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. 

Nursing in Public - The Positive Spin

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

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

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From Lara Snyder:

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

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From Marion Luebberman:

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

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From Tiffany Kyle: 

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

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

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

Does Your Baby Have a Tongue or Lip Tie?

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

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

 

What is a tongue tie and lip tie?

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

Tongue tie

Upper lip tie

How do tongue and lip ties cause breastfeeding challenges?

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

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

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

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

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

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

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

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

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

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

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

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

It is very important that parents do suck and stretching exercises after the procedure to prevent scarring down.  My colleague, Melissa Cole, IBCLC, created this quick and easy video for suck exercises after tongue tie revisions: http://vimeo.com/55658345.  She recommends doing these a few times a day, during baby’s quiet alert time, to retrain baby’s tongue to suck effectively and to prevent scarring down.  A local dentist recommends bending baby’s upper lip up to his/her nose after an upper lip tie release to prevent scarring down.

Will my breastfeeding challenges resolve immediately after the procedure?

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

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

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

Catherine Watson Genna: Is My Baby Tongue Tied?

Dr. James Ochi: Tongue Tie Survey

More researched-based articles about tongue and lip ties:

American Academy of Pediatrics Tongue Tie article

Dr. Kotlow: Tongue Tie Fact Sheet

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

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

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

Did your baby have a tongue or lip tie?

How did this affect breastfeeding?

Help a Mama Out: Tips for Talking with your Boss about Pumping

'Help a Mama Out' Topic of the Week:

Tips for Talking with Your Boss about Pumping

What's your best tip for discussing your pumping rights/schedule with your boss? 

Shelly Hovies Rogers: Be assertive with your rights, but be flexible and willing to work with your boss and coworkers.  I found my workplace to be quite accommodating to me when I nicely, but matter of fact, told them what I needed.  Also, although I didn’t have to quote the state law, I familiarized myself with it, just in case I needed to use it. 

Kelly Reyes: Before I left for maternity leave, I discussed my need to pump with my boss and then HR, just to make sure we were all on the same page.  When I had issues with the way the ‘wellness room’ schedule was being managed, my boss went to bat for me and fixed the problem that day! 

Marie Bishop: My best advice is to know the law and stand up for yourself and your baby.  In states, such as California, it is required by law that your employer provides a non-restroom space that is private for you to pump.

Meggin Dueckman: We just talked about it!  We’re all pretty close at work, so it was no problem.  I was the first of our staff to want/need to pump at work.  Mind you, here in Canada we get a year of maternity leave, so it’s not as common for people to want to pump as frequently when they return to work.  I only pumped 1 times a day at work, more for my own comfort!

Jamie Howell Swope: As a teacher at a school, it wasn’t an easy process, but I went in knowing the law and advised my principal ahead of time why I wanted to meet with her.  That way she had time to think about how to make it work, too.

Kat Picson Berling: I was really lucky in that 2 of my coworkers were pumping moms, so they had paved the way.  I told my boss that I was going to take 2 pumping breaks at x and y time and I will be in this office and it will take 15 minutes.  He was fine with it.  I’m not going to lie…. Because I had a cubicle at work, it was sometimes difficult to find a place to pump.  Even our HR coordinator wasn’t sympathetic for me.  Just make sure to know the law. 

Chantel McComber: My advice would be to put your fears aside.  Sometimes it’s hard as a working mom to ask for things because not everyone has them.  Remember that you are doing this for your health and your baby’s health and those are two things that should always come first.

Jennifer Haak: When I discussed my date of return, I told my boss that I needed a lock installed on my office door and I explained why.

Andrea Blanco: First, know your right.  Be sure that your company falls under those rights.  Then file that information away and try *not* to use it as it can be perceived as a threat (and no one likes to be threatened.)  Second, have a plan in place.  I find that if you’re willing to have the conversation in advance, go into it as sweet as possible, and have it all planned out as to how it will work for you (with consideration given to work environment/demands/pumping law.)  Then, it is much harder for your employer to say no. 

For the United States Lactation Accommodation laws, check out Break Time for Nursing Mothers

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

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

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

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

Why did he bite me!?

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

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

What should I do?!

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

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

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

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

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

If I Give My Newborn Baby a Bottle, Will She Refuse the Breast?

Originally published on February 11, 2014; Revised August 27, 2024

Author: Robin Kaplan, M.Ed, IBCLC, FNC

The short answer is “we don’t know”.  There is so much information out there about nipple confusion.  Some will tell you that if anything other than a breast *touches* your baby’s mouth, he’ll never want to breastfeed again. Others will regale you with stories about how their exclusively breastfed baby had bottles! cups! pacifiers! in the first few hours of life and had no problem switching back to breast.  Each baby and situation is different.  It’s never a given that your baby will, or will not, develop nipple confusion if he/she has a bottle before breastfeeding has been successfully established.

ABOUT SDBFC

The San Diego Breastfeeding Center was established in 2009 by Robin Kaplan, International Board Certified Lactation Consultant, Functional Nutritionist, and parent.  Her vision was to create a judgment-free, inclusive support system for families navigating infant feeding challenges. 

SDBFC offers a wide range of one-on-one breastfeeding, infant feeding, and nutrition consultations - as well as classes, support groups, online articles, and social media - making it your one-stop-shop for all things infant feeding!

What is Nipple Confusion?

Bottle nipples and breast nipples have a very different feel to the baby, so sometimes when babies are used to one and they are introduced the other, it can seem confusing.  You can help to prevent this by choosing a bottle nipple with a sloped, wide base rather than a small, thin, long nipple.  This will help the baby to continue to open his/her mouth widely while feeding, which is what we want him/her to do while at the chest/breast.  However - it is often a “flow preference”, rather than nipple confusion, that can cause a baby to have a difficult time switching from bottle to chest/breast.  Even the “slow flow” bottles the nurses use in the hospital flow much faster than the breast, especially during those first few days when milk volume is low.  Plus, even with those “slow flow” bottles, the baby doesn’t have to work very hard to get the milk to flow into his/her mouth.  When the bottle is tipped, the milk often just pours into his/her mouth.  At the chest/breast, the baby has to suck for a while to elicit the “letdown” of milk, and then throughout the feeding is only rewarded when he/she sucks at the breast.  With a bottle, the milk pours into his/her mouth whether he/she’s sucking or not.  These babies are smart!  They learn very quickly that with one form of feeding, they don’t have to work as hard.

How Can I Avoid Flow Preference?

The easiest way to avoid flow preference is to only feed your baby at chest/breast until breastfeeding has been established, baby is back to his/her birth weight, and has gone through his/her first growth spurt that occurs around 2-3 weeks of life.  However, there are many different situations when it may be necessary or appropriate for a baby to fed in an alternative way during those first few weeks of life.  Some of these situations may include: premature babies who haven’t developed the suck, swallow, breath pattern yet; birth complications that force parent and baby to be separated for some period of time; anatomical challenges that prevent the baby from being able to latch on properly (tongue/lip ties); or sometimes parent’s preference - damaged nipples, etc.  If you do feed your baby another way, there are things you can do to avoid the possibility of your baby developing a flow preference, or preferring an alternative feeding method.  If your baby is able to latch comfortably, one option is to supplement at the chest/breast using a tube and syringe, and to either deliver the supplement very slowly and only when baby is actively sucking, or allow the baby to pull the supplement on his/her own.  This helps the baby to continue to associate the breast with food, as well as ensuring baby has to work for the flow.  If you do bottle feed, you can pace the bottle feeding so that it simulates a feeding at the breast - I’ll discuss this in greater detail in the next paragraph.

What if I Need/Want to Give my Brand New Baby a Bottle?

If a baby does receive a bottle, there are some things you can do to help prevent a flow preference from developing.  The most important thing to realize is that there really isn’t a truly “slow flow” nipple, and that most bottles are the same, even the ones that claim to be designed for a nursing baby.  It’s not so much the bottle you choose, but the method you use to feed the baby.  Baby should be fed in a paced manner, so that the length and pace of the feeding mimics a breastfeeding session.  The amazing online breastfeeding resource, KellyMom, has a great article on how to properly bottlefeed a breastfed baby - http://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/.  Another great resource regarding bottle/breastfeeding is www.breastandbottlefeeding.com.  Both sites contain a great amount of information on “nipple confusion” and flow preference and how to avoid them.  

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Ashley’s Success Story

As an IBCLC, I work with a lot of moms trying to get their babies back to breast after being fed via bottle.  I’m always excited to share my own story to give them some hope and let them know that it is possible to transition a baby who is exclusively bottle fed to a baby who exclusively breastfeeds!  My first child was born in New York City, in the fall of 2007.  The hospital I delivered at had two lactation consultants on staff, but the one who was scheduled to work the day my daughter was born was in a car accident and not able to come in. So I fed my baby with an incorrect latch for a day and a half. By the time the lactation consultant arrived on the day we were being discharged, my nipples were cracked and bleeding.  I was in extreme pain and every feeding brought bouts of panic and anxiety with it.  Looking back, I realize that she had a lip tie and that may have been causing the painful latch.  I chose to pump for a few days to allow my nipples to heal, and found that pumping and bottle feeding caused much less stress.  So I exclusively pumped for my daughter for 4 months.  

Exclusive pumping is hard work!  You’re basically doing double feedings - by feeding the pump, then feeding your baby.  Plus with the constant washing of pump parts, I felt like I was chained to the house every three hours so that I could pump to maintain my supply. On the flip side, there were benefits to it as well.  My husband could feed the baby and I was able to get out of the house early on to do things like laundry.  :)  However, I always felt like I was missing out on a HUGE piece of those early months with my baby.  I’d always assumed I’d breastfeed exclusively, and felt like a failure that I wasn’t.  I kept trying periodically, but my baby would often cry at the breast and I would get frustrated easily and give up, assuming it would never happen.  But I kept trying, and finally, at 4.5 months, she was latching regularly and I was able to put away the pump!  She nursed until 14 months old, and I’d never felt such pride or accomplishment about anything before.  I use this story to encourage moms that just because their babies aren’t latching RIGHT NOW, that doesn’t mean that they won’t later.  

If your baby is struggling with bottle feeding or breastfeeding, we are just a consult away!

Don’t let bottle feeding or breastfeeding struggles cause stress for you or your baby!  Our consultants can help identify the root cause(s) of why your baby is struggling going between breast and bottle and can offer suggestions for ways to overcome these challenges!  Book a one-on-one postpartum consultation today

SDBFC is committed to providing high-quality lactation and functional nutrition consultations to parents in San Diego and beyond. Explore our postpartum, prenatal, and functional nutrition consultations, take a breastfeeding class or attend a workshop.

About the Author

Robin Kaplan has been an IBCLC since 2009, the same year that she opened up the San Diego Breastfeeding Center.  Robin was the founding host of the Boob Group podcast and published her first book, Latch: a Handbook for Breastfeeding with Confidence at Every Stage in 2018.  Melding her passions for supporting lactating parents and holistic health, Robin finished her Functional Nutrition Certification in 2023. In her free time, she enjoys hanging out with her two teenage boys, hiking, traveling, weaving, cooking, and searching for the best chai latte.

Tackle your Postpartum Trouble Spots: Arms

Written by guest blogger, Autumn Bonner

Hi Moms! Are you starting to feel more toned and tight from our first 2 trouble spot workouts?  In case you missed them, check out my previous articles about how to tone your tummy and your butt.  Today we complete the program by tackling our arms!  

Your arms are actually one of the few parts of your body that doesn’t go through major change during pregnancy, but the normal weight gain that comes along with growing a baby may have left you with a wiggly wave.  You know the kind I mean, when you wave and then your under arm keeps waving?  To get rid of the extra fat and tone those guns, it takes the same 3 keys: toning, cardio, and healthy eating. 

Let’s talk about toning for a minute. Many women are afraid of lifting weights or doing push-ups for fear of ending up with hulk arms.  Good news, women simply don’t have enough testosterone to bulk up like men do (even when you lift heavy weights).  So don’t be afraid to really challenge yourself with the strength exercises below.  You’ll end up with the toned tight arms you desire, no hulks in sight! Plus, strong arms are really a necessity for motherhood. Have you lifted a car seat carrier lately?  The everyday tasks of mothering include lots of lifting, pulling, and pushing. The moves below will strength all the muscles in your arms and shoulders to prepare you for your daily life as a mom. 

Here’s your 20 minute Arm Toning Plan! For this workout you’ll need:

• Your baby 
• Ergobaby carrier (or similar carrier)
• Timer (you can use your phone)
• Chair
• Diaper bag or dumbbell 
• Mat 

As with any exercise plan, be sure to get your doctor’s clearance before starting a new activity.

Warm up – Put your baby in the Ergobaby carrier. For 1 minute, march in place and pump your arms to raise your body temperature and prepare for the workout.  Then switch to a step touch for another minute and swing your arms as you move. Repeat both moves again for a total of 4 minutes.

Cardio/Strength – We are going to alternate between 1 minute of cardio and 1 minute of strength, so get your timer ready. 

1 – Tricep Dip – This move tackles the wiggly wave! Sit on a chair with your hands by your sides gripping the edge of the seat. With your feet flat on the floor move your hips away from the bench (keeping your butt near the edge). Bending your elbows back along your sides, lower down slowly, then press up to the starting position. Complete as many repetitions as you can in 1 minute. Your little one provides some extra weight to challenge your triceps. 

2 – Power Punches – Let’s sculpt the shoulders! Stand with your feet a little wider than shoulder width and your toes and knees pointing outwards (like a dancer’s plie squat).  Extend one arm to the side and alternate punching high and low as quickly as you can.  As you punch, squat up and down with your legs. Stay on one arm for 30 seconds and then switch to the other arm. You will really feel this in your shoulders.

3 – Diaper bag curl – Whether it’s a diaper bag, infant carrier, or bag of groceries, we use our biceps all the time as moms! For this move, grab your diaper bag (or a dumbbell) and hold it in one hand. Keeping your elbow near your side, perform a curl to lift the bag up to your shoulder. Slowly return to the start. Repeat as many reps as you can for 30 seconds and then switch arms.

4 – Mountain Climber – For the last two moves, take your baby out of the carrier and lay him/her below you on a mat. The mountain climber is a total body move that is great for cardio.  Your arms are stabilizing your body so they will get a workout too. Come into a plank position on your hands. Make sure your hands are directly below your shoulders and that you are a straight line between your head and your feet. Bring in one knee at a time towards your chest.  The faster your pace, the more challenging this move will be. Try to keep going for a whole minute.

5 – Push up kiss – Give a little love and get toned arms! Assume a push up position. You can choose to be on your knees to start or your toes for more challenge. Make sure your hands are directly under your shoulders and that your hips are in line with your body. Slowly lower down and give your baby a kiss at the bottom, then push up to the top.  Keep going for a full minute.

Take 1 minute to rest and then repeat these 5 exercises once more. 

Stretch – Finish by stretching as your baby lies nearby on the floor and rehydrate.

So there you have it! You now have a complete workout program to tackle your trouble spots and help you fit back into those pre-pregnancy jeans. When you feel like you are ready for more, I encourage you to sign up for a free 30 day trial of my online program for moms at www.MyTailoredFitness.com. We have an entire workout program designed for moms including more great exercises you can do with your baby in the carrier. Follow us on Facebook, Pinterest, Instagram, or Twitter for more fitness and nutrition tips!  Here’s to a healthy and happy 2014!  

Tackle Your Postpartum Trouble Spots - Butt

Written by guest blooger, Autumn Bonner, co-owner and co-founder of My Tailored Fitness.

Hi Moms!  Autumn here from Tailored Fitness back this week to help us tackle our next trouble spot, the Butt, with a baby-wearing workout you’ll love.  If you missed our first post about how to tone the tummy, you can check it out here, Tackle Your Postpartum Trouble Spots: Tummy.  

There are 3 changes that occur during pregnancy that affect our backsides:

1. Weight gain – It is completely normal to gain weight in places other than your belly during pregnancy.  It’s part of the way your body makes sure you have enough nourishment for the growing baby. You may have noticed that as your front was getting larger (aka: breasts and belly) that your backside was getting larger too (aka: your butt).  I like to think of it as nature’s way of making sure we don’t fall over .   
2. Loss of muscle tone – Towards the end of pregnancy, the weight of your growing belly makes it much harder to exercise and to build up the intensity necessary to maintain muscle tone. We end up losing much of our muscle tone, especially in our glutes!  
3. Postural Shift – There are also some crazy postural changes that occur during pregnancy. If you look at the two pictures below showing your posture pre-pregnancy and your posture at the end of pregnancy, you can see that your pelvis tilts forward. This causes the muscles on the backs of your legs (your glutes and hamstrings) to stretch and in turn lose some of their strength.  

So to get your derriere back where it belongs after pregnancy, it takes the same 3 things we talked about last week:

1. Toning
2. Cardio
3. Healthy Eating

Here’s a 20 minute Butt Toning Plan that combines toning and cardio! Combine this plan with your healthy eating and your tummy toning workout from last week and you will be well on your way to your pre-baby body (or an even better one)!  As with any exercise plan, be sure to get your doctor’s clearance before starting any activity.

Warm up – Put your baby in the Ergobaby carrier and find a set of stairs you can climb. If you don’t have any at your house or in your apartment complex, look for a nearby office building or park that has some you can use.  Chances are they will be empty. To warm up, walk up and down the stairs for 2 minutes. Be sure to be near the handrails in case you lose your balance.  It’s harder to see your toes when wearing your baby, although you may be used to that from being pregnant! 

Cardio - To get your heart rate up, alternate between 1 minute of quick stair climbing (of course safety is #1, so only go as quickly as you feel comfortable, it won’t take much to get your heart rate up) and 1 minute of slow start climbing with a glute squeeze after each step. The photo shows a glute squeeze, but basically as you step up on a stair, lift your back leg straight behind you and squeeze your glute! Keep alternating for a total of 5 minutes.

Strength –Keep that baby in your carrier for these strength exercises. 

1 – Squat and Squeeze – With one foot on the step, lower into a squat with the weight on your heels. Since you are wearing your baby, you will naturally want to drop your chest, but keep your chest up and let the legs do the work. Rise up from the squat and step onto the step lifting your outside leg up into a side glute squeeze. You will need to engage your abs to maintain your balance as you lift your leg.  Slowly return to the starting position and repeat for 10 reps, then switch legs and do 10 reps on the other side. Rest and then repeat another set.

2 – Wall Sit – Find a stable, smooth wall. Place your back against the wall and lower down until your thighs are parallel to the ground. Make sure your entire back and shoulders stay against the wall and hold for 1 minute. Rest and then repeat for another minute.  This is a great time to connect with your little one. She/he can definitely help distract you from your burning legs! 

3 – Butt Blaster – This one is killer, but so good for targeting the glutes. Take your baby out of the carrier and lay his/her below you on a matt. Come onto your hands and your knees. Keeping your leg bent, lift one leg up pushing the heel up to the sky. Return to the start and then open the knee to the side. Keep alternating lifting back and side on the same leg for a total of 10 reps. Then switch and repeat on the other side. Rest, and repeat both sides a 2ndtime.

Stretch – Finish by stretching as your baby lies nearby on the floor. Also, be sure to drink lots of water throughout the day. 

If you are looking for more ideas for how to tone your glutes with your baby in your Ergobaby carrier, check out this lower body strength video from My Tailored Fitness, my fitness program for moms. 

Be sure to check back next week as we tackle our final trouble spot: arms!

Common Concerns While Breastfeeding - What is That White (and painful!) Spot on My Nipple?

Welcome back to our blog series…. Common Concerns While Breastfeeding.  These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls we receive.  Rather, these are the questions that come from clients and friends in the middle of the night, by text or by email, that don’t necessarily warrant a lactation consultation.  They can often be easily resolved with a few simple tricks.  So, we would like to share those tricks with you!

Many moms know the pain associated with a shallow latch during the early days, but have you ever had nipple pain suddenly begin after weeks or months of pain-free breastfeeding?  After checking nipples for signs of a poor latch, you notice a white spot on the nipple in question - you pick at it for a few seconds, but it still remains.  What is it?  What caused it?  What can you do to resolve it and get back to pain-free breastfeeding?  This is what’s called a “milk blister” or “milk bleb” and is not cause for great concern, but it can be an uncomfortable and unwelcome guest!

 

What is a milk blister?

A milk blister is a small white or yellow spot on your nipple - it is normally blocking a milk duct, hence sometimes the pain associated with it is felt both at the tip of the nipple as well as radiating out into the breast.  It can’t easily be wiped away or removed.  It may sometimes be associated with a plugged duct.  It is perfectly safe to continue to breastfeed while you have one.

What causes a milk blister?

There are two causes for what we call a milk blister.  One is that a bit of skin has grown over an open milk duct, blocking it and creating a blister.  The other is the build up of fatty milk at the site of the milk duct, and the calcification of this fatty milk, which then blocks milk from flowing from this duct. The things that can increase risk for a milk blister are:

• A recent plugged duct

• Nipple is pinched often while baby is breastfeeding

• Oversupply

• Unusual pressure from a bra or sleeping position

• Thrush

How can I get rid of the milk blister?

• Place some organic coconut oil on a cotton ball and place it on your nipple, inside your bra, in between feedings for a few days.  This will help break down the calcification at the tip of the nipple, as well as fight off any bacteria or yeast.

• Soak your nipple/breast in a saline bath of warm water several times a day.  According to Kellymom.com, add 2 tsp of epsom salt to 1 cup hot water.  Allow the salt to dissolve and soak your affected breasts prior to feeding. Then place a hot, wet facecloth over your breast right after the saline bath and right before breastfeeding/pumping.  This should help to soften the nipple and help the blister release while baby is feeding or while pumping.

• Apply moist heat to nipple prior to feeding

• Try to remove the skin prior to feeding - rub with a warm washcloth

• If all else fails, you can also ask your healthcare provider to use a sterile needle to open the blister.  After this procedure, follow up with organic coconut oil to keep the area moist and allow it to heal.

What if I keep getting milk blisters?

• Consider seeking help from a Lactation Consultant to try to resolve the underlying cause of the recurring blisters.

• Be sure your bras provide soft but strong support - avoid ones with underwire that may cause plugged ducts.

• Consider reducing the amount of saturated fat in your diet.

• Consider taking sunflower lecithin, 1200mg, 4 times a day, to keep milk ducts ‘slippery’ thereby preventing recurring plugged ducts and milk blisters.

What Every Mom Should Know About Breastfeeding During the Early Weeks

How much breast milk does my baby need per feeding?
What is common nursing behavior for a newborn?
How will I know that my baby is getting enough?

As a new mom, these are common questions that you may ask your pediatrician, midwife, postpartum nurse, family, and friends and GUESS WHAT..... they may all have a different answer!

How complicated is that?  

Sometimes you may feel like there are ‘too many cooks in the kitchen’ and that all of the advice you receive contradicts what you just heard from someone else 5 minutes ago. 

Talk about frustrating! 

Well, one of our goals at the San Diego Breastfeeding Center is to make breastfeeding as seamless and uncomplicated as possible.  We want to empower moms with knowledge and confidence to get breastfeeding off to a great start!

After listening to local moms express discontent about hearing contradictory breastfeeding information, we decided to do something about it.   First, we canvased our local breastfeeding mamas and asked, “What information do you wish you would have known about breastfeeding during those early weeks?”  Then we hired one of those awesome mamas, Elisa Suter, of Paper Doll Design Studios, to design a brochure that shares our top tips that every mom (and pediatrician) should know about breastfeeding during the early weeks.

Here is the final product!  Isn’t it beautiful?  We hope that this brochure provides the clear, consistent, evidence-based breastfeeding information our mamas are looking for.  

If you live in San Diego and would like us to deliver these brochures to your pediatrician's office, please email us at robinkaplan@sdbfc.com. 

If you live outside of San Diego and would like to order the Adobe file to personalize this brochure for YOUR local pediatricians and clients, please email us at robinkaplan@sdbfc.com