Are Tongue and Lip Ties Being Overdiagnosed and Overtreated?
Written by Robin Kaplan, M.Ed, IBCLC, Owner of San Diego Breastfeeding Center
That has been the million dollar question of the week. Since Rachel Cautero published her article in the Atlantic last week about this topic, conversations about tethered oral tissue (TOTs) have had a resurgence of epic proportion. To discuss this topic, I was interviewed by Meghna Chakrabarti on NPR’s On Point this week. Her interview, entitled To Improve Breastfeeding, Babies Get Their Tongues Clipped. Is it necessary?, included the Atlantic journalist (Rachel Cautero), a pediatric ENT from John Hopkins (Dr. Jonathan Walsh), and me, an IBCLC from San Diego.
I encourage you to listen to this interview, as there were many important issues brought up that parents need to hear. I also encourage you to consider listening through an unbiased lens, as the first 30 minutes are fairly skewed due to the sharing of personal breastfeeding experiences by Meghna and Rachel. They talk about being informed of their infants’ tongue ties during a very vulnerable early postpartum period and how upsetting this information was to them. They shared how they both decided to stick with breastfeeding, despite significant pain for weeks and months, instead of considering a tongue tie release. And they both ended up finding that breastfeeding eventually got better and that they felt frustrated with all of the discussions online about tongue tie and upper lip tie releases, which they feel is being sold as the ‘cure-all’ to lactation woes.
Keep in mind….these are just two individuals’ stories out of many. We all have our personal stories of parenthood/breastfeeding/labor, etc that skew the way we view a situation because they evoke an emotional response in us. These emotional reactions are normal, but are that person’s point of view.
What I would like to share are the most pertinent points about tethered oral tissue (TOTs) that were shared in this interview, as well as a few more that weren’t shared due to time constraints.
4 Main Take-Aways about Tethered Oral Tissue (TOTs)
Tethered oral tissue can restrict range of motion in the tongue, lips, and cheeks
All people have frenulums, but to have tethered oral tissue (TOTs) means that the frenulum is restricting range of motion and impacting function. Here is a handout that includes many of the symptoms that can be related to TOTs.
These TOTs do not stretch over time, but some children/adults learn to compensate despite the tightness. This is why some children and adults don’t show or feel that they have long-term complications.
Releasing restricted frenula can have a profoundly positive effect on both parent and baby and their ability to meet their breastfeeding goals, but is not always necessary.
International Board Certified Lactation Consultants (IBCLCs) identify tethered oral tissue at a higher rate than pediatricians/ENTs because they are the professionals completing full oral/feeding assessments.
IBCLC assessments are not 15 minute well-baby checks. They are extensive assessments, lasting 1-3 hours, using research-supported evaluation tools.
TOTs cannot be evaluated just by looking in the mouth or at a photo of the mouth, tongue, and lip. Function must be taken into account.
Parents should be walked through each part of the oral/feeding assessment so that they can make an informed decision about what is best for their child.
It is always necessary to go back to basics (positioning and latch) first, before blaming a tongue or lip tie. If the symptoms for the breastfeeding parent or baby are not relieved with the basics, then further assessment is necessary.
Parents should be presented with a menu of options: bodywork (CST/PT/OT/Chiro, etc); oral exercises; tummy time; supplementing; exclusive pumping, etc. - everyone deserves to be supported regardless of their decisions.
There has been an increase of identification of and recommendation to release tethered oral tissue in the past two decades, with good reason
Increased research and ultrasound investigation on how the tongue and lips function while feeding have shown what is necessary to achieve comfortable, effective breastfeeding and milk removal. This information was not available until the past two decades.
There has been a shift in the international culture to be more pro-breastfeeding than it was during the 1900s. It is unfortunate that some families feel ‘pressured to breastfeed’, as Rachel mentioned in the interview. Personally, I think this shift in societal views towards breastfeeding has more to do with current research identifying the vast health-promoting and immunological benefits to mom and baby when breastfeeding, rather than parents feeling pressured to breastfeed.
TOTs are nothing new. Tongue ties and frenotomy descriptions can be found in early Japanese writings, other historical documents, and even the bible. In the 1600s, frenotomy was widely known and there is documentation that describes that midwives would keep one fingernail long and sharp so that she could release the tight frenulum without the use of an instrument.
In the early 1900s, formula was advertised as better than breastmilk and breastfeeding was considered as something that only impoverished people do. Up until then, if a mother could not breastfeed her baby, the family hired a wet nurse or the baby would die due to lack of nourishment. Formula changed the way we looked at infant nutrition and breastfeeding, which meant tethered oral tissue wasn’t viewed as important to address. With this pendulum shift to positive views about breastfeeding, parents want answers when challenges arise. And many of these challenges can be attributed to TOTs.
There is a lack of evidence specifically studying the long term effects of tethered oral tissue (TOTs)
There are several case studies and randomized control studies on how frenotomies improve breastfeeding outcome.
There are some correlations between TOTs and challenges eating solid foods, speech and change in oral/dental structure, but there is only a small amount of research to back this up. We clearly need more research.
What we do know is that children with TOTs often mouth breathe, which is widely recognized as pathological and may lead to:
open-mouth posture, which can block the airway when sleeping, leading to bruxism, snoring, sleep apnea
impaired swallowing, which can lead to a palate that doesn’t naturally expand and Eustchian tubes not opening and equalizing pressure in the middle ear
So, what’s the overall take away message?
When a family has breastfeeding challenges and doesn’t receive a comprehensive oral/feeding assessment that evaluates tongue and lip function, then we run the risk of tongue/lip ties being overdiagnosed and overtreated.
For more information about tethered oral tissue, check out these resources:
SOS for TOTs by Lawrence Kotlow, DDS
Tongue-Tied by Richard Baxter, DMD, MS
Kellymom: Breastfeeding a Baby with a Tongue Tie or Lip Tie (Resources)
Tongue tie articles on SDBFC’s website
Check Out Our Line-Up of New Classes at SDBFC!
We are so excited to share with you our line-up of new classes starting in February at the San Diego Breastfeeding Center. Our new space in La Mesa is truly feeling like a new home and we are loving how comfortable and welcoming it feels. Branching out to offer classes beyond breastfeeding is something new for us, but we realized that there are very few places in East County that offer parenting support for new families. Our goal is to offer a wide variety of classes, full of resources to support you throughout the first few years of your parenting journey, creating a community in our space and beyond.
We are so excited to share with you our line-up of new classes starting in February at the San Diego Breastfeeding Center. Our new space in La Mesa is truly feeling like a new home and we are loving how comfortable and welcoming it feels. Branching out to offer classes beyond breastfeeding is something new for us, but we realized that there are very few places in East County that offer parenting support for new families. Our goal is to offer a wide variety of classes, full of resources to support you throughout the first few years of your parenting journey, creating a community in our space and beyond.
Here is what we have scheduled for February 2019. For dates and registration, click on the links below!
Birthing from Within Childbirth Series - Childbirth preparation series, offered monthly.
Preparing to Breastfeeding - Learn about positioning, latch, common concerns, and how to survive the first weeks of breastfeeding.
Leche de Mama - Our Preparing to Breastfeeding class in Spanish
Birthing Again - Birthing from Within refresher for parents preparing to birth again.
Infant Massage Series - Got a fussy kiddo who could use some massage to relax his body and digestive system? Perfect for babies ages 2 week to precrawling. A new series will start at the beginning of each month.
Introduction to Solids - Ideal for those families with 4-6 month olds, wondering how to venture into the new world of solid foods.
Breastfeeding for the Working Mom - Learn how to protect your milk supply, set up a pumping schedule, and make sure your caregivers are not overfeeding your baby by bottle. Best taken up to 6 weeks before returning to work.
Peaceful Parenting 101 - Learn what a peaceful parent is, how to practice self regulation, foster connection, and how to coach your child to gain cooperation.
Lastly, here is a sneak preview of our March and April classes. In addition to the classes above, we will soon have registration available for:
Babywearing 101
Breastfeeding while Babywearing
Gentle Sleep Solutions
Kid-free Afternoon - Macrame Workshop
Fourth Trimester
Empowered Couples Class
ErgoMomics workshop
Are you interested in teaching a class in our space? Send us an email at info@sdbfc.com! We would love to connect!
Also, please follow our Facebook Events page and Instagram page, as our future classes will be announced there as soon as registration is live.
Looking forward to supporting you on your parenting journey!
SDBFC Will Match Your Donation Until the End of 2018!
Looking for an awesome nonprofit to donate to before the end of the year? Everyone wants a tax write-off, right?
With only 5 days remaining in 2018 and $975 left to go to reach our goal of raising $5000 for the San Diego Breastfeeding Center Foundation, we thought we would offer you a little incentive.
From now until January 1, 2019, the San Diego Breastfeeding Center will match donations to the San Diego Breastfeeding Center Foundation (up to $1000 total)!
Want to know where our money was spent in 2018?
65 low-income families received a free-$25 private initial breastfeeding consultation
39 low-income families received a free-$25 private follow up breastfeeding consultation
150 families enjoyed festivities at our free Big Latch On 2018 event
With a new partnership with Black Infant Health in 2019, we hope to increase the number of consultations by at least 25%. Will you please help fund our programs in 2019 by donating today?
Inspired to make a difference in the life of a new family?
$85 pays for one initial 90-min breastfeeding consultation for a low-income family
$55 pays for one follow up breastfeeding consultation for a low-income family.
Any amount will help us to reach our goal of $5000 for 2018! We are only $975 away from reaching our end-of-year goal! SDBFC will match funds up to $1000 total until the end of 2018.
Donate online through our CrowdRise campaign or directly through our SDBFC Foundation website.
To donate by check, please send to:
San Diego Breastfeeding Center Foundation
3355 4th Ave.
San Diego, CA 92103
We're Moving!
Check out our adorable new office!
It is with great pleasure and excitement that we get to share this HUGE news with you! After months of looking for a new home for SDBFC, we have officially signed a lease and are moving at the end of December. Our new home is an adorable 1000sf house with two consultation rooms, a classroom, patient parking/tons of free street parking, close freeway access, and walking distance to family-friendly restaurants/coffee shops (the perfect place to hang out after a consultation or class!) For the past 9 years, it has been Robin’s dream to have a free-standing breastfeeding and parent-education center and our new location feels absolutely perfect!
Now that we will have our own classroom space, we hope to offer a variety of prenatal and postpartum classes, ranging from childbirth education and newborn care to postpartum exercise, infant massage, and interactive parent/baby classes. Please stay tuned as we begin to announce new class offerings for you and your kiddo, as well as a grand opening sometime in February/March.
New Location Details:
New address for San Diego Breastfeeding Center (as of January 2, 2019)
8325 University Ave.
La Mesa, CA 91942
Breastfeeding support group info:
December 2018 - Wed breastfeeding support group will remain at our Hillcrest office for the rest of the month from 11:30a-1p
January 2019 - Wed breastfeeding support group will move to our University Ave office. Same time: 11:30a-1pm
Class details:
If you, or someone you know, teaches prenatal, postpartum, or parenting classes and are interested in teaching in our new space, please contact our Administrative Assistant, Stephanie, at info@sdbfc.com.
We look forward to supporting you along your breastfeeding and parenting journeys! See you in La Mesa!
Help Us Extend Lactation Services to ALL families in San Diego
We'd like to introduce you to Dania Lindenberg, one of the most caring, passionate pediatricians in San Diego and a board member of the San Diego Breastfeeding Center Foundation.
I joined the SDBFC Foundation Board because I believe so strongly in its mission to extend lactation services to all moms. Lactation services, especially from skilled, caring, and professional lactation consultants such as Robin Kaplan and her colleagues at the SDBFC, can make or break a new mom’s breastfeeding experience. Many of us no longer have a “village” to help us with breastfeeding. Caring, knowledgeable and supportive lactation consultants help fill this gap.
As a pediatrician, I refer the majority of my new breastfeeding moms for lactation support. An inability to pay for services without significant hardship prevents many new moms from scheduling these consultations; frequently, new mothers become overwhelmed trying to navigate breastfeeding and give up. The benefits of breastfeeding for both mom and baby, including economic benefits, are well known. Making lactation services available to more women will help increase breastfeeding success. Breastfeeding is hard! As a currently breastfeeding mom of 4 children, I have sought help with each baby, most recently from Robin with my 2 month old daughter. I want all new moms to be able to benefit from skilled lactation support. The SDBFC Foundation’s mission is to help make this happen. I am honored to be able to be a part of something so important.
In order for this incredible nonprofit organization to continue its important work, it needs your support. Please consider donating—anything helps. And spread the word to any new moms you know, as they too may benefit.
- Dania Lindenberg, MD
Inspired to make a difference in the life of a new family?
$85 pays for one initial 90-min breastfeeding consultation for a low-income family
$55 pays for one follow up breastfeeding consultation for a low-income family.
Any amount will help us to reach our goal of $5000 for 2018!
Donate online through our CrowdRise campaign or directly through our SDBFC Foundation website.
To donate by check, please send to:
San Diego Breastfeeding Center Foundation
3355 4th Ave.
San Diego, CA 92103
Increase Access to Breastfeeding Support this #GivingTuesday
We’d like you to meet AnaKaren. She is one of the moms who was able to access affordable breastfeeding support because of the San Diego Breastfeeding Center Foundation.
Breastfeeding was something I always knew I wanted to do, I just didn't know how hard of a process it was going to be. When I had my baby girl I suffered from postpartum anxiety and pretty bad baby blues. Diana, like all babies, lost a lot of her birth weight and was not gaining it back as fast as she should've been. Breastfeeding her became a real struggle, and with my anxiety I was at a loss. I almost gave up multiple times because I didn't know what I was doing wrong, and I always had this anxious feeling that she was going to lose weight again because she was not feeding well.
Someone recommended I reach out to the San Diego Breastfeeding Center, so I called and made an appointment with Robin. When I arrived for my appointment I was welcomed with a warm smile and I instantly felt more comfortable. During our meeting I felt reassured and was given many helpful tips and advice. When our appointment was over I received an email with my breastfeeding plan and all the tips she had provided. I was so happy at how efficient the appointment was, and how fast Robin emailed me with the information. During our appointments, Robin was able to point out to me that my baby had a lip and tongue tie and I was referred to two dental specialist. Diana was able to get both her lip and tongue tie revised which helped immensely with breastfeeding. During our appointments, I was not only able to receive great advice but I was able to afford coming back two more times.
With limited income and a husband in school, it would've been very difficult to be seen at SDBFC without their affordable $25 appointment fee. Being able to afford the appointments made the difference between breastfeeding my baby and not breastfeeding. My baby and I are now three months into this incredibly breastfeeding journey, and I continue to see all the support I receive from the SDBFC team every time I go to their free breastfeeding support groups. Without their affordable cost fee and support I know my baby and I would've had a completely different outcome on this breastfeeding journey. The bond that my baby and I have created through breastfeeding has been possible because of the support and help from San Diego Breastfeeding Center.
AnaKaren
Breastfeeding is a right. It is not a privilege for only those who can afford support. That is why I give. - Robin
Join me in helping local families, like AnaKaren’s, gain access to critical breastfeeding support on this #GivingTuesday.
Wondering how to do this?
We are asking you to help us #SupportSDMoms by donating your weekly coffee money! It’s that simple! If everyone reading this email donated $20 today, the amount they would spend at a coffee shop this week, we would be able to raise over $40,000 on #GivingTuesday.
Can you help us reach this goal?
All you have to do is click on this CrowdRise link or on this SDBFC Foundation link to donate this week’s coffee allowance and help bring affordable breastfeeding support to hundreds of local low-income moms.
To donate by check, please send to:
San Diego Breastfeeding Center Foundation
3355 4th Ave.
San Diego, CA 92103
READ THIS BEFORE YOU SHOP ON AMAZON THIS HOLIDAY SEASON!
DID YOU KNOW….
While 93% of moms start breastfeeding exclusively at birth in San Diego, only 56% continue doing so at 3 months, largely due to a lack of financial resources and access to ongoing lactation support.
You can donate to the San Diego Breastfeeding Center Foundation with every purchase you make through Amazon Smile?
You can help low-income mothers gain access to critical breastfeeding support by purchasing Amazon items online, just by shopping through smile.amazon.com instead of amazon.com!
GUESS HOW EASY THIS IS???
We are asking you to take 60 seconds of your time today to designate the San Diego Breastfeeding Center Foundation as your charitable recipient for Amazon Smile. All you have to do is go to their website (smile.amazon.com) and choose the San Diego Breastfeeding Center Foundation as your Amazon Smile recipient. Or you can click on our direct charity link (https://smile.amazon.com/ch/81-1935497) Then as you make your holiday purchases, as well as your staples of diapers, nipple cream, baby toys, book, etc, the SDBFC Foundation will receive 0.5% of every purchase, at no extra cost to you. This money will go directly to paying for lactation consultations for families in need.
I met with Robin after the birth of my second baby to help with nursing pain and latch difficulties. I had been laid off from my job during maternity leave and enrolled my children in Medi-Cal coverage. The reduced fee for Medi-Cal patients encouraged me to seek help for my breastfeeding journey. It eased a financial burden as well as a mental and emotional need as Robin is an expert in her field. As a Medi-Cal patient, you often wonder if you are receiving the same level of care as privately insured patients. There is no question here. Robin and her staff are with you for life, breastfeeding and beyond.
Megan
Amazon Smile Details:
AmazonSmile is a simple and automatic way for you to support your favorite charitable organization every time you shop, at no cost to you. When you shop at smile.amazon.com, you’ll find the exact same low prices, vast selection and convenient shopping experience as Amazon.com, with the added bonus that Amazon will donate a portion of the purchase price to your favorite charitable organization.
To donate to the San Diego Breastfeeding Center Foundation directly, you can send a check to:
San Diego Breastfeeding Center Foundation
3355 4th Ave.
San Diego, CA 92103
Or donate through our website: https://www.sdbfcfoundation.org/donate.
Baking for a Cause - Petite Paleo Bakery
Community. It’s what makes living in a particular location worthwhile and fulfilling. I have had the pleasure of living in San Diego for most of my life and each new life chapter has encouraged me to broaden my community. Becoming a mom 13 years ago (and having a child with severe food allergies) led me to search for a more environmentally-conscious, wholistic, and wholefoods-based community. One of these generous community members has asked to kick off our ‘end of the year nonprofit fundraising campaign’ with a Bake Sale! We are so grateful to have Rose, of Petite Paleo Bakery, in our community and for her incredible generosity. Please allow me to introduce Rose!
My name is Rose Malihan and I am the owner of Petite Paleo Bakery. Our delicious homemade Paleo inspired baked goods are free of gluten, grains, dairy, soy, and refined sugars. Our natural sweeteners are dates, coconut sugar, or honey. We also offer savory wraps and rolls and use organic and local ingredients as much as possible. And most importantly, all of our sweets and treats are kid-tested and mom-approved!
I was passionate about health and fitness before I became a mom, so breastfeeding was an obvious choice after my baby was born in 2010. We met Robin at her weekly breastfeeding support group when my daughter was less than a month old. I am so thankful that we found her, because unfortunately for us, breastfeeding was challenging! My newborn baby girl was not latching correctly, nursing was painful, and she was slow to gain weight. Robin was so compassionate and put us in touch with the right healthcare providers, and soon thereafter, I gained more confidence about being a mom, nursing in public, and advocating for what I felt was right for us. My daughter started gaining weight more steadily, and we continued our nursing journey until she was two years old.
I am forever grateful for Robin and the San Diego Breastfeeding Center, and for the resources they provided to us when we needed it the most. Being able to breastfeed my baby for as long as we did was the most amazing experience, and I am thankful that we had that time to bond, and that my body experienced the beauty of nourishing a life.
When I started Petite Paleo Bakery earlier this year, one of my goals was to make a difference in the community, and especially with families. I chose to bake in honor of Robin and the San Diego Breastfeeding Center Foundation, because they made what I feared at many times to be impossible, possible. I was able to provide one of nature's most precious gifts of love and health to my daughter the first two years of her life. Through our bake sales, we will raise money to help provide this gift to other local families in need, in hopes that they may also have this beautiful and empowering experience. We appreciate your support!
Rose will be offering two separate bakes sales. One for pick up before Thanksgiving and one before the Christmas holiday.
If you are interested in just donating to our nonprofit foundation, feel free to head over to our website. Our End of the Year Fundraising Campaign starts next week and we would love to include you as one of our donors!
Meet SDBFC's Newest Lactation Consultant - Sophie Talke
We are thrilled to announce that we have a new lactation consultant on staff at SDBFC! Sophie Talke is an IBCLC and Registered and Licensed Occupational Therapist. She brings a wealth of knowledge working with children and their families, as well as personal breastfeeding experience. Welcome to the SDBFC family, Sophie!
TELL US ABOUT YOURSELF!
I am originally from the Bay Area in Northern California. I moved down to San Diego for college where I attended the University of California, San Diego and received a Bachelors of Science in Biology. I swam competitively during my four years at UCSD on their swim team. I fell in love with the San Diego area. The warm weather, beaches, and active lifestyle could not be beat! A couple of years later, I decided to go to graduate school for Occupational Therapy. I completed my Masters degree at the University of Southern California in Los Angeles. I moved back down to San Diego as soon I was finished. Several years later, I met my husband, Kurt, and we got married in beautiful Lake Tahoe. We now have an amazing 20-month-old son, Jacob, who is the light in our lives. He is full of joy and energy, and it has been so much fun watching him grow and learn everyday. We are a very active family and love to spend time outdoors. We run, hike, bike, swim, and love to travel together as a family. We recently got back from an amazing trip to Spain and cannot wait to plan another adventure soon!
WHAT INSPIRED YOU TO BECOME A LACTATION CONSULTANT?
After working in the occupational therapy field for over 8 years, I knew that I was still searching for the right fit and a specific area in which to specialize. I have always been drawn to the health field because I enjoy helping people and making a difference in their lives. I pursued lactation consulting before ever having a child of my own. It was through watching close friends and family members struggle with breastfeeding that I became interested in the field. This specialty was so intriguing, and I knew that it was going to be the perfect fit for me! Becoming a lactation consultant has personally helped me so much with my own breastfeeding journey with my son. I am excited to be able to work with mothers and babies while sharing my knowledge and experience with them.
WHAT ARE YOU MOST EXCITED ABOUT WORKING WITH SDBFC?
I am so excited to be a part of this amazing team! All of the IBCLCs are so caring, knowledgeable, and gifted at helping others become successful in their individual breastfeeding journeys. I have had multiple friends receive wonderful care through SDBFC, and they have been able to breastfeed despite various challenges. I am excited to be able to offer this same quality care to all of the families that I encounter along the way.
WHAT ARE YOUR TOP 3 TIPS FOR A BRAND NEW BREASTFEEDING FAMILY?
Do not be afraid to ask for help! There is no shame in seeking help from others along the way, whether it is with breastfeeding or in any other area of your life.
Keep an open mind and enjoy the journey ☺ Everyone’s journey is different, and that is okay!
Remember that it is just a phase and you will get through it! Challenges may occur along the way, but you can and will persevere. You will come out the other end as a stronger person!
Exclusive Pumping - How Does it Change Over Time?
Exclusive pumping is an incredible, challenging journey. And what it looks like for a newborn can differ from pumping for an older baby. Explore the full journey here.
Written by Amanda Glenn, from HTTPS://EXCLUSIVEPUMPING.COM/
When exclusively pumping, does the pumping regimen change over time or stay the same?
When you start exclusively pumping, most lactation consultants recommend that you pump the same number of times that your baby eats, which is about 8-12 times per day. Usually, each session is about 15 minutes.
Whether or not this changes as your baby gets older is completely up to you! There is no harm is keeping this schedule up as long as you continue to exclusively pump. However, most exclusive pumpers find pumping so often to be pretty exhausting and start to drop pumping sessions around the 6-8 week mark. (Here are some sample pumping schedules by age.)
When you drop pumping sessions, what you're really doing is consolidating your pumping time - you're pumping for the same amount of time per day, but just less often. So, for example, if you are pumping 8 times a day for 15 minutes, and you want to drop down to 7 times a day, you would add about 2 minutes to each of your 7 remaining sessions.
(Why drop pumping sessions if you're still going to have to pump for the same amount of time each day? It helps you avoid the hassle of stopping what you're doing, getting hooked up to the pump, and putting your breast milk away and washing your pump parts.)
Increasing the length of your sessions will help you maintain your supply; you'll pump less often, but get more milk at each session because you'll get multiple letdowns of milk.
Middle of the Night Pumping Sessions
The other thing that changes with regard to exclusive pumping schedule over time is overnight pumping. When your baby stops waking up in the middle of the night to eat, many women drop their middle of the night pumping sessions as well.
This makes sense, as your pumping schedule should mimic your baby's feeding schedule (and also because you need to sleep). However, some women do decide to keep a middle of the night session if milk supply is an issue for them, because prolactin levels can be higher at night.
Managing Pumping with an Older Baby
Another thing that can change your pumping regiment as your baby gets older is how you manage to get your pumping sessions in. When your baby is a newborn, you may have family members or your partner home with you at times to help hold the baby when you need to pump, or you may be able to feed your baby a bottle while you pump with a hands-free pumping bra.
Older babies like to play with tubing and are mobile, so being tied to a pump can sometimes be more challenging. Luckily, their sleeping habits tend to be more predictable, so it's easier to schedule your pumping sessions for times when they are napping. (When this doesn't work, sitting next to baby in a high chair with some finger foods and/or toys is my best strategy for dealing with this.)
Going Back to Work
Another thing that might affect your pumping regiment over time is going back to work. In the United States, many new moms have to go back to work when their babies are 12 weeks old. The good news is that exclusively pumping moms are a bit ahead of the game - if you're an exclusive pumper, you are already very familiar with a breast pump, and you know your baby will take a bottle.
However, you do need to figure out how to fit your pumping sessions in with work. Women with office jobs may have an easier time with this, especially if they can work on a laptop with a hands-free pumping bra. If pumping at work for you is easy, it might make sense to do more pumping sessions at work so that you can spend the time that you do have at home with your baby.
Other moms, like teachers, have a harder time getting breaks from work to pump. If this is true for you, you might have to be creative with your pumping schedule in order to get your pumping sessions in, maybe by concentrating your pumping sessions at home before your baby gets up and after he goes to bed.