Tongue/Lip ties

5 Breastfeeding Myths and Misconceptions that Really Annoy the Heck Out of Us!

How many times have you heard a so-called breastfeeding ‘fact’ from a family member, friend, healthcare professional, or online resource that has your ‘mama-radar’ going off at warp speed?  Maybe something just doesn’t sound right. Maybe it goes against all of your breastfeeding instincts. Maybe it is completely contradictory to what you heard the previous day. Well, it’s time to start busting those myths and misconceptions! 

World Breastfeeding Week 2019 begins in a few days and this year’s theme is all about empowering breastfeeding families.  We couldn’t think of a better way to empower breastfeeding families than by providing real facts to some of the most common breastfeeding myths/misconceptions! We will also be chatting about additional breastfeeding misconceptions on Baby Tula’s Facebook Live on August 2, 2019 at 10am PST, so definitely join us that day!

So, here we go…..

Myth #1: When pregnant, you should rough up your nipples to prepare them for breastfeeding.

Ok, so who thought up this ridiculous idea??? Why would we ever think that "roughing up" our nipples by rubbing them with a towel was a good recommendation. There is no need to cause nipple trauma and scabbing before your baby even arrives! In fact, rubbing your nipples can actually remove the protective substances produced by the breast during pregnancy and afterwards. Sure, your nipples may feel sensitive for those first few days to weeks, but with a great latch, they will become less sensitive over time, all on their own. No need to do anything to prepare them prior to your baby being born.

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Myth #2: If your baby feeds more than every 2-3 hours, then he/she is not getting enough.

So, this statement is a little complicated.  Sometimes, this can be true, especially if your baby is not gaining weight well and feeding every hour throughout the day and night.  This situation might indicate that your baby might not be getting enough milk and your milk supply/baby milk transfer should be assessed.

Typical baby behavior is feeding about 8-12 times per 24 hours, especially for the first few months.  Remember, babies’ tummies are small, so they need frequent, small feedings. Some babies with reflux and tummy issues also like small, frequent feedings.  There are also situations where babies temporarily feed more frequently, like during cluster feedings times (aka witching hours) and during growth spurts (which last a few days.)  Cluster feeding often happens when your baby needs a bit more snuggling time to unwind from the day and growth spurts are nature’s way of requesting more milk for future feedings. So, these are totally normal situations when a baby would feed more frequently than every 2-3 hours and don’t indicate a low supply, at all.


Myth #3: Nursing beyond a year is just for mom’s benefit

So, let’s just think about this one for a second.  Is there an on/off switch that makes breastmilk less valuable and nutritious on a baby’s first birthday?  Does it suddenly lose all of its immunological properties? I think not. In fact, there are so many nutritional, social, mental, and physical benefits for breastfeeding beyond a year, as well as the fact that breastfeeding beyond a year is normal.  Kellymom.com has incredible resources on this subject, so I will just share a few of my favorites:

  • According to Dewey (2001), in the second year (12-23 months), 448 mL of breastmilk provides:

    • 29% of energy requirements

    • 43% of protein requirements

    • 36% of calcium requirements

    • 75% of vitamin A requirements

    • 76% of folate requirements

    • 94% of vitamin B12 requirements

    • 60% of vitamin C requirements

  • Immunities in mother’s milk continues as long as breastfeeding continues and some increase in concentration as the child gets older.

  • The American Academy of Pediatrics recommends that “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child… Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother… There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.” (AAP 2012, AAP 2005)

So, if you want to breastfeed for longer than a year, go for it!  It is fantastic for both you and your child. What’s most important is the breastfeeding family’s goals for how long they want to breastfeed…. Not what others believe should be the goal!


Myth #4: Small breasts = small milk supply; Large breasts = large milk supply

As a lactation consultant, I see breasts of all shapes and sizes and this misconception could not be further from the truth. Milk supply is determined by the amount of glandular tissue you have in your breasts and how this fatty tissue expands and multiplies during pregnancy and after your baby is born. Milk supply also significantly depends on breast emptying after your baby is born…. The more you empty your breasts when feeding or pumping, the more signals are sent to your brain to produce more milk. The actual breast is just the vessel/container to hold the milk. So, a size DD breast can hold more milk at one time, compared to a size B breast, but may not necessarily differ in the amount of milk made over a 24 hour period.

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Myth #5: If your baby is taking forever to transfer milk while breastfeeding, then you have a lazy baby

I don’t think there are many phrases I despise more than ‘lazy baby.’ Think about this…. Why would a baby choose to be lazy? Your baby’s only job is to feed to stay alive, therefore survival is based on being as robust a feeder possible. A baby who seems ‘lazy’ and takes over an hour (on average) to breastfeed is actually a baby having a difficult time breastfeeding. This could be caused by tethered oral tissue (tongue/lip tie), jaundice, using a nipple shield, prematurity, as well as many other reasons. So, babies who appear ‘lazy’ are often just doing the best that they can with the situation they’ve been dealt. And this is a fantastic reason to meet with an IBCLC to see how you can help your baby begin to feed more effectively and easily, as soon as possible!

So, what other breastfeeding myths and misconceptions absolutely drive you crazy?

Share them in the comments and we will do our best to remedy this misinformation in our interview on Baby Tula’s Facebook Live this week.

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.

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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.

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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:

Dr. Ghaheri’s website

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)


Do's and Don’ts of Using the Nipple Shield

Do's and Don’ts of Using the Nipple Shield

Written by Robin Kaplan, M.Ed, IBCLC

Is your baby having a difficult time latching?  Is breastfeeding incredibly painful?  Do you have a cracked nipple that just won’t heal?  Then most likely you have been recommended to try a nipple shield.  While the nipple shield can often be a terrific temporary tool to help with these situations, it is important to know how to use them correctly, as well as have an exit strategy for how to discontinue usage as soon as possible.

Podcast and Personal Stories about Tongue Ties and Lip Ties

Written by Robin Kaplan, M.Ed, IBCLC

Last week on The Boob Group, I had the esteemed pleasure of interviewing one of the most prominent experts on tongue ties and lip ties, Catherine Watson Genna.  Catherine has written multiple articles and books about the mechanics of the tongue while breastfeeding, as well as the breastfeeding challenges that can occur when a baby has a tongue or lip tie.  One of her earliest articles was written for the American Academy of Pediatrics, helping to bring awareness to this subject for the practitioners who babies see the most.

Click here to listen to The Boob Group's podcast episode: Tongue Ties and Lip Ties: Symptoms, Treatment, and Aftercare.

 

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?

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. 

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.

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.

Does Your Baby Have a Tongue or Lip Tie?

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

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