(619) 606-2211


The content on this website ( is the property of Robin Kaplan, M.Ed., IBCLC, except in the case of guest blog posts, which have been posted with permission of the authors credited.

The information and opinions provided on this blog are not a substitute for medical advice or consultation with a qualified medical professional; nothing contained on this website shall be presumed or shared as medical advice at any time.

Links to other websites and blogs that may be of interest to you, the reader, are provided; this does not imply endorsement of or collaboration between Robin Kaplan and the owners/authors of those websites and blogs.


I'm Told my Baby Needs Supplementation...Now What?

Written by Danielle Blair, MS, IBCLC

If you are planning to exclusively breastfeed your baby, the thought of being told to offer supplements (meaning extra milk in addition to direct breastfeeding) for your baby may be downright terrifying.  You may be concerned about nipple confusion, milk supply, or exposing your baby to formula.  Hopefully by learning about common reasons for supplementation and supplementation methods, you can avoid unnecessary supplementation and learn how to offer supplements in ways that are less likely to interfere with breastfeeding.


Why might a baby need to be supplemented?

There are many common reasons why a baby might need supplemental feedings.  It is important for you as a parent to advocate for your baby by making an informed decision that the supplement is medically necessary.  Some common medical issues that can arise shortly after birth that may lead to supplements are prematurity, low birth weight, poor feeding, low blood sugar levels (hypoglycemia), elevated bilirubin levels (jaundice), dehydration, excessive weight loss or poor weight gain.  In all of these cases, the first step is to ensure that baby is breastfeeding effectively.  If not, a supplement might be called for as part of the baby's medical treatment.


What is a supplement?

Often we think of supplements as formula in a bottle, but in many cases, a supplement can be expressed breast milk.  Mothers can express their own milk, either by hand or with a breast pump, and offer it to baby by spoon, cup, syringe, supplemental nursing system, or bottle.  Each feeding method has pros and cons, and not all are appropriate for every situation.  If you are instructed to offer your baby a supplement, ask your healthcare provider or IBCLC to help decide which method is best to feed your baby.


What if I can't express enough milk for my baby?

In most cases, the only milk a baby needs is what he can take from the breast or what mom can express from her breast.  However, sometimes the medical treatment for baby's condition may include milk volumes that exceed mom's current supply.  This is especially true if supplements are recommended before mom's milk production surges about 3-5 days after delivery.  In this case, you may need to use donor milk or formula.  Your IBCLC can help you with pumping or hand expression techniques.  She might also recommend renting a hospital-grade pump until your milk production increases.


Will my baby ever be able to fully breastfeed after supplements?

Generally, the answer to this is YES!  Most reasons for supplementation are short-term problems that are resolved relatively quickly with good treatment.  Premature babies grow and get stronger, and typically get better at breastfeeding around their due dates or shortly after.  A baby who is having difficulty with breastfeeding immediately after birth will often be ready for breastfeeding within a few days after birth.  By expressing milk to feed to your baby, you are helping to establish and maintain the milk supply that your baby will need.


When can I stop supplementing?

Part 2 (next week) will discuss how you know it's time to wean from supplements and helpful tips for doing so. 

For more information about supplementation reasons, methods, and choices, check out these The Boob Group podcast episodes: 

Exclusive Breastfeeding and Early Supplementation 

Breastfeeding the Jaundiced Baby  

When Breastfeeding Doesn’t Go As Planned 

Low Milk Supply: Donor Milk, Milk Banks, and Formula 


About Danielle: 

I first became interested in supporting breastfeeding mothers after receiving wonderful support when I was a new mother.  What began as a way to "pay it forward" grew into a passion and a calling.  I have been helping new mothers breastfeed their babies since 2004 and became an International Board Certified Lactation Consultant (IBCLC) in 2010.  I am the owner of Gaithersburg Breastfeeding, LLC, offering home visits in Montgomery County, Maryland, and also work at a local hospital providing in-patient lactation services.  I have worked with mothers at all stages of breastfeeding, from the delivery room through toddlerhood and beyond.  I truly love supporting mothers as they learn the art of breastfeeding, and particularly enjoy watching moms develop the confidence that they can breastfeed their babies!

In addition to my work in lactation, I hold bachelor's and master's degrees in engineering from West Virginia University.  Much of my professional work in engineering involved sharing scientific information in layman's terms, as well as teaching and training; these skills have served me well as I teach parents about their new babies.  I live in the Maryland suburbs of Washington, DC, with my husband and two children.


The Lip Tie/Tongue Tie Challenge 

To help parents understand a bit more about how tongue and lip ties can affect breastfeeding, over the next few weeks we will be featuring stories from moms whose babies experienced these challenges.  We would like to extend a HUGE thank you to the brave mamas who submitted their stories for our blog!  We know you went through a ton of challenges and we are so appreciative that you were willing to share your stories!  If you have a story you would like to share on our blog, please send it to

For more information about tongue and lip ties and how they can affect breastfeeding, please see our article: Does Your Baby Have a Tongue or Lip Tie?


Written by Julie Sanders

My issues with breastfeeding my daughter started pretty much as soon as we left the hospital. I started experiencing a lot of pain in my nipples. Not just while she was nursing, but all the time. I was told it was normal for her to nurse 8-10 times a day, but my daughter was nursing 20+ times a day. Essentially, she was constantly nursing, with maybe a 10-20 minute break between sessions. I found that since any side-lying, cradled position was extremely painful, only the football hold position worked for me. I went to a breastfeeding support group her second week, and I learned that my daughter was chomping my nipples while she nursed, and that’s why they were in constant pain. Nipples are supposed to come out of a baby’s mouth just as round as when they went in, but mine were shaped like a football after a nursing session. No wonder! Someone suggested I try nursing her lying down because she was perhaps trying to stem a strong flow of milk into her mouth, but that didn’t help. On top of it all, I also got a clogged duct, which was painful and scary. I was in such excruciating pain I would cry when my daughter wanted to nurse because I just wanted a break for my poor nipples to heal. I didn’t know why it was so hard or what was wrong. The only thing that got me through this period were gel pads. The moist, cold combination was wonderfully soothing.

When my doula came over for our postpartum visit, she checked my daughter’s latch and suggested that we have her evaluated for a tongue tie. She said it didn’t look like her tongue reached far enough forward in her mouth (past the gums). We had never heard of a tongue tie before. She explained it is a very common, simple procedure our pediatrician could perform to snip the underside of her tongue to allow for greater mobility. I rejected the idea at first. The idea that my daughter wasn’t born with her mouth properly equipped to handle breastfeeding seemed ridiculous to me. My daughter was perfect in every way! But later that week when she had a wellness checkup, we asked about the tongue tie. Our pediatrician said it looked like there was indeed a tongue tie, and he would revise it if we wanted him to.  So he clipped the frenulum under her tongue. It was done with scissors while the nurse and my husband held her down. He gave her just a topical gel to numb the area, then had to do about 3-4 snips to cut what he deemed enough. She wailed like I had never heard before and cried real tears. I cried real tears too. It was scarring. I nursed her immediately afterwards to help stop the bleeding and she slowly calmed down. The bleeding stopped very soon and she seemed on the road to recovery. She had a little discomfort for the next day or two. I thought the nightmare was finally over. But it wasn’t. At first I noticed a relief in how she nursed, but it was very short lived. I found out at the breastfeeding support group the next week that there were exercises we were supposed to be doing to help my daughter learn to use the full range of motion of her tongue. The lactation consultant who runs the group emailed me a video with instructions. I did them several times a day, as suggested, but nothing changed.

At around three weeks we finally saw a lactation consultant. I wish I had seen her during week one! Within minutes of telling her our history and examining my daughter, she told us my daughter also had a lip tie, and explained that my daughter nursed constantly because she was only able to get enough milk to satiate her for a short time before she would get hungry again. I hated the idea that my daughter had another tie. My perfect baby was still perfect!  But we followed the advice of the lactation consultant and went to a pediatric dentist in the San Bernadino area who uses a laser instead of scissors, a tool that was supposedly less traumatic on both patient and parent. The thought of driving 80 miles with a baby so young almost deterred us, but we decided to go for it.

The dentist had my husband lie down in the chair and hold my daughter face up on his tummy. Being held by dad was far less traumatic than being pinned to a table by strangers. She also got to wear adorable little sunglasses to protect her eyes from the laser. The dentist checked her out and said she did indeed have a lip tie, and he wanted to do another revision on her tongue to cut more of the frenulum. It literally a minute per tie, if even. He lasered, she cried, and before I could even get upset he was done. I nursed her immediately, just like before, and she calmed very quickly. They gave me exercises to do with her several times a day to help the range of motion for her mouth. Once again I left with the feeling of “It’s over. It’s finally over.” But it wasn’t.

The discomfort again only lasted a day or two, and seemed a little worse for her lip than her tongue. I did the exercises but she just kept chomping. Though with the new mobility of her tongue, her bottom gums were padded a bit, and the pain, while still painful, was much more bearable by comparison. By this point I had gone through so much, I was determined to make this work. My lactation consultant had told us “body work” might be required. After all, my daughter had used her mouth to nurse a certain way her whole life thus far and she was used to it. So we went to a craniosacral therapist. The therapist observed my daughter while she nursed and felt all around her head to examine how her muscles were moving. She massaged around her head and jaw for a bit, and then she told us my daughter’s jaw was very tight, and that’s why she wasn’t latching correctly, but that there wasn’t anything she could do to loosen it.

Next we tried a chiropractor. Chiropractic was another kind of body work my lactation consultant had suggested we may need. She recommended a few people who worked with babies in my area. Over the next two weeks I saw the chiropractor three times. She adjusted areas in my daughter’s upper spine and around her jaw to try and loosen it. Between the three appointments and our periodic massaging of her jaw, gradually at around six to seven weeks old, my daughter’s jaw loosened, she stopped chomping my nipples, and started sucking the way Mother Nature intended. It felt like an eternity, but she is now three months old and our time breastfeeding is easy, a lovely bonding experience and no longer something I dread. It’s easy and wonderful, and it was worth every minute we spent at appointments and every dollar we spent on doctors and specialists and consultants.

I learned a great deal during this trial. A good lactation consultant is invaluable. Ours not only identified our issue right away, but she had all the references to specialists we needed. We were not in a place where we could have researched and found someone to go to on our own. We trusted our lactation consultant, we went where she sent us, and we were never disappointed. Surrounding myself with people who supported my determination to exclusively breastfeed was also pivotal. Being a new mom is an emotional time with many ups and downs even when breastfeeding is going well. My mental state really ran the gambit, and having people to tell me it would get better and that I could do it helped me through my lowest moments. The friend who introduced me to gel pads is an absolute saint! And I learned how strong a person I am.  Compared to this experience, labor was easy. I always referred to what we were going through as “a breastfeeding challenge” because a challenge is something you overcome, and usually leaves you stronger and better off than when you started. 


Nursing in Public - The Positive Spin


Recently, there have been a lot of stories in the national and local news about mothers being illegally harassed for nursing their babies in public (“NIP”).  The latest one involved a Twitter exchange between a breastfeeding mom and a Delta Airlines Public Relations employee

While we think it is so incredibly important that these types of incidences are highlighted and spoken about, we also believe it can paint an incorrect picture that if you nurse your baby in public, you’d better be ready for a fight.  So we thought we’d seek out some positive experiences mamas have had feeding their little ones while out and about - below are a few of the responses we received.  For every woman that may be made to feel uncomfortable for NIP, it is our greatest hope that there are 100 that receive smiles, nods, and even an occasional high five.  


From Lara Snyder:

Our son is three months old and so far I have had nothing, but positive and amazing breastfeeding experiences! The first time we ever tried NIP-ing was when my family was flying home to Colorado, for Christmas. It was my husband's and my first time flying with an infant so we got to the airport early. Our son was only one month old and like any one month old he got hungry often! Since it was my first time flying with a baby and NIP-ing I was really nervous that someone would give me a hard time and make the flight difficult. Luckily nothing like that happened! After getting through security our son started to get fussy because he was hungry, so my husband found a comfy bench to put all our stuff down and so I could nurse. Oddly enough the bench was right outside some bathrooms and quite a few people saw what I was doing!! Once we got all our stuff situated and I got comfortable, my husband simply said, "Ok I'm going to the bathroom, you feed the baby," without even second thinking my boob was going to be out in public. Sitting right there in the middle of the San Diego Airport, I fed our baby boy while airport employees and multiple travelers walked by. No one said a thing about my nursing! I'm sure a few people felt uncomfortable, but they just looked away. One man even came out of the bathroom and began talking to my family. It was a little strange to me and my husband because we didn't know this person, but he was rather nice and wished us safe travels! Once we got on the plane the positive experience continued and our wonderful little man slept the entire flight! The pressure changes bugged him a little, and even then I started nursing him and everything went smoothly! My husband offered to sit in the middle seat (even though he hates it) just in case an unappreciative person sat next to us, they would have nothing to complain about because they would see my husband and not me! After our flight landed in Colorado we waited to be the last couple off the plane, and a lot of the other passengers were surprised there was a baby on board!  Both my husband and I were so grateful I could nurse my son during the rough patches during the flight, and we felt so proud of our little man surprising everyone by not being that crying baby on the plane!


From Marion Luebberman:

I had to take my little guy to two life celebrations for friends who had passed away before he was four months old. I was terrified both times because I was sure people would give me the stink-eye for bringing a baby to something so somber, but the truth is, people love to see babies during times of sorrow. At the first event, I had to nurse during the eulogy and my son was only a couple months old so he was very floppy and not cooperative at all. The mother and aunt (neither of whom I'd met before) of our deceased friend came over and offered to help me. I was struggling with my cover and they both said "we've all been there, do what you gotta do!" I felt so comfortable there and my boy was fed and happy. At the next service, which was attended by 200+ bikers, my husband and I were talking to the widow of the friend we had just lost. She lit up at the sight of a little baby and told me that if I had to feed him at any time, I was welcome to "whip it out and do what you gotta do!" I did just that and nobody blinked an eye. If I could pass on any message to moms who are wary of nursing in public, I would tell them what these awesome moms told me - do what you gotta do!


From Tiffany Kyle: 

In my 15mo of breast feeding I can honestly say I have never had a negative experience nursing in public. One day stands out especially for me as being an incredibly positive moment. I was at Starbucks with my son and I think he was probably 7 or 8 months at the time. It was one of the Starbucks that has comfy furniture and it was quite crowded. I had been chatting with the people around me a little bit and they were commenting on how cute my baby was. When my son needed to nurse, we did our thing. I'll admit I wondered for a split second if any of these strangers who were sitting very near to us would have a problem with it, but everyone was more than supportive. The lady across from me gave me a high five and said what a great job I was doing and no wonder my son was such a happy guy. Seriously made my day. :)


Thank you so much to all of the ladies who contributed their positive stories - let’s keep it going by not only sharing our own experiences, but creating a happy memory for the next woman you see feeding her baby at the zoo, or the park, on the airplane, or in the grocery store - give her a high-five and tell her what a fantastic mama she is, and “to do what you gotta do!”


Do you have a positive NIP experience you would like to share with our readers?  Send your story to and we will include it in an upcoming article!   


Does Your Baby Have a Tongue or Lip Tie?

Painful, cracked, compressed-after-breastfeeding nipples.  Baby not gaining weight well.  Constant breastfeeding sessions that seem to take over an hour.  Excessive baby fussiness and gas.  These are some of the many signs that your child may have a tongue and/or lip tie.  So, what is a tongue and lip tie and how do they affect breastfeeding? What are ways to fix them and improve breastfeeding?

With several fantastic articles already written on this subject, we are going to give brief answers to these questions and link to our favorite comprehensive resources.  Also, over the next month, we will be sharing stories from breastfeeding mothers whose babies had tongue and/or lip ties.


What is a tongue tie and lip tie?

There are pieces of connective membranes under the tongue and behind the upper lip called frenula.  Everyone has a lingual (tongue) frenulum and a labial (lip) frenulum, which means that if your baby has one, it doesn’t automatically mean that you are going to have breastfeeding challenges.  It’s how the tongue and upper lip function that determine if the frenula are causing a problem.

Tongue tie

Upper lip tie 

How do tongue and lip ties cause breastfeeding challenges?

When the frenula are tight, they act like rubber bands, tethering down the tongue to the base of the mouth or the upper lip close to the upper gumline.  This makes it difficult to move the tongue in an effective manner or flange the upper lip out.  When the tongue doesn’t have full range of motion, it can cause all sorts of issues.  Some moms’ nipples will be compressed, causing pain and ineffective milk extraction.  Some babies will become very tired and fatigued while breastfeeding, having to work extra hard to compensate for the lack of range of motion in their tongues.  This can turn into ineffective, long feedings and slow weight gain for babies.  Other babies gain weight perfectly fine, but have tons of gas and excessive fussy periods because they are taking in so much air while breastfeeding due to the inability to push the milk back in a wavelike motion.  Babies with tongue ties or significant lip ties often continually fall off the breast, as they are unable to form a good seal and suction.  Other babies have such difficulty latching on to the breast that they refuse to breastfeed altogether.


Here are two articles that describe how tongue and lip ties can affect breastfeeding:

A Breastfeeding Mom’s Symptoms are as Important as Baby’s

Baby’s Weight Gain is Not the Only Marker of Successful Breastfeeding


Why didn’t my healthcare provider mention this to me? 

Most health care providers have not been trained to assess and diagnose tongue or lip ties.  Again, it is how the tongue and lip function (or not function) that cause the breastfeeding challenges.  Most health care providers have not been trained to complete suck assessments on infants, therefore they cannot accurately assess what the tongue is doing while feeding.  The best person to assess for a tongue or lip tie is a trained IBCLC (International Board Certified Lactation Consultant).


Who can treat my child’s tongue and/or lip tie and what are my options?

The best person to diagnose and treat a tongue or lip tie is a trained dentist, ENT (Ear, Nose, and Throat surgeon), oral surgeon, naturopath, pediatrician, or other medical professional trained to do minor surgery.  Make sure to do your research, as not all professionals that revise tongue and lip ties know how to release them effectively.  If the professional doesn’t do the revision procedure effectively and completely, then it will not fix the breastfeeding challenges completely and your baby may have to have the procedure again.  

In most cases, the tongue or lip tie revision is done at an office visit.  Some practitioners will numb the area before the procedure, although it isn’t necessary.  Some practitioners, such as ENTs and pediatricians, may use blunt-edged scissors to snip the tight frenulum.  Others, such as dentists, may use laser for the revision procedure.  


Are there any negatives to having the tongue or lip tie revised?

There is very little risk for having your baby’s tongue or lip tie revised.  Most parents comment after the procedure that their only regret is that they didn’t do it sooner, as it improved their breastfeeding challenges tremendously.  Some babies may be a little fussy after the procedure, but most will settle with some extra cuddles.  Some parents find that a little infant tylenol or homeopathy can help relieve pain (but always check with your healthcare provider for appropriate dosing.)  


How can I keep the frenulum from scarring down after the procedure?

It is very important that parents do suck and stretching exercises after the procedure to prevent scarring down.  My colleague, Melissa Cole, IBCLC, created this quick and easy video for suck exercises after tongue tie revisions:  She recommends doing these a few times a day, during baby’s quiet alert time, to retrain baby’s tongue to suck effectively and to prevent scarring down.  A local dentist recommends bending baby’s upper lip up to his/her nose after an upper lip tie release to prevent scarring down.


Will my breastfeeding challenges resolve immediately after the procedure?

Most moms report some immediate improvement after the procedure, but it can sometimes take up to a few weeks or months to resolve all of your breastfeeding challenges, depending on other confounding issues, such as mom’s milk supply or baby’s progress.  Remember, your baby has been using his/her tongue and upper lip in this way since he/she was in utero, so it may take some time to ‘relearn’ how to use his/her tongue and upper lip effectively.  Body work, such as craniosacral therapy and chiropractic, can help speed up this process as it can reset your baby’s nervous system, as well as relax the muscle tension that your baby may have developed while using compensating mechanisms.


Here are some additional online resources that have excellent information about tongue and lip ties.  Stay tuned for our featured stories from moms whose breastfeeding challenges improved after having their babies’ tongue and lip ties revised.  Better yet, sign up for our newsletter and have these articles delivered directly to your email inbox!


Websites that offer ways to see if your baby might be tongue tied:

Catherine Watson Genna: Is My Baby Tongue Tied?

Dr. James Ochi: Tongue Tie Survey

More researched-based articles about tongue and lip ties:

American Academy of Pediatrics Tongue Tie article

Dr. Kotlow: Tongue Tie Fact Sheet

The Leaky Boob: The Basics of Tongue and Lip Tie: Related Issues, Assessment, and Treatment

Boob Group episode: Tougue Ties and Lip Ties: Symptoms, Treatment, and Aftercare


If you would like to submit your personal story about breastfeeding a baby with a tongue or lip tie, please email it to

Did your baby have a tongue or lip tie?

How did this affect breastfeeding?



Baby Jaws - Breastfeeding a Teething (or Toothy!) Baby


All rights reserved by George Probst - Flickr

Duh Nuh Duh Nuh………….Duh Nuh Duh Nuh. (come on, you know you just read that out loud).  

You know they’re coming.  You’ve heard all the severe warnings from well-intentioned friends and family.  You’re scared of what’s to come, but know you’ve gone too far to turn back.  Shark-infested waters, you ask?  Noooooo - a breastfeeding baby who has grown TEETH!  

Somewhere around 6-8 months (sometimes earlier, sometimes later), your baby’s first tooth will erupt.  This is most likely an event you will celebrate, both because of the milestone that it is, but also because it may be a temporary break from the cranky, drooly, mouthy baby who replaced your own sweet one a couple of months back.  There are lots of symptoms that point to teething, but the most common ones are: red and swollen gums, increased irritability and drooling, sleep disturbances, and low grade fevers.  Your baby has most likely learned that chewing or gumming on items helps ease the pain and will try to cram everything within reach into his/her mouth.  As that tooth begins to emerge, there may be some small worries creeping in on your excitement about this next stage.  What will it be like to breastfeed a baby with teeth?  Will my baby bite me? Some moms will find that they do start to feel the baby’s teeth while nursing - baby may scrape teeth across nipple when latching or delatching.  And yes, sometimes the baby will bite.


Some rights reserved by stefernie


Why did he bite me!?

Short answer is that it’s not because he doesn’t like you!  New teeth bring a whole new sensation for baby.  He may want to explore his world using his new teeth and will scrape and/or bite items that come into his mouth.  Another reason that your baby may clamp down onto your nipple during a feeding is because of teething pain. As mentioned above, babies learn that biting and chewing on items may offer them some relief.   If they are experiencing teething pain while breastfeeding, they may try to alleviate that pain by biting down.  Or, your baby is finished with the feeding and wants to play!

Note: Sometimes when persistent nipple pain starts when the top teeth come in, it can be caused by an unresolved upper lip tie that is causing the baby’s top teeth to scrape against the nipple.  Make sure your baby’s upper lip flanges out, like fish lips, to prevent this pain, or consider having his/her upper lip tie revised.


What should I do?!

Almost all moms will have the same reaction the first time their babies bite them while breastfeeding - some loud yelling and possibly a quick change of position!  This is a completely normal and expected reaction, but you may notice the sudden sound and movement startles your baby.  The best thing you can do is soothe your baby and resume the breastfeeding session.  If your baby should bite you again, calmly remove the baby, give them a quiet vocal command (‘no’, ‘that hurts mommy’, etc) and temporarily end that feeding session. If your baby is still hungry, then offer the breast again to finish the breastfeeding session.  

Also, some moms find it helpful to rub a cold, wet facecloth on baby's gums before latching to desensitize the teething pain before latching.

Because of the sucking mechanism babies use when breastfeeding, it is impossible for them to actually remove milk from the breast when they clamp down on the nipple, therefore biting may indicate baby isn’t hungry enough to feed.  This is clear when a baby will bite towards the end of the feeding.  One way to prevent this is to watch your baby while feeding, and when he/she starts to show signs that he/she is almost done (suck pattern will slow greatly, baby may come off often and smile and interact with you), calmly remove him/her from the breast and end the feeding session.  

For almost all breastfeeding babies, this biting is a temporary phase.  As they grow more accustomed to their new teeth and learn that biting means the breast is taken away, they will likely stop the behavior.  If your nipples become cracked or sore because of any biting, we recommend applying organic coconut oil - it is soothing along with having antibacterial and antifungal properties.  


All rights reserved by dawngalloper12


Rest assured, the biting is normally a very fleeting behavior.  Before long, the waters will once again be safe to enter.  


Has your baby ever bitten you while breastfeeding?

What did you do?



Page 1 ... 3 4 5 6 7 ... 56 Next 5 Entries »