the likelihood of plugged ducts or mastitis. Causes for increased resistance:
⭐️ Breast implants or reduction causing scar tissue in the breast
⭐️ Sleeping in the same posture especially on your side where you put pressure on the breast for extended periods of time
⭐️ Tight fitting clothing/bras that constrict movement of milk and lymph between feedings
⭐️ Shoulder injuries where there is inflammation or scar tissue
⭐️ Neck injuries or issues with neck mobility
⭐️ Tension in your body from stress or poor posture for extended periods of time during breastfeeding (bringing yourself to the baby)
⭐️ Not moving the body enough/sitting for prolonged periods of time in the same position
⭐️ Increased overall inflammation in the body such as from infection or excessive fluids from IVs used during labor and delivery or from immune disorders
⭐️ Having very large, heavy breasts which act more like an appendage where milk and fluid can fill the lower quadrant of the breast and have difficulties moving out again

What can you do?
❤️ Shake your breasts!! Get that fluid moving manually with your hands
❤️ Lean over and dangle your breasts to reduce pressure on them and help them free flow
❤️ Practicing yoga works well, especially with poses like downward dog where you’re changing the orientation of the fluid in your breast related to gravity.
❤️ Avoid restrictive clothing and bras
❤️ Get a massage!! Having hands on the body helps get the fluid inside moving in the right direction
❤️ See my video for lymphatic drainage massage

Manuka Honey for Nipple Damage

HONEY: It’s the Bees Knees for Nipple Healing

A person with sore, cracked nipples will do absolutely anything to bring relief to the pain and heal the damage. Sterile, medical grade manuka honey is one of the most unique and beneficial forms of honey in the world. And one of the best remedies for long standing injured nipples. Research shows that not only does honey have potent antibacterial properties which can prevent infection but it also stimulates the growth of new tissue and formation of blood cells, promoting the healing of wounds. Rich in anti-oxidants, anti-bacterial and anti-inflammatory properties, manuka honey can be used between feedings to heal nipples fast. But don’t run out to Vons or Kroger yet. This is not honey you buy in the bread aisle at the grocery store. Medical grade manuka honey has been irradiated to destroy any botulism spores and is completely safe to use with nursing a newborn.

Clover or flower honey like in the cute honey bear you put in your tea is not safe for your baby. Babies under 12 months should not be given honey, because honey contains bacteria that an infant’s developing digestive system can’t handle. Eating honey can cause your baby to become ill with a condition called infant botulism. You want to look for sterile or medical grade manuka honey, like what is found in Medi-honey paste or dressings.

Have cracked nipples? Lactation Hub has the correct honey you need to heal your nipples quickly.

Slacker boob

Did you know? Around 70% of women produce more milk in the right breast. Which means 30% make more in the left. It is VERY common for one side to produce more than the other. Some times double on one side. We don’t know why. This is not a reason to neglect one side. You want to make sure you rotate which breast you offer first. Babies may prefer one side over the other for various reasons:

👶🏽They like to lay with their head in a certain direction or their body is uncomfortable in the opposite position

👶🏿They prefer the flow (one side may flow faster or slower than the other)

👶🏼They may prefer the flavor (YES!! Milk can taste different form each breast during the same feeding!!)

If you want to help balance out a slacker boob:

🔆Offer the slacker first more often. 

🔆End on the slacker can also help, especially if baby just wants to use you like a pacifier. 

🔆Pump the slacker side during or after feedings can also help stimulate more milk production

🔆Make sure you have the correct sized pump flange on the slacker side. Our nipples can often be different sizes and using the wrong sized flange can drop supply on that side

🔆Hand expression on that side at random times of the day even for a few minutes will jump start increased production. 

🔆If it’s positional from your baby (they only want to lay cross cradle to the right and not the left, experiment with other positions like football or side lying to help baby compensate for their body. If your baby prefers one side of the other from a positional perspective, consider taking your baby for some infant bodywork like chiropractic or craniosacral therapy.

What’s up with my baby biting, gumming, chomping, hitting, pulling and pinching the nipple/breast while breastfeeding?

Babies are masters at breastfeeding. They will exhibit all kinds of behaviors at the breast that will make you question if you have any milk and wonder what’s wrong with the baby. Most babies discover they have power and control over the breast and that different behaviors get different things. Biting, tugging, gumming, pulling, patting, chomping, shaking the nipple and breast are normal infant behaviors. Repeatedly latching on and off can also be normal when it doesn’t happen all the time. They happen during growth spurts, cluster feeding and teething. And may increase when baby discovers they can get a reaction from you for them. These behaviors increase or decrease the flow rate of milk and help stimulate supply and let down during growth spurts and teething.

What can you do? Stay calm. Most likely it’s normal and will change with time. Lots of skin to skin time between feedings can help keep baby calm and will naturally increase your supply during growth spurts. Using breast compressions while feeding can help increase flow and help trigger let downs. If baby is teething, give plenty of opportunity to chew and bite on appropriate toys and food items outside of nursing times. If baby is biting to slow flow, try a laid back position and make sure you’re not promoting an oversupply from over use of the Haakaa or pumping at sporadic times. Continue to watch for wet and dirty diapers and know that usually these behaviors are normal and don’t last.

If baby is having these behaviors all the time and isn’t making the amount of wet and dirty diapers you would expect, schedule a lactation consultation immediately.

Breastfeeding weaning

There is no right or wrong age, it is completely up to you. Breast milk does not lose nutritional value (ever), so you get to decide how long you want to breastfeed. You also get to decide when you stop and all reasons for wanting to stop are valid. It is OK to wean for your emotional or mental well being and you do not have to justify your choices of how you feed your baby to anyone.

The age of your baby and how quickly you want to wean can play a role in how you wean.

Be prepared that some may experience mood changes and feelings of depression when weaning as your oxytocin and other hormones are dropping to stop milk production. If you need a specific plan to help you quickly wean, schedule a consultation with me to develop a plan that works for you.

Tips for gentle weaning:

✏️Start when your baby has already naturally started to wean, ex. only a quick snack before nap or waking up at 2am to pacify to sleep

✏️If transitioning from breast milk to formula, you can add formula to your breast milk bottles in slowly increasing amounts to make the transition easier on baby’s tummy (ex mix 2oz of breast milk with 1oz of prepared formula for several days, then mix 1.5oz each if breast milk and formula for a few days, then 2oz of formula with 1oz of breast milk)

✏️Don’t offer, don’t refuse

✏️Wear clothing that makes accessing the breast/chest more difficult.

✏️Distract child with favorite activities or offer alternatives like a favorite snack

✏️Change your routine

✏️Postpone: “After we play”

✏️Shortening the length of feeding or space feedings out

✏️Talk to your toddler about weaning. Older children (2 years and up) can be part of the process by talking to them about what is happening.

✏️Alternate between offering bottles and the breast

✏️Be consistent – this is a hard one but it can be even more confusing to your baby if you allow them to nurse one time and not the next.

✏️Lots of cuddles. Your breast/chest is more than just food but also a great source of comfort. Showing them you are still a source of that comfort despite not nursing is incredibly important

Ways to quickly wean:

⚓️Empty the breast only to comfort, trying not to stimulate the breast to make more milk

⚓️Breast gymnastics/“milk shakes” often to keep milk from sitting in the breast and clogging the ducts

⚓️Epsom salt soaks of the entire breast for soothing

⚓️Drinking 2-4 cups of sage or peppermint tea per day

⚓️Green cabbage leaves in the bra until they are soggy and then replacing the leaves

⚓️Cabocream (an alternative to the cabbage leaves

⚓️Cold packs on the breasts after feeding or pumping to reduce swelling

⚓️Starting on a hormone based birth control, especially The Pill (estrogen based) will drop supply

⚓️A last resort would be to take an antihistamine like Benadryl or Claritin-D as these are also notorious for dropping milk supply. This should be done with caution and under the direction of your primary care physician

True SELF-weaning by the baby before a year old is very uncommon. In fact, it is unusual for a baby to wean before 18-24 months unless something else going on (work, inefficient feeding, tongue tie, etc). A self weaning child is typically well over a year old (more commonly over 2 years) and getting most nutrition from solids, drinking well from a cup, and has been cutting back on nursing gradually.

Reasons a baby under a year may be perceived to self wean:

🔑Solids were introduced too soon

🔑Scheduled feedings/sleep training/pacifier use (all decrease time a baby would naturally want to be at the breast/chest)

🔑Lactating parent loses a lot of weight fast which can decrease milk supply

🔑Medications or hormonal birth control which will decrease supply

🔑Lactating parent is pregnant

🔑Baby taking lots of solids before one (human milk should be the primary nutrition source through one year of age)

Empty breasts make milk faster than full breasts

FULL/EMPTY BREASTS

While it seems counterintuitive, the emptier your breasts are, the faster they make milk. A full bread has no place to store or hold the milk, so milk production slows to prevent plugged ducts and breast discomfort. Cluster feeding on an emptier breast actually tells the body to make more milk at a faster rate!! Some incorrectly assume you have to wait for the breast to “fill up” before feeding your baby or for pumping while at work. This will eventually lead to less milk, as a fuller breast tells your body baby isn’t eating very often and to slow milk production. The more frequent you empty the breast, the higher the fat content in that milk and the faster milk is made. The longer often you wait and the fuller the breast, the higher the water content in that milk and the slower your body will make milk overall.

W atch the baby, not the clock. Breasts may feel really full between feedings in the first few weeks after birth, but they’re also not supposed to stay engorged. There will come a time when they stay soft and don’t feel full between feedings or pumping, so waiting for that as a cue to feed will also sabotage your supply. Don’t be alarmed when your breasts no longer feel full between feeding. You’re entering a new stage where you’ll still make plenty of milk for your baby as long as you’re routinely emptying that milk. Trust your body. Trust your baby.

My baby won’t breastfeed I think there’s a tongue tie

As an SLP/IBCLC, I look at three things when doing an assessment on infants: what does the tongue look like, what can the tongue do, what symptoms is it causing. The tongue needs full range of motion (in and out, side to side, and up and down ) for feeding, dental hygiene and to some extent speech. You can have a frenulum can still have good range of motion. A frenulum is considered tied when the tongue can’t move in all directions and it’s causing symptoms because it’s not functioning correctly.

Symptoms to watch out for are:

👅Can not grasp and hold a nipple for breast or bottle feeding

👅Pops on and off the breast/unable to latch or maintain the latch

👅Leaks milk from breast or bottle

👅Fatigues easily from tension on the tongue and jaw/“sleepy” at the breast

👅Wants to feed all the time and never seems satisfied

👅Causes nipple pain and damage when latched

👅Pinches the nipple when feeding causing recurrent plugged ducts and mastitis

👅Doesn’t empty the breast well causing low milk supply

👅Tongue constantly in a “stimulation” mode instead of efficient sucking at the breast, causing an over supply of milk with fast let down

👅Cannot create the vacuum needed to draw breast milk and makes a clicking or loss of suction sound at the breast

👅Poor weight gain

👅Chokes and gags during feeding

👅Fussy at the breast

👅Swallows air while feeding causing reflux, gassiness or colic

When range of motion is restricted, or is causing symptoms, I will refer to a pediatric dentist who also looks at how the frenulum is impacting structure: is it pulling on the structures of the floor of the mouth and the jaw? Is it putting tension on the bone? In those cases, when function is restricted and it is currently causing symptoms, a revision is warranted. I never recommend revision to avoid symptoms down the road. It’s not ethical.