Advocating When Your Baby has a Tongue or Lip Tie

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 robinkaplan@sdbfc.com.

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?

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Written by Kimberly Berry

I am often referred to as a "boob nerd" by many friends. Articles, research, blogs....anything breastfeeding related always interested me. I absorb the information like a sponge. Sharing and helping moms with nursing just came naturally. I never heard of tongue or lip tie though until I was pregnant with my second. A few things I read made me wonder if some of the struggles I had with my daughter were due to a possible tongue/lip tie in her. She had self weaned recently though, so I never gave it much more thought. That reading on tongue ties proved to be invaluable to me in just a few short months however.

My handsome baby boy came flying into this world at 5:01pm on a Friday afternoon. The moment he was handed to me after his birth, I saw it glaring right back at me as he cried and took his first breaths. A tongue tie. His frenulum stretched all the way to the tip of his tongue. I kissed and nuzzled him close to calm him, warm him. Once calm, I looked at my husband and said, "He has tongue tie." My husband, confused said, "..ok?" not knowing what I knew. Not knowing how that can affect breastfeeding. Not knowing the possibility for pain and injury for me while nursing our second child. The nurse nearby heard me and chimed in to say "Oh, it's just a small one, no worries!" I told her I wanted to see a lactation consultant. She nodded her head and continued on with her work. 

I then began the process of trying to get him to latch for his first feed, although I knew that it could quite possibly be as bad, or even worse than the pain I just endured to bring him into this world. He was disinterested. So we snuggled and I tried every five minutes or so. Finally, 45 minutes after his birth, he latched. I unlatched and relatched him over two dozen times before it felt even remotely close to ok. I asked again to see the lactation consultant on staff. I did breast compressions and massage to help encourage colostrum into his little mouth that he was trying so hard to get to work correctly. Becoming annoyed, I would then ask every person that came into my room to bring me a IBCLC. I was met with "Yes, sure thing!", "You are on the waiting list", "Your nipples are just too big for his mouth"... I could go on and on with the excuses I heard the rest of that day and overnight. We struggled through each feeding. He was frustrated, and so was I. When he cried, his tongue looked like a heart. My heart broke that this was going on and help was seemingly out of reach. 

Finally, at 9am the next day, a IBCLC stopped in to "see how breastfeeding was going." I told her that I had been asking to see a lactation consultant since his birth the evening before. Shocked, she said she was not made aware we needed her. We discussed for several minutes how crucial nursing support is to new mothers and who she was going to speak with about the situation. I made my notes on who to contact as well  as who to advise of the lack of proper treatment. Then we got down to the business at hand. She agreed immediately that my son had a tongue tie, and not "just a small one" as the nurse had called it. She called right then for the ENT to work us into the schedule immediately to have it clipped. Unfortunately, we were knocked back on the list several times due to other emergency surgeries that day. While I am a patient person, I was becoming angered that the fact that my child was having trouble eating was not a concern to most of the staff. 

The next day, the day of our discharge, arrived and we were still muddling through feeds. I was starting to become very sore. Again, we were told time after time that we were next in line for his procedure, only to be knocked back again by an emergency surgery. How many emergency surgeries were there?! How many other new mothers were waiting for the same help I was??? The IBCLC I had spoken with the day before was not working. The other IBCLC couldn't get to us until that afternoon. Our nurse was sympathetic, but said this seemed to be typical of the weekend. Finally, I said enough is enough and took matters into my own hands. I looked up the ENT my daughter sees. Being a Sunday, the after hours line was activated. I left a message to see if anyone could call me back to let me know if they preformed frenulectomies on newborns. Thankfully, a sweet nurse called me back after about 5 minutes. She said that they did do the procedures, but I would have to call back in the morning for a appointment. 

We left the hospital and never looked back. I bared through the pain of the feedings until that appointment with the ENT the next afternoon. The frenulectomy was not easy to watch, but it helped so much. When he nursed when it was over, I could tell a difference, not a huge one immediately, but enough that I didn't wince up and have tears in my eyes the whole time. We only had to relatch six times instead of more than a dozen times. Each day thereafter, nursing was getting better and better. We practiced the exercises and I continued trying to heal my nipples. After several days, he started gaining weight and I was settling into being a mommy of two. Nursing became a joy again. Something I once again looked forward to. It was now my time to look in awe at my newborn and be proud of my body’s amazing ability to grow this perfect being and now continue to nourish it. 

Without a doubt, if I didn't know anything about breastfeeding or tongue ties, I would have thrown the towel in and given up. It was clear for me to see why so many new mothers do. In a mom’s group I help with, I constantly tell new mothers to check for tongue/lip ties. Even if someone says there isn't one, or if its minor and won't affect breastfeeding, know how to look yourself and find someone who will help you. You have to be your own advocate. Your babies advocate. We look to these medical professionals to guide and help us. Unfortunately, sometimes that's not always the case. It's crucial for them to receive the proper training, listen to their patients, and have resources available to help mothers and babies. It's crucial for mothers to be determined, educated, and supported. All of these things go hand in hand for successful breastfeeding. My son went on to nurse until he self weaned at 13 months.

I’ve Had My Baby - Now What? Breastfeeding During Weeks 3-6

Welcome back to our new series, I’ve Had My Baby - Now What?  This is a guide with basic information to help you navigate the first days, weeks, and months of breastfeeding your new baby.  

Today we’d like to talk about weeks 3 through 6 of your baby’s life, and what breastfeeding looks like.  What can you expect for normal behavior from your new baby, and when do you know there’s a problem that you should seek professional help for?

What does normal breastfeeding look like in weeks 3-6?  How often should my baby be eating, and how long should feedings take?

It’s extremely common for babies at this age to still want to feed frequently, every 2-3 hours.  Some *may* become more efficient and take in more at feedings and start to space them out a bit more, but don’t fear if your baby hasn’t done this yet!  Feedings may start to speed up as mom’s milk volume is higher and baby has had good practice breastfeeding, but again, don’t worry if your baby still feeds at the breast for as long as he/she did in the early weeks.  It can take some time for mom and baby to really get their groove and you may still be working out some kinks during weeks 3 through 6.

How much weight should my baby be gaining at this age?  How will I know if he/she is getting enough when I’m not seeing my pediatrician as frequently for weight checks?

Up to 4 months of age, we expect babies to gain .5-1 oz/day, or 4-7 ounces a week.  There are many ways other than weight to be sure that your baby is getting enough milk.  If your baby is having plenty of wet and soiled diapers each day, and generally seems content after feedings for two hours or more (outside of growth spurts and cluster feeding periods), you can feel good that he/she is probably getting enough.  If you want a little more concrete evidence, a great way to track your baby’s weight is by attending a free weekly breastfeeding support group.  There will often be a scale there to weigh your baby, you can do test weights to see how much baby is taking during that feeding, get help from a lactation consultant or educator, and, the BEST part, meet and connect with other moms.

Can I give my baby a bottle now?  If so, who should give it and how often should they do so?

 Once breastfeeding has been established, weeks 3-5 are the perfect time to introduce a bottle to your baby if you’d like them to take one.  It’s normally best that someone other than mom gives the baby the bottle, as babies often associate mom with breastfeeding and may refuse a bottle from her.  Plus, often times, partners and grandparents have been waiting for their moment to participate in the feeding of the baby.  We recommend that mom start pumping after week 3, once a day or so, to start to save up milk for that first bottle.  2-3oz is an appropriate amount to start with.  Be sure that the bottle is fed to the baby in a breastfeeding friendly manner.  If mom is going back to work, we recommend that baby receives a bottle on a somewhat regular basis, a few times a week, so that he/she remains familiar with it.  Plus, mom should pump every time baby receives a bottle to maintain her milk supply.

My baby is inconsolable for a few hours in the evenings.  Why is this happening and what can I do?

Many babies have a “witching hour”, or as I like to call it, “an unhappy hour”.  The term is a bit misleading as the behavior normally lasts for more than an hour!  It occurs most frequently in the late afternoon/evening hours.  Babies are often fussier than normal during this time, and want to eat often.  And while they want to feed often, they may pull off more frequently as well.  There are a number of theories as to what causes this fussiness at this time.  They may be feeding often to “tank up” on calories before taking a long sleep (sounds wonderful!).  They may be overstimulated from their day and having a hard time winding themselves down.  This is often a busy time for the entire household, as partners are home from work and older siblings may be home from school.  Best thing that you can do during this time is to offer the breast often.  Learning to nurse in a baby carrier can be a lifesaver as it will allow you to be hands-free while the baby is snuggled, fed, and comforted.

How will I know if my baby is colicky?  Is this the same as the ‘witching hour?’

Many parents confuse normal fussy behavior for colic.  Colic is defined as 3 hours or more of crying, 3 or more times a week, for 3 or more weeks in a row.  It normally resolves itself around month 4.  If your baby’s crying looks like this, he/she may have colic.  There are no definitive cause for colic, but it could be related to gut issues due to food sensitivities.  The “witching hour” is the period of time of day when your baby may seem unusually fussy, normally lasting for a couple of hours. This behavior peaks around 6 weeks and then often starts to fade.

If I am still having a challenging time building up my milk supply at this time, have I missed the window for increasing my milk supply?

Not at all!  Depending on the reason for mom’s low supply, there are plenty of things that can help boost  supply at this stage.  The most important thing is to learn why mom is struggling with her milk supply.  As always, lots of good breast stimulation is best - either from a baby or a hospital grade pump. There are also herbs and medications that are available that can help boost supply as well.

There may be times when things aren’t going the way they should.  If you find this, please contact an International Board Certified Lactation Consultant to help you.  Some signs that you might need some additional help:

• Sore, cracked, bruised, or bleeding nipples.

• Baby is gaining less than 4oz per week.

• You suspect your baby may be tongue-tied.

• Painful, recurrent engorgement.

• Oversupply.

• Baby is having problems stooling.

• Overly gassy, fussy, or colicky baby.

• Breast infection - mastitis, abscess, or thrush.

For  more information about what normal breastfeeding looks like in the first few weeks, check out our article,What Every Mom Should Know About Breastfeeding During the Early Weeks, which highlights our brand new brochure!  Also, check out Ashley as she discusses more tips and tricks for breastfeeding during weeks 3-6 on the Boob Group episode, New Mom Breastfeeding Manual: Weeks 3-6.

Mother Kicked Out of LA Fitness for Breastfeeding in the Locker Room

It happened again in San Diego!  How is this possible?  Another nursing in public incident that clearly violated California state law!  An incident where a mother felt violated and shamed for nursing her baby in a public place.  Another reason that reinforces the need for our San Diego Nursing in Public Task Force.

Here is Monique Golueke’s story, in her own words. 

"It had been over a year since I had been to the gym and after what happened today, it's not likely I'll be returning, at least not to LA Fitness. I was so excited to attend a step class alongside one of my best gals.

On April 22, 2014, I reinstated my membership, paid the fees, and signed my boys up for the unlimited Kids Klub pass. Forty-five minutes into our class, I was notified that the boys had been crying and they weren't able to settle down. I swooped them up and took them directly to the ladies’ restroom/locker room where I washed both of their little hands. My 9-month old still seemed upset so I decided to nurse him while my toddler sat next to me and played with my phone. About five minutes later, I was approached by an LA Fitness employee.  She told me that we needed to leave and that children were not allowed in the locker room.

I explained that I was nursing my son and she responded by saying that since I was new I probably didn't know the rules. She told me that an "elderly" woman had complained. Upon signing back up for the gym, there was no mention of the rules regarding the children.

When approached, I felt completely mortified, embarrassed and ashamed. I asked the employee where I should be nursing and she told me that there was a bathroom located in the kids club. Escorted out I felt embarrassed, ashamed and humiliated.  Keep in mind that there are no signs posted stating that children are not allowed in the ladies’ restroom/locker room. My intention was to nurture and care for my children in a safe and friendly environment.

Escorted me out-what now?

They were more than happy to accept my money, then send me on my way.

I decided to call corporate and notify them of what happened and also have my account deactivated, I also asked them to refund my money. They were apologetic and handled the situation by having the manager from the Oceanside location contact me.

The manager called me and asked what had upset me: the fact that I was breastfeeding or the fact that the kids were in the locker room. I barely understood what he was asking. It was clear he didn't understand the legality of the situation. He told me that if I ever wanted to return to LA Fitness, I was welcome to nurse my baby in the restroom located in the Kids Klub.

I'm not positive but I think the only place to sit in the restroom that he was referring to is on the toilet. 

At that point, I decided to again contact Corporate and inform them of the absurd conversation I had with the manager.  They were apologetic and explained that if they needed to contact me they would. The conversation was strange and at this time I was heated and enraged. The woman didn't really say much."

After Monique shared her story in a private Facebook group, women from all over San Diego county banded together to organize a peaceful nurse-in in front of the Oceanside LA Fitness, showing their support for Monique as well as upholding a mother’s right to nurse in public.

Click here for the video from ABC 10 News showing the Nurse-In at LA Fitness.

Jill Greuling, Vice President of Operations for LA Fitness, issued this statement to 10News: 

"We support the right of women to breastfeed in our facilities. When Mrs. Golueke voiced her intention to do so to one of our staff, she was offered space in the Kids Klub or, as an option, the separate restroom within the Kids Klub and a chair if she wanted more privacy. The staff member initially spoke to Mrs. Golueke to let her know that children are not allowed in the locker room area. This conversation occurred because another member observed her in the locker room with small children and reported it to us.”

Unfortunately, this statement is untrue.  Monique was ONLY offered to breastfeed in the Kids Klub restroom and that is a significant problem.  The CA law states that a women is allowed to breastfeed her child, anywhere she and her child  are authorized to be.  If children are in fact not allowed in the locker room at LA Fitness, then the law doesn’t protect Monique in that area of the gym.  The issue is with the statement from the staff member who recommended that Monique breastfeed her baby in the Kids Klub bathroom.  This is not an appropriate place to breastfeed a child.  It is unsanitary and demeaning.  It is important for all LA Fitness staff to know that this is not an appropriate recommendation and that, instead, mothers should be alternatively told that they may breastfeed in the lobby or in a comfortable spot in the Kids Klub.

At this time, the San Diego Nursing in Public Task Force is sending a letter to the LA Fitness Corporate office kindly requesting that they create a breastfeeding-supportive policy statement for their members, including a list of appropriate areas where mothers may breastfeed their children in their facilities (not including a bathroom.)  We will also be offering language that they can share with their staff members on how to kindly respond to a mother who is breastfeeding her child in a place where her child is not authorized to be.

We will keep you posted!

Was it Something I Ate? Food Sensitivities in the Breastfed Baby

Witten by Lindsey Hurd, MS, RD, LDN, IBCLC, and Owner of Angel Food Lactation & Nutrition, LLC

From a gassy gut to red inflamed skin, breastfeeding moms often question the influence of their diet on behavior and symptoms in their little one. There’s no denying the influx of food sensitivities and allergies in children and adults, but what about the smallest members of our society? In my practice, I see many families who have infants showing signs of food intolerance, often times leading to symptoms such as eczema, bloody stools, sleeplessness, reflux, digestive discomfort from gassiness, abdominal pressure, and the infamous mucus-filled stool. “Is it something I ate?” mom asks. “Is it a virus or bacterial infection?” “Where did this come from? She was fine a week ago!” The world of food sensitivities is vast and perplexing, yet we are beginning to find our way as we learn more and more from our families each day. Over the next few months, I will be sharing a little insight into theories of why we are seeing this influx, how babies receive components of mom’s diet in her milk, and what we can do about it. 

What’s With The Influx??

There are many theories aiming to define the cause of food allergies, however none have been proven as fact. Some include the hygiene hypothesis, the dietary fat hypothesis, antioxidant hypothesis, and the vitamin D hypothesis. The hygiene hypothesis discusses our hygiene habits, from our current water system to the use of cleaners and hand sanitizers & soaps. This may contribute to the lack of exposure to pathogens (germs) and therefore suppressing the development of our immune system possibly leading to a greater risk of allergies and sensitivities. The fat hypothesis, vitamin D hypothesis, and antioxidant hypothesis dive further into our dietary intake and focus on quantities of healthy fat consumption and fresh fruit/vegetable intake as compared to a diet consuming highly processed foods, lacking key nutrients that are necessary for optimal functioning of the body.  Regardless of the exact cause, we know the increase in food sensitivities is real. 

Maternal and Infant Immunity

Mothers and babies, although becoming two at birth, are still incredibly connected in their need for one another.  In pregnancy, mom begins to share healthy bacteria, or microbiota, and immune boosting antibodies to her baby en utero. That’s right, before she is even exposed to her new environment! Mom’s amniotic fluid contains these bacterial warriors specifically made for her baby as she learns what she will need to survive in her future environment. As she initiates her swallowing reflex, practicing for her big job of feeding, she begins to lay down the start of her future microbiome. Once baby is earth-side, she relies on her mother’s breast milk to continue this amazing level of immune support as she slowly becomes dependent on her own body to provide protection. 

How does one establish immunity you ask? Mom absorbs something called antigens, or substances that stimulate the production of antibodies from her environment by way of her digestive system and through her nose, mouth, and respiratory system, etc. This creates antibodies to help her fight off any offending bugs or substances that may harm the body. When a mom is breastfeeding, she passes these antibodies on to her baby. Through her breast milk, she offers immunity toward anything that may be harmful in their specific environment. This explains how mom can get sick, but baby remains healthy or contracts a much smaller version of the illness. Given that part of mom’s immunity is based on antigens present in her digestive system, it makes sense to imagine how food can cause the production of antibodies. This is especially true if she is sensitive or intolerant to a certain food. In turn, baby receives these antibodies from mom’s milk and responds to the food in a similar fashion. 

How Do I Know If I Am Intolerant To Foods?

Many children and adults will become intolerant or sensitive to certain foods at multiple points in their life, however these sensitivities come and go with variability in its duration. The key signs of childhood or adult food intolerance are usually digestive or dermatologic in nature. This includes diarrhea, constipation, excessive gas, abdominal pain/bloating, variability in stool appearance, and alterations in skin appearance such as eczema, rash, acne, etc. Many times, adults have experienced these symptoms for so long they are unaware of its presence or feel it is normal for their bodies. Treatments and medications may be chronically used, masking the underlying problem. Therefore, dietary modifications are not pursued, leaving the gut-wrenching effects of these ‘repeat offenders’ present in the body.  

You may be thinking, “Yikes, that’s me!!” If so, congratulations! You have just identified the first step in removing or minimizing your digestive and/or skin related woes from your daily life. Better health is right around the corner for you and your baby… the next step is to determine what the offending food(s) might be. This process is most successful with daily self-reflection of dietary intake and physical symptoms. As always, seeking assistance from a Registered Dietitian specialized in food sensitivities will not only offer reliable, evidence-based information, but also help you navigate through your day-to-day life with new eating patterns! 

As you work through the removal of offensive foods, of equal importance is achieving the optimal gut environment… Next month, we will discuss how food sensitivity alters the maternal and infant digestive system, ways to restore balance, and how mom’s digestion relates to breastfeeding. This is a fascinating concept; you won’t want to miss it! 

Can’t wait a month to find out more? Visit www.angelfoodlactationandnutrition.com to schedule a Skype consult with Lindsey and begin your journey toward better health and a happier baby today! Want to stay connected between posts? Find Angel Food Lactation & Nutrition on Facebook at www.facebook.com/angelfoodlactationandnutrition for current articles, events, fun discussions and more!

Also, check out The Boob Group podcast episode, Breastfeeding the Dairy Intolerance Baby, for more information about food intolerances and breastfeeding.

Breastfeeding Your Baby with Jaundice

Written by Danielle Blair, IBCLC

The term jaundice gets used a lot regarding babies.  It can have many different meanings depending on the context.  From the Mayo Clinic website:

“Infant jaundice is a yellow discoloration in a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin, a yellow-colored pigment of red blood cells.”

Types of Jaundice 

Baby's livers are immature, and they may not break down the bilirubin efficiently after birth.  Some amount of jaundice is considered normal for healthy babies.  We expect the bilirubin levels to rise slowly in the first several days after birth before peaking and then decreasing.  This type of jaundice is called “physiologic jaundice” and typically requires no treatment other than good feeding management.  Physiologic jaundice can be intensified in breastfed babies by mild dehydration that often occurs before milk volumes increase, which then can lead to “breastfeeding jaundice”.  In the case of physiologic or breastfeeding jaundice, the baby's skin may appear slightly yellow, often just on the face or torso.  A second peak of jaundice known as “breast milk jaundice” may occur during the second week of life.

In some cases, bilirubin levels rise very rapidly in the first 24 hours after birth.  This is not considered normal and can be a sign of infection or improper liver function, and merits immediate evaluation by a doctor.  Babies born before 38 weeks gestation, babies with bruising from delivery, babies with different blood types than their mothers (also known as ABO incompatibility), and breastfed babies are at increased risk of clinical jaundice.

Test for Jaundice

Bilirubin levels are determined by blood testing.  The levels that are considered normal depend on the baby's relative risk of jaundice and the number of hours since birth.  For example, a premature baby will be considered clinically jaundiced and require treatment at a lower bilirubin level than a full-term baby.

Treatments for Jaundice

If bilirubin levels rise very quickly after delivery, a baby may be monitored closely for good feeding, and may need treatment such as phototherapy (often called “bili lights”) or assistance with feeding to ensure that the baby takes in enough fluids to flush out the bilirubin.  A baby with very high bilirubin levels will likely have very yellow or orange colored skin from head to toe.  He may be very sleepy and feed poorly.  In rare cases, prolonged high bilirubin levels can cause brain damage.  This is why some cases of jaundice may require treatment.  

If your baby has elevated bilirubin levels, you may be encouraged to breastfeed more frequently, to use breast compressions to help baby take in more milk, or to offer some expressed breastmilk in addition to breastfeeding.  

For the baby who is not feeding well or is very sleepy, expressing milk and feeding in another way, such as by spoon, dropper, tube/syringe, or bottle, may be a temporary solution to help baby take enough milk volume to prevent severe jaundice.  Offering expressed milk in addition to breastfeeding can also help keep bilirubin levels under control in high-risk babies.

If better feeding management does not work, your baby may need phototherapy to help break down excess bilirubin in the bloodstream.  A “bili blanket” is a pad with UV lights that is wrapped around the baby, allowing baby to stay with mom and continue breastfeeding.  “Triple lights” are arranged in an isolette to allow as much of baby's body as possible to be exposed to the UV lights to bring down elevated bilirubin levels as quickly as possible.  For triple lights, a baby will typically be admitted to a NICU or special care nursery.

Sometime supplementation with formula is necessary to keep a jaundiced baby well-hydrated and to help treat the jaundice.  Formula should only be used if an insufficient volume of breastmilk is available.

Also, don't forget to check out our Boob Group podcast episode, Breastfeeding the Jaundiced Baby

I’ve Had My Baby - Now What? Breastfeeding During the Second Week

Welcome to our new series, I’ve Had My Baby - Now What?  This is a guide with basic information to help you navigate the first days, weeks, and months of breastfeeding your new baby.  

Today we’d like to talk about the second week of your baby’s life, and what breastfeeding looks like.  What can you expect for normal behavior from your new baby, and when do you know there’s a problem that you should seek professional help for?

Now that my milk has increased in volume, what should feedings look like?  How much does a baby need at each feeding and how long should it take?

Most moms will see their milk change from the first low-volume colostrum to the fuller-volume mature milk somewhere between day 3 and day 5.  So by week 2, there is often more milk for baby to take per each feeding.  However, in the early days of the second week, a baby only needs about 1.5 ounces per feeding.  By the end of the second week, the baby will need 2-2.5 ounces per feeding.  Feeding length should still be determined by baby and when baby seems satisfied, but most little ones at this age should be able to get a full feeding in 30 - 60 minutes.

How much weight should my baby gain in week 2 of life? When should they regain their birth weight?

It’s normal for all babies to lose some of their birth weight in the first few days of life.  Once mom’s milk transitions to the fuller volume milk between day 3 and day 5, baby should gain ½ - 1 oz per day.  Most babies who are breastfeeding well will reach their birth weight by 10-14 days.  If your baby doesn’t regain their birth weight by 14 days, it might be a good idea to seek the help of a lactation consultant.

My baby seems to prefer one of my breasts over the other, and even has a difficult time latching onto the other one - is this normal and what can I do?

It is common for babies to prefer one side over the other.  They have often been lying in one position in utero, which can cause tightness in their necks and jaws.  Sometimes a long and difficult labor can affect the baby’s ability to latch onto one side - if the pushing section was long and baby was in birth canal for many hours - the compressions to his head may affect him in this way.  Often babies will work it out in the first few weeks, but if your baby continues to struggle, we often recommend body work for the baby, in the form of Craniosacral Therapy or Chiropractic care.

My baby starts choking shortly after starting to breastfeed.  What is causing this and what can I do?

Some moms find that their milk “lets down” very quickly.  When a baby begins to feed, the stimulation of the nipple releases hormones for mom to signal her body to “eject” the milk from the milk ducts.  When this happens quickly and forcefully, sometimes the sudden flow can take the baby by surprise and they may come off the breast coughing and sputtering.  If all is going well, the baby should learn to manage this within the first couple of weeks.  Feeding in a laid-back position can also be very helpful to slow down your let down. If your baby continues to struggle with a forceful letdown, it could indicate that there is something happening anatomically that is preventing him from being able to adapt.  This would be a good time to visit with a lactation consultant.

My 2 week-old baby is suddenly famished!  He went from eating every 2-3 hours to wanting to eat *constantly*!  He never seems satisifed and is fussy at the breast. Does this mean my milk supply is decreasing?

All babies go through a growth spurt around 2 weeks of age. The behavior above describes what a baby will act like during these growth spurts. It’s a natural occurrence to help build your milk supply to help keep up with the baby’s increasing needs.  Growth spurts usually last 48-72 hours.  As long as your baby is continuing to have plenty of wet and dirty diapers, there is no reason to think that your milk supply is faltering.

There may be times when things aren’t going the way they should.  If you find this, please contact an International Board Certified Lactation Consultant to help you.  Some signs that you might need some additional help:

• Sore, cracked, bruised, or bleeding nipples.

• Baby is still well under birth weight near 14 days of life.

• You suspect your baby may be tongue-tied.

• Painful, recurrent engorgement.

• Oversupply.

• Baby is having problems stooling.

• Overly gassy, fussy, or colicky baby.

• Breast infection - mastitis, abscess, or thrush.

For  more information about what normal breastfeeding looks like in the first few weeks, check out our article, What Every Mom Should Know About Breastfeeding During the Early Weeks, which highlights our brand new brochure!

What a Difference a Tongue Tie Revision Can Make

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 robinkaplan@sdbfc.com.

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?

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Written by Nina Jacobs 

Aubrielle was born on August 3rd, 2013 at 36 weeks due to my preeclampsia. She was 5lbs 13 ounces of tiny beautiful joy. I knew from the moment I found out I was pregnant that I wanted to breastfeed (my goal being for a year). I had no idea then, that it would be such a wonderful, beautiful, bonding, humongous part of my life. We were in the hospital for 5 days because of Aubrielle being considered a "late premie" and all of the meds I had to come off of to make sure I didn't have a seizure. Aubrielle was immediately diagnosed with a severe tongue tie by the pediatrician and two lactation specialists. We made an appointment to have her tongue tie snipped at 4 days old with ENT. In the mean time, she was latching, and eating as best as her little mouth could while we supplemented with pumped milk and feeding her through a tube and syringe. 

When we arrived at her appointment, the ENT doctor asked us if she was latching. She was with a nipple shield. He said that she was so small and fragile and because she was able to latch, he would not perform the operation on his daughter if it was him. So, we went home. We spent the first month figuring everything out. We didn't keep to any schedule and just took cues from her. Aubrielle would eat for 40-70 minutes and ask to eat again 2-45 minutes later....all day and all night. I didn't know any difference and just was rolling with it. 

At her one month check up, she wasn't gaining THAT much weight. She was still under 5% (the same that she was born at). We chose not to supplement and to reschedule the tongue tie procedure because the pediatrician was outraged that she didn't get her tongue tie snipped and that she was feeding so frequently.   She would still fall asleep every time she ate and by the time she woke up she would be starving again. By the time we called to reschedule her procedure, they couldn't see us until she was 9 weeks old. Around her 6 week growth spurt, I came to the doctors office crying. It seemed like she was literally eating every second that she was awake. They still couldn't see us until 9 weeks. We pushed through and never supplemented.

At her two month check up she was still in the 5% for weight. We finally had the procedure done. It was awful... more blood and tears than I expected and I could tell that she was in pain every time she began to eat for 5 days after the procedure, even with the tylenol we were giving her. But, oh.my.gosh. The difference in her eating, her behavior, and my supply was NIGHT AND DAY. Instead of eating for 70 minutes she would eat for 20. She didn't fall asleep every time and was clearly satisfied after each feeding. It was the hardest, best thing we did. I wish we would have pushed for it at 4 days old. For three days after the surgery we had to "sweep" in between her tongue and bottom of her mouth, and for the first two days it would start to bleed a little, but nursing always stopped the bleeding. In fact, in the doctor's office, that is how they had us stop the bleeding. 

Before tongue tie revision

After tongue tie revision

We still used the nipple shield until she was 5 months old, which is when she took it off, threw it on the ground herself, and kept eating. Now at 6 months plus, she is a happy, healthy, thriving, nursing baby who went from the 4th percentile at her two month check up (a week before her surgery) to the 30th percentile at her 4 month check up. She has tripled her birthweight  at 6 months and only eats every 2-3 hours during the day, and only wakes up once at night to eat. 

Breastfeeding After a Tongue Tie Revision

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 robinkaplan@sdbfc.com.

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?

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Written by Cinda Brown

Lily and I had a rough start with our breastfeeding relationship from the very beginning. She latched soon after she was born and in that instant I felt sharp pain and noticed there was blood. She had caused damage with her first latch. We stayed at the hospital for about 24 hours, and in that time she had pretty severely damaged both of my nipples. I consulted with friends and professionals who had breastfed before, but didn’t get the kind of guidance I probably should have. No one’s fault, but no one had seen or experienced what I was going through so they gave me what they thought was very well meaning advice. Unfortunately I really needed to see an IBCLC, but I didn’t know that such a person existed.

After 2 rounds of mastitis, one being 7 days postpartum with 104 degree temperature, completely exhausted with a baby who cried all night long, I finally called the breastfeeding warmline at Balboa Hospital. Lily was about 4 weeks old. I don’t know why I hadn’t called it before, but I suspect it was because I thought I had received help already. I had been told by a friend that I was getting mastitis because Lily wasn’t emptying all the milk from my breast and that I needed to pump. So I did, starting at about 5 days postpartum. I ended up with such an oversupply from this, but didn’t know that I shouldn’t have been doing that. I think that this is ultimately what caused my second bout of mastitis. All the while I was scabbed and cried every time Lily latched. My nipple looked like the pointed end of lipstick when she finished nursing. This was unsustainable and I had no idea how women were able to breastfeed their children.

So, back to the call to Balboa. The nurse had me come in right away. She said that she suspected that Lily had a tongue tie and tried to also help me with technique. The technique didn’t help a lot, but I had developed a ton of bad habits trying to deal with the pain....like cursing, hunching over, stiffening my body in pain while she nursed, and the list goes on. She tried to help me relax, but it was to no avail. I was in so much pain. She talked to me about seeing the doctor for a possible clipping and I was immediately against it when it was described to me. We were talking about cutting in Lily’s baby mouth! Really?!?! I just had to be tougher and with that thanked the nurse for her help, and I truly meant it. I just had to go home and practice more. My husband helped me with what we had learned and it was exhausting for both of us. Neither of us could get Lily’s latch correct no matter what we tried. This led to lots of tears and frustration between both of us as we struggled to get it right. I was adamant that I was going to breastfeed, and at some points I felt like it was going to kill me to achieve that goal.

Two days later I was back with the nurse at Balboa, in tears. I was ready to see the doctor to talk about this procedure. I knew that the breastfeeding relationship between Lily and me wasn’t going to last much longer. Lily was about 5 weeks old at this point, so I had been enduring for 5 long, excruciating weeks. We met with Dr. Jim Murphy and he explained the procedure. I was onboard, knowing that at this point I was willing to try anything. The procedure wasn’t entirely pleasant, but I suspect it was because Lily was being held still, which she didn’t like and that she wasn’t being held close to me, which she did like. The clipping was really quick and Dr. Murphy immediately gave her back to me to have her latch. It felt very different! No big pinching feeling. Relief!

We were told to do stretching exercises after each nursing session. I did them religiously. It wasn’t all rainbows and unicorns as Lily had developed her own technique to get milk, which involved biting or gumming my nipples. It worked for her, but not for me. We had to learn together how to make this work well for both of us. Because of my abundant oversupply, she was not the typical underweight baby at her checkups. In fact she was right around 100% for both height and weight at each one. No one had suspected that we were having a problem.

A few weeks later the lipstick nipples, pain, pinching, and scabbing were back. We went back to see Dr. Murphy and he said that her tongue had healed in a way that indicated that he had to re-release her tongue. Heart breaking. We had to do the clipping again. We did, it was quick, and Lily latched right on. Nursing became easier after this, although we did have to go through a relearning process again. 

By the time I had to go back to work (when Lily was about 11 weeks old) we were doing great. She was sleeping better at night and I was able to think about trying to go running. Prior to this the thought of running was horrifying because my breasts and nipples hurt so badly. I continued to pump ALL THE TIME to try to relieve the pressure, knowing now that I was just keeping the output at maximum level. I was so relieved to have identified the problem that had caused us so much pain and suffering, so I started trying to learn as much about it as I could.

I’m a huge breastfeeding advocate and am an active duty Navy mama. I understand the challenges and difficulties presented to mothers with young children, and trying to balance this with a demanding job. I have sought education and am now working toward completing the Certified Lactation Educator certification and hope to help many more mothers have a successful breastfeeding relationship with their children. My own command has responded with support for the new mothers by allowing me to establish breastfeeding rooms and a support group. Lily is now almost 2 and a half, and nurses now more than ever. I know that if it weren’t for that wonderful nurse and Dr. Murphy that we wouldn’t be here today, and I am forever grateful for their assistance and that we were able to get the tongue tie clipping procedure.

Combining Lactation and Maternal Nutrition

Today, I'm thrilled to introduce a new guest blogger, Lindsey Hurd, MS, RD, LDN, IBCLC.  Lindsey is the owner of Angel Food Lactation & Nutrition, LLC, a business in Wilmington, NC that specializes in perinatal nutrition and lactation services.   Over the next several months, Lindsey will be sharing her brilliant knowledge about breastfeeding and nutrition, including multiple articles about breastfeeding children who have food intolerances.  

Before Lindsey starts writing her monthly articles, we wanted our readers to have the opportunity to get to know her first.  Welcome to our blog, Lindsey!  We are so excited to have you share your passion and expertise!

Tell us a little about yourself.

My name is Lindsey Hurd and I am a registered dietitian (RD) and board certified lactation consultant (IBCLC) working in private practice in Wilmington, NC. My business, Angel Food Lactation & Nutrition, LLC, specializes in providing perinatal nutrition and lactation services. Consultations are offered in a home or office setting. Skype consults are available for families who are not local or are in need of flexible scheduling. Locally, I offer grocery store tours to instruct families on how to navigate their food selection and how to prepare foods that taste good and fall within their nutritional goals. Overall, I am here to support moms and babies, uniquely catering my advice and suggestions to fit their needs. Families trust Angel Food Lactation & Nutrition to provide specialized counseling for food sensitivities in baby, gestational diabetes, lactogenic (foods that enhance milk supply) meal planning, and nutrition support from infancy through preschool.

My journey began with an undergraduate degree in Exercise Science. In learning about the powers of exercise, I found a passion for instructing individuals on the role of nutrition, the biggest contributor to one’s overall wellbeing. Upon completion of my undergraduate degree, I continued to expand my knowledge in health and wellness by completing a Master of Science in Nutrition and a program in dietetics to become a Registered Dietitian. To provide comprehensive care from preconception through preschool, I chose to become an IBCLC, the expert in lactation support. I completed the Mary Rose Tully Training Initiative through the Carolina Global Breastfeeding Institute at UNC- Chapel Hill and successfully passed the boards, fulfilling my goal for the future. With my career path set, I continued to work in nutrition and lactation for more than 4 years.

Why did you decide to focus on perinatal, postpartum, and pediatric nutrition?

I quickly became fascinated with perinatal and pediatric nutrition as I progressed through my studies. The most noteworthy experience was completing my master’s practicum with an International Board Certified Lactation Consultant (IBCLC) in private practice. I fell in love with her job and was amazed at the impact she had on infant nutrition. I immediately realized that I would never find another profession to fulfill my aspiration of providing families with the tools necessary to find their perfect balance of health and happiness. I truly believe this stage of life ‘chose’ me!

From establishing childhood eating habits to the physical demand of sustaining a pregnancy, family planning naturally becomes one of the most important seasons in our lives. Offering education, counseling, and individualized support to those who wish to make the most of this opportunity fills my heart with joy. I am motivated to improve my practice daily to better serve families needs, large or small. Currently, I am very active on Facebook, posting educational resources, up to date research, and a little something fun every now and then. I enjoy connecting with my followers who simply wish to further educate themselves or find a little motivation to continue achieving their goals. Clients teach me how their passion and determination can improve personal habits, overcome speed bumps, and create a ‘new normal’ with the ideal support in place. I am honored to receive an invitation into the lives of each family as a trusted resource in helping them meet their feeding goals. 

What role does nutrition play in breastfeeding and making milk?

From flavor learning and brain development to boosting milk supply, each bite directly affects baby from conception to weaning, and some even argue beyond. Enhancing maternal nutrition to balance foods mom needs with foods she loves will directly change the outcome for mom and baby alike. Nutrition plays a huge role in our lives beginning with the first feeding at the breast to the last bite of your favorite meal - mine would be ground honey almond butter on fresh bread from our local bakery! On a physiological level, pregnancy and lactation are two of the largest periods of nutrient demand for a woman’s body. Naturally, it makes great sense to say nutrition plays a strong role in maintaining the health and wellbeing of a mother and her baby. The two are largely connected throughout the perinatal period with mom’s diet providing the foundation for baby to grow in pregnancy. 

Lactation quickly follows this period, requiring enough nourishment to triple the baby’s growth within the first year and establishing his or her immunity throughout the first two years of life! Beyond providing nutrients for baby, mom must also support the needs of her own body. Fortunately, a woman’s body is built to increase the absorption of nutrients, the efficiency of energy metabolism, and to put the baby’s needs first, ensuring optimal development.  What does this mean for the mom’s body you might say? It means that she must increase her awareness of proper nutrition to keep this well-established process functioning at full capacity! This is often easier said than done, especially as a family multiplies. This is where I feel the most effective in my practice, bringing clarity and assurance to women as they progress through the childbearing years. 

What type of guidance do you offer to breastfeeding moms whose babies are dealing with food intolerances?

Food sensitivities in our littlest ones can often be a challenging and stressful event for families. The sudden onset, the varying symptoms, and the persistent nature make this speed bump hard to navigate for families in today’s society.  I found a need for diving deeper into food intolerance within the breastfed baby and toddler as I saw more and more families struggle with elimination diets, unnecessarily removing critical foods, and navigating the world of food selection with restrictions. In hopes of enhancing my understanding, I completed a certificate of training in food allergy management and many days of self-study to learn how milk transfers food components from mom’s diet and how maternal and infant immunity play a role in the progression of sensitivities. My goal with each family is to educate moms on how to restore balance, to find replacement meals for foods they love, to honor breastfeeding, and to get baby symptom free. Overall, I am here to support moms and babies - uniquely catering my advice and suggestions to fit their needs.

What type of services do you offer?

Angel Food Lactation & Nutrition, LLC offers nutrition and lactation assessments for the whole family. Skype/web based consultations are available for those who are unable to schedule a direct face-to-face visit, or wish to have flexible scheduling.  Have more availability after bedtime? Wish to schedule on a weekend or when both parents are home? Want to schedule, but live in another state? This offering is best for you! Consults are held in the comfort of your own home, using your preference of video chat or voice only.

Classes, small group consultations, and professional seminar presentations are additional ways Angel Food Lactation and Nutrition, LLC, aims to serve those interested in nutrition and lactation for families local to the Wilmington NC area.

Want to know more about these topics? The how, what, and when? Stay tuned for more posts to come and visit my webpage www.angelfoodlactationandnutrition.com for individualized counseling to meet your unique goals.

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 robinkaplan@sdbfc.com.

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?

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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.