Breastfeeding and Low Supply: Common and Surprising Causes and Solutions

Breastfeeding and Low Supply: Common and Surprising Causes and Solutions

Great 4th Trimester Info

The Fourth Trimester – AKA: Why Your Newborn is Only Happy in Your Arms. July 6, 2012 tags: 4th trimester, baby calming, baby colic, baby only happy if being held, baby wants sleep, baby won't sleep, baby won't stop crying, babycalm, babycalming, babywearing, can't put baby down, contented baby, controlled crying, fussy baby, Gina Ford, gripe water, happiest baby, high needs baby, how to calm a crying baby, how to put baby in a routine, how to relieve colic, how to settle baby, how to stop a baby crying, how to treat baby colic, in utero, newborn colic, newborn help, skin to skin, stop baby crying, The Baby Whisperer, the fourth trimester, treatments for colic, womb to world . 67 Votes Quantcast “My baby is only happy in my arms, the minute I put her down she cries” “He sleeps really well but only when he’s laying on my chest, he hates his moses basket” “She cries every time we lay her on her play mat” “He hates going in his pram, he cries the second we put him in it”. How many times have you heard these comments from new parents? How many times have you said them yourself? I’ve lost count of the amount of times I have been asked these questions! What amazes me though is that society in general doesn’t get it, they don’t get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! How to calm a crying baby, treat colic, baby wants sleep, baby won't sleep, baby won't stop crying, baby cries unless in my arms, newborn colic, unhappy baby, fussy baby, gina ford routine, find my local antenatal classes, find local baby classes We spend more than time though, the ‘putting babies down’ industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on………………having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn’t enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn’t consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak. “Empathy: the intellectual identification with or vicarious experiencing ofthe feelings, thoughts, or attitudes of another.” To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world – but which world? The world they have spent most of their life in, their ‘womb world’ or the world they are in now – our world. To fully understand we must appreciate the enormous transition they have made – a concept known to many as ‘The Fourth Trimester’ -some make the womb to world transition easily, others less so and it is this latter group in particular “the clingy babies” we can learn so much from through this concept. “Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to “behave.” If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he’s labeled an “easy baby”; if he does not adapt readily, he is labeled “difficult.”” – Dr. William Sears. So lets quickly compare the two different ‘worlds’ your baby has lived in: The fourth trimest, womb to world, life in utero, why babies cry, how to calm a crying baby Pretty different huh? On top of this the big thing to understand is that in utero the baby’s world was constant, each day was the same, the stimulation didn’t change, but now they are born each day is different – ever changing, ever stimulating! the fourth trimester, 4th trimester, womb to world, newborn colic, why is my baby only happy in my arms, babywearing You’ll find a more in-depth discussion on this idea and much more in my BabyCalm Book – available from Amazon in the UK or with worldwide free delivery from The Book Depository if you live elsewhere in the world. how to calm a crying baby, find local antenatal classes, stop baby colic, treat colic, how to get baby to stop crying, how to get baby to sleep, baby classes, babycalming The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help – but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally. Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don’t already know, you will soon learn what your baby likes best and that’s what matters, that it is unique to *your* baby. Prescriptive ‘do this/don’t do this’ baby calming lists don’t help anybody – because they forget they are dealing with individuals – both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won’t work, some you won’t like – and that’s OK! because really it isn’t about these tips it’s about you and your baby getting to know each other! Movement The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride. Swaddling Imagine how snug your baby was at the very end of your pregnancy inside of you – now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don’t want to or indeed can’t then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby’s hunger cues if you are feeding on demand: Never swaddle over your baby’s head or near his face Never swaddle your baby if he is ill or has a fever Make sure your baby does not overheat and only swaddle with a breathable/thin fabric Only swaddle your baby until he can roll over** Always place your baby to sleep on his back Do not swaddle tightly across your baby’s chest Do not swaddle tightly around your baby’s hips and legs, his legs should be free to “froggy up” into a typical newborn position. Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before. ** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Skin to Skin Contact Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin – the love and bonding hormone – in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you. Bed-Sharing Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it’s a subject that makes society very uncomfortable, but…it is an *amazing* baby calmer! It’s really important that you think about how bedsharing will work and follow some important safety guidelines HERE. babywearing, baby carrier, baby sling, moby wrap, good carrier for a newborn baby, good sling for a newborn baby Babywearing Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of “quiet alertness” – a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us – yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands! Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby’s spine whilst not placing any pressure on your baby’s growing hips – newborns should always be carried facing inwards with a “frog leg” pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an ‘in arms’ position – i.e: how your baby would be held if you were holding them! This great picture from JePorteMonBebe highlights this newborn hold position perfectly. Babywearing is a great way for dads to bond with babies! It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling – it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up: babywearing, safe babywearing, ticks guide for safe babywearing, how to choose a baby sling, how to choose a baby carrier Position The “tiger in the tree” position below, taken from baby yoga, is often magical, stopping a crying baby in an instant! newborn colic hold, baby colic hold, tiger in the tree, tiger in a tree, baby yoga Noise Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A white noise CD such as the one by BabyCalm HERE can be played on loop whilst your baby sleeps to help keep them calm. Feed If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine – whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby’s skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier. Deep Bathing The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby’s tears in seconds – even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer. Outside If all else fails many babies stop crying the minute they hit the open air – I’m not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air – but it works! attachment parenting book, fourth trimester book, babycalm book, babycalming book, parenting book If you like this article you’ll find many more suggestions and discussions on baby sleep, colic, babywearing, co-sleeping/bed-sharing and much more in my newly released BabyCalm Book – available from Amazon in the UK or with worldwide free delivery from The Book Depository if you live elsewhere in the world! Written by: Sarah (Mum to Four, Parenting Author and Founder of BabyCalm Ltd) You can read more of Sarah’s articles HERE. Share this: Twitter538 Facebook10K+

Tongue Tie's effect on breastfeeding

Tell Me About Tongue Ties! By Norma Ritter, IBCLC, RLC Have you noticed how so many babies these days are being diagnosed with tongue and/or lip ties? What are tongue ties, and do they really affect breastfeeding? Why do they seem to be more prevalent lately? How can they be treated? There is a lot of confusion about tongue ties, also known as ankyloglossia. Here is some information to help you wade through the facts and myths surrounding this topic. What is a tongue tie? The normal development of a fetus includes the growth of little bits of tissue called frenums (also known as frenulums), which attach the tongue to the floor of the lower jaw. We are all born with some of this tissue, but for some babies it is so tight that they cannot move their tongues properly. This can affect their ability to breastfeed, or even take a bottle or a pacifier. Tongue tie can also have other serious health effects. In a similar way, a baby's lips can be attached to his gums, making it difficult to get a good grasp on a nipple. Babies who have lip ties almost always also have tongue ties. Tongues and lips are only considered *tied* if their movement is restricted, impairing mobility. It is important to note that many people have frenums which do not cause any problems at all. Each case needs to be assessed on an individual basis. There are different kinds of tongue tie. They are classified according to where the frenum is attached on the base of the tongue. Class 1 ties are attached on the very tip of the tongue. These are the ones that most people think of when they talk about tongue ties. Class 2 ties are a little further behind the tip of the tongue. Class 3 ties are closer to the base of the tongue. Classes 1, 2, and 3 are also known as anterior ties. Class 4 ties, also known as posterior ties (PTT), may be submucosal, ie. underneath the mucous membrane covering, so they must be felt to be diagnosed. Babies with this kind of tie are often misdiagnosed as having a short tongue. This video shows how to recognise a PTT. Lip ties are classified in a similar way. They range from Class 1 which are tiny, reaching only from the underside of the upper lip to the top of the gum, to Class 4, which have tissue connecting the lip to right under the gum ridge, located between the positions where the top front teeth will emerge. Tongue and lip ties are considered to be midline defects. Midline facial defects tend to run in families. These include cleft lip, submucosal cleft palate, cleft chin, extra or missing teeth, nasal atresia and deviated septum. How and why does it affect breastfeeding? Babies who are tongue-tied may have problems affecting a secure latch to the breast. They can overcompensate by increased suction causing nipple damage and pain. When they can no longer maintain latch through suction, there may be a click and a slight loss of suction or the baby may completely detach from the breast. This may not only cause pain, but also affect the baby’s ability to adequately drain the breast, leading to supply issues. In severe cases, baby is really not able to attach at all. Why do we seem to be seeing more tongue ties now? Babies have always been born with tongue ties. You may have heard stories of midwives who used to keep one fingernail long and sharp to cut class 1 and 2 ties at birth as a matter of routine. When bottle feeding started to become popular, it was considered to be not just a viable alternative to breastfeeding, but actually superior to it, and mothers were encouraged to feed their babies “scientifically.” Tongue tie was one of the reasons given to wean the baby to a bottle, and most of the accumulated knowledge about it was forgotten. When breastfeeding became popular again, the attention to the problem re-emerged. For a long time, only anterior tongue ties were recognized. It was easy to spot the typical heart-shaped tongue of ties which started at the tip of the tongue. Even so, it was very difficult to find a doctor who was willing to snip the tie, so mothers either suffered the pain or, more frequently, switched to bottle feeding. But lately, in the past ten years, things have started to change. There has been a tremendous amount of new information from research studies, especially about posterior ties, and the use of lasers for very delicate surgery has revolutionized the treatment. The newest research is looking into environmental factors, and the possibility of a specific gene mutation being linked to the cause of tongue ties. In a recent informal poll on a Facebook page for healthcare professionals dealing with tongue and lip ties, every one of the International Board Certified Lactation Consultants (IBCLCs) in private practice who responded stated that the vast majority (over 90%) of the babies they saw had tongue and/or lip ties. Another Facebook page, which acts as an online support group for parents whose babies are tongue tied, has over 3,600 participants, with about 100 new people joining every week. What is going on? First, you have to realize that IBCLCs in private practice tend to see the most difficult cases. Since it can hurt to nurse if your baby is tongue tied, many mothers stop breastfeeding in the first few days. Some of those who do seek help are told that breastfeeding is not affected by tongue ties, or that bottle feeding is the solution, or even that there is no such thing as a tongue tie. Those who persevere may eventually get their babies treated, but the tongue may not be released sufficiently, and so the problem persists. Many of these mothers may have seen several health care providers before finding that knowledgeable and supportive Facebook page. In one case, a mother saw ten IBCLCs before she found one who recognized the problem! All these mothers are looking for validation and for personal recommendations to practitioners who both recognize and release ties. There are many myths about lip and tongue ties, but here are some facts. It is possible to have both an anterior (frontal) tie AND and posterior one. Although some (anterior) ties are associated with heart-shaped tongues, tongue tips can look rounded or squared if there is posterior tie Posterior ties are often misdiagnosed as a short tongue. A baby with a tongue tie may be able to stick out his tongue. Tongue and lip ties, like the webs of skin between your thumbs and index fingers, do not suddenly shrink, stretch, or disappear. Tongue and lip ties can affect a baby's ability to breastfeed. Babies who are tongue tied are often not able to drink well from a bottle or take a pacifier. Older tongue-tied babies may have difficulty in swallowing solid food. Their tongues may not be mobile enough to move the food to the back of their mouths. A mother whose baby is tongue tied may start out with plenty of milk, but the lack of adequate stimulation to her breasts can result in a decrease of her milk production. This, of course, can lead to poor weight gain in the baby. Digestion starts in the mouth, and so tongue ties can lead to digestive problems like colic and reflux. Tongue tie can affect speech, causing both delays in speech onset, and also in the ability to form certain sounds and words correctly. Tongue tie can affect the way teeth come in. For example, the front bottom teeth may be pulled inwards. Babies with tongue ties often have narrow palates, so teeth may be overcrowded. When you see a lip tie, there will almost always also be a tongue tie. Babies who have lip ties are not able to open up and properly flange their lips, and this can affect their ability to grasp the breast. Lip ties may push the two front teeth apart, leading to expensive orthodontic work later. In many cases, if the lip tie is not released, the front teeth will grow apart again after the braces have been removed. Tooth decay can be caused by food being pushed into the pockets on either side of a lip tie. It may seem trivial, but tongue-tied babies will eventually become tongue-tied children and adults who cannot lick an ice cream cone or French kiss - not trivial to those affected; it is much easier, safer, and less traumatic to fix a tongue tie in infancy than to wait until later childhood or adulthood. Treating tongue and lip ties If you suspect that your baby has a lip or tongue tie, you will want to get it evaluated. This is where an experienced IBCLC can help. The number of health care providers who are knowledgeable about tongue ties is growing, and your local IBCLC will be able to recommend a practitioner (usually a pediatric dentist or Ear, Nose and Throat Specialist (ENT) who can diagnose and release the tie. Tongue and lip ties can be released either with a scalpel or scissors, or by laser. Lasers do not require anesthesia, and *seal* the revision instantaneously, so there is minimal bleeding and no risk of infection. Here are three videos of older children's tongue ties being released by lasers. Most people are amazed at how quickly it can be done. Warning, these are graphic! Laser Anterior Tongue Tie Revision In Calgary, Alberta Laser Posterior Tongue Tie Revision in Calgary, Alberta Lip tie release This video shows how the healing takes place, day by day: After-care – who does what? You will be able to nurse your baby immediately after the procedure, and many mothers notice a difference in the way their babies nurse right away. However, there is still more work to be done. After a couple of hours your baby's mouth will start to be sore, and doctors usually recommend an over the counter analgesic. Some mothers prefer to use homeopathic preparations. Your baby may be fussy, but he or she will soon calm down. Do not be surprised if your baby refuses to nurse during this time because of the soreness. This is a very temporary nursing strike and usually resolves quickly. During this time, you can hand express or pump your milk to relieve engorgement, and feed it to your baby with a spoon, cup or bottle. As the videos show, an incision is made into the frenum to release the tightness. This incision needs to be kept open while it heals. This is done very quickly, three or four times a day for about 2 weeks, by stretching the tongue and massaging the incision. This video shows how: It is easiest to do the stretching from behind the baby's head. One way is to place him on the floor and sit behind him. With an older baby or a toddler, some mothers find it helps to positioning your knees over their child's shoulders to keep their arms from waving around. A tongue-tied baby who cannot breastfeed properly learns to compensate. After his tongue has been released, he needs to learn how to nurse using a different set of muscles. This is where bodywork, like chiropractic and craniosacral therapy, can help by releasing the muscles needed. This bodywork is very gentle, done mostly with fingertips, and some of it can be done while the mother is holding the baby. When the baby's latch to the breast is good, it should feel comfortable for the mother and enable the baby to breastfeed efficiently. An IBCLC who specializes in latch issues can help your baby get the deepest possible latch. The IBCLC can also teach you some gentle exercises to help your baby strengthen and stretch his newly-released tongue. If your baby has not previously been able to nurse, she can help you in getting him to the breast and in increasing your milk production. You can read more about aftercare here: For more information about tongue and lip ties, see the references below. REFERENCES 1. Coryllos, E. Watson Genna, C. Salloum, A. (2004) Congenital tongue-tie and its impact on breastfeeding American Academy of Pediatrics

Tongue Tie effect on Breastfeeding.

Tell Me About Tongue Ties! By Norma Ritter, IBCLC, RLC Have you noticed how so many babies these days are being diagnosed with tongue and/or lip ties? What are tongue ties, and do they really affect breastfeeding? Why do they seem to be more prevalent lately? How can they be treated? There is a lot of confusion about tongue ties, also known as ankyloglossia. Here is some information to help you wade through the facts and myths surrounding this topic. What is a tongue tie? The normal development of a fetus includes the growth of little bits of tissue called frenums (also known as frenulums), which attach the tongue to the floor of the lower jaw. We are all born with some of this tissue, but for some babies it is so tight that they cannot move their tongues properly. This can affect their ability to breastfeed, or even take a bottle or a pacifier. Tongue tie can also have other serious health effects. In a similar way, a baby's lips can be attached to his gums, making it difficult to get a good grasp on a nipple. Babies who have lip ties almost always also have tongue ties. Tongues and lips are only considered *tied* if their movement is restricted, impairing mobility. It is important to note that many people have frenums which do not cause any problems at all. Each case needs to be assessed on an individual basis. There are different kinds of tongue tie. They are classified according to where the frenum is attached on the base of the tongue. Class 1 ties are attached on the very tip of the tongue. These are the ones that most people think of when they talk about tongue ties. Class 2 ties are a little further behind the tip of the tongue. Class 3 ties are closer to the base of the tongue. Classes 1, 2, and 3 are also known as anterior ties. Class 4 ties, also known as posterior ties (PTT), may be submucosal, ie. underneath the mucous membrane covering, so they must be felt to be diagnosed. Babies with this kind of tie are often misdiagnosed as having a short tongue. This video shows how to recognise a PTT. Lip ties are classified in a similar way. They range from Class 1 which are tiny, reaching only from the underside of the upper lip to the top of the gum, to Class 4, which have tissue connecting the lip to right under the gum ridge, located between the positions where the top front teeth will emerge. Tongue and lip ties are considered to be midline defects. Midline facial defects tend to run in families. These include cleft lip, submucosal cleft palate, cleft chin, extra or missing teeth, nasal atresia and deviated septum. How and why does it affect breastfeeding? Babies who are tongue-tied may have problems affecting a secure latch to the breast. They can overcompensate by increased suction causing nipple damage and pain. When they can no longer maintain latch through suction, there may be a click and a slight loss of suction or the baby may completely detach from the breast. This may not only cause pain, but also affect the baby’s ability to adequately drain the breast, leading to supply issues. In severe cases, baby is really not able to attach at all. Why do we seem to be seeing more tongue ties now? Babies have always been born with tongue ties. You may have heard stories of midwives who used to keep one fingernail long and sharp to cut class 1 and 2 ties at birth as a matter of routine. When bottle feeding started to become popular, it was considered to be not just a viable alternative to breastfeeding, but actually superior to it, and mothers were encouraged to feed their babies “scientifically.” Tongue tie was one of the reasons given to wean the baby to a bottle, and most of the accumulated knowledge about it was forgotten. When breastfeeding became popular again, the attention to the problem re-emerged. For a long time, only anterior tongue ties were recognized. It was easy to spot the typical heart-shaped tongue of ties which started at the tip of the tongue. Even so, it was very difficult to find a doctor who was willing to snip the tie, so mothers either suffered the pain or, more frequently, switched to bottle feeding. But lately, in the past ten years, things have started to change. There has been a tremendous amount of new information from research studies, especially about posterior ties, and the use of lasers for very delicate surgery has revolutionized the treatment. The newest research is looking into environmental factors, and the possibility of a specific gene mutation being linked to the cause of tongue ties. In a recent informal poll on a Facebook page for healthcare professionals dealing with tongue and lip ties, every one of the International Board Certified Lactation Consultants (IBCLCs) in private practice who responded stated that the vast majority (over 90%) of the babies they saw had tongue and/or lip ties. Another Facebook page, which acts as an online support group for parents whose babies are tongue tied, has over 3,600 participants, with about 100 new people joining every week. What is going on? First, you have to realize that IBCLCs in private practice tend to see the most difficult cases. Since it can hurt to nurse if your baby is tongue tied, many mothers stop breastfeeding in the first few days. Some of those who do seek help are told that breastfeeding is not affected by tongue ties, or that bottle feeding is the solution, or even that there is no such thing as a tongue tie. Those who persevere may eventually get their babies treated, but the tongue may not be released sufficiently, and so the problem persists. Many of these mothers may have seen several health care providers before finding that knowledgeable and supportive Facebook page. In one case, a mother saw ten IBCLCs before she found one who recognized the problem! All these mothers are looking for validation and for personal recommendations to practitioners who both recognize and release ties. There are many myths about lip and tongue ties, but here are some facts. It is possible to have both an anterior (frontal) tie AND and posterior one. Although some (anterior) ties are associated with heart-shaped tongues, tongue tips can look rounded or squared if there is posterior tie Posterior ties are often misdiagnosed as a short tongue. A baby with a tongue tie may be able to stick out his tongue. Tongue and lip ties, like the webs of skin between your thumbs and index fingers, do not suddenly shrink, stretch, or disappear. Tongue and lip ties can affect a baby's ability to breastfeed. Babies who are tongue tied are often not able to drink well from a bottle or take a pacifier. Older tongue-tied babies may have difficulty in swallowing solid food. Their tongues may not be mobile enough to move the food to the back of their mouths. A mother whose baby is tongue tied may start out with plenty of milk, but the lack of adequate stimulation to her breasts can result in a decrease of her milk production. This, of course, can lead to poor weight gain in the baby. Digestion starts in the mouth, and so tongue ties can lead to digestive problems like colic and reflux. Tongue tie can affect speech, causing both delays in speech onset, and also in the ability to form certain sounds and words correctly. Tongue tie can affect the way teeth come in. For example, the front bottom teeth may be pulled inwards. Babies with tongue ties often have narrow palates, so teeth may be overcrowded. When you see a lip tie, there will almost always also be a tongue tie. Babies who have lip ties are not able to open up and properly flange their lips, and this can affect their ability to grasp the breast. Lip ties may push the two front teeth apart, leading to expensive orthodontic work later. In many cases, if the lip tie is not released, the front teeth will grow apart again after the braces have been removed. Tooth decay can be caused by food being pushed into the pockets on either side of a lip tie. It may seem trivial, but tongue-tied babies will eventually become tongue-tied children and adults who cannot lick an ice cream cone or French kiss - not trivial to those affected; it is much easier, safer, and less traumatic to fix a tongue tie in infancy than to wait until later childhood or adulthood. Treating tongue and lip ties If you suspect that your baby has a lip or tongue tie, you will want to get it evaluated. This is where an experienced IBCLC can help. The number of health care providers who are knowledgeable about tongue ties is growing, and your local IBCLC will be able to recommend a practitioner (usually a pediatric dentist or Ear, Nose and Throat Specialist (ENT) who can diagnose and release the tie. Tongue and lip ties can be released either with a scalpel or scissors, or by laser. Lasers do not require anesthesia, and *seal* the revision instantaneously, so there is minimal bleeding and no risk of infection. Here are three videos of older children's tongue ties being released by lasers. Most people are amazed at how quickly it can be done. Warning, these are graphic! Laser Anterior Tongue Tie Revision In Calgary, Alberta Laser Posterior Tongue Tie Revision in Calgary, Alberta Lip tie release This video shows how the healing takes place, day by day: After-care – who does what? You will be able to nurse your baby immediately after the procedure, and many mothers notice a difference in the way their babies nurse right away. However, there is still more work to be done. After a couple of hours your baby's mouth will start to be sore, and doctors usually recommend an over the counter analgesic. Some mothers prefer to use homeopathic preparations. Your baby may be fussy, but he or she will soon calm down. Do not be surprised if your baby refuses to nurse during this time because of the soreness. This is a very temporary nursing strike and usually resolves quickly. During this time, you can hand express or pump your milk to relieve engorgement, and feed it to your baby with a spoon, cup or bottle. As the videos show, an incision is made into the frenum to release the tightness. This incision needs to be kept open while it heals. This is done very quickly, three or four times a day for about 2 weeks, by stretching the tongue and massaging the incision. This video shows how: It is easiest to do the stretching from behind the baby's head. One way is to place him on the floor and sit behind him. With an older baby or a toddler, some mothers find it helps to positioning your knees over their child's shoulders to keep their arms from waving around. A tongue-tied baby who cannot breastfeed properly learns to compensate. After his tongue has been released, he needs to learn how to nurse using a different set of muscles. This is where bodywork, like chiropractic and craniosacral therapy, can help by releasing the muscles needed. This bodywork is very gentle, done mostly with fingertips, and some of it can be done while the mother is holding the baby. When the baby's latch to the breast is good, it should feel comfortable for the mother and enable the baby to breastfeed efficiently. An IBCLC who specializes in latch issues can help your baby get the deepest possible latch. The IBCLC can also teach you some gentle exercises to help your baby strengthen and stretch his newly-released tongue. If your baby has not previously been able to nurse, she can help you in getting him to the breast and in increasing your milk production. You can read more about aftercare here: For more information about tongue and lip ties, see the references below. REFERENCES 1. Coryllos, E. Watson Genna, C. Salloum, A. (2004) Congenital tongue-tie and its impact on breastfeeding American Academy of Pediatrics

Pacifiers? Good or Bad?

Don’t Cry as Pacifiers Go Bye-Bye August 15, 2013 By Cindy Hutter Mixing Pacifiers and Breastfeeding Just because a mother is breastfeeding doesn’t mean her baby can never use a pacifier. The American Academy of Pediatrics recommends that breastfeeding babies only be given pacifiers after breastfeeding is established, typically after one month. In hospitals around the country the break-ups are happening. Pacifiers and babies are no longer being seen together. These once ubiquitous partners are now going their separate ways as hospitals are tossing pacifiers and other artificial teats following evidence that they can interfere with breastfeeding. Since beginning work to create an environment that supports breastfeeding—including removing artificial teats—Providence Hospital in Washington, DC, has seen its exclusive breastfeeding rates climb from 4 percent in July 2012 to 55 percent in April 2013. Texas Health Huguley Hospital in Forth Worth similarly has seen its exclusive breastfeeding rate rise from 33 percent in January 2013 to 49 percent in June. Break-ups are never easy. Hospitals purging the pacifiers say that educating staff and mothers as well as slowly ramping up removal efforts were vital to the successful systems change. “Once our team was educated about the drawbacks of pacifier use we shared it with physicians and got their buy-in. Then we started talking to the nurses and they saw that the pacifiers weren’t needed. This buy-in is what has made the removal so successful for us,” says Sharon McMillian, RN, director of the Maternal and Infant Health Unit at Providence Hospital. McMillian is part of a team at Providence that is participating in Best Fed Beginnings, a national quality improvement project that aims to help hospitals improve maternity care and increase the number of “Baby-Friendly” hospitals in the United States. The Baby-Friendly designation is granted to facilities that adhere to the evidence-based Ten Steps to Successful BreastfeedingExternal Link. One of the steps calls for giving no pacifiers or artificial nipples to breastfeeding infants because they interfere with the development of optimal breastfeeding habits. Lori Feldman-Winter, MD, MPH, faculty chair of the Best Fed Beginnings project, explains that sucking on a pacifier often leads to unrecognized hunger cues that would otherwise result in more breastfeeding. Also, the way a baby positions its mouth and tongue when sucking an artificial nipple is different than when at the breast. Going back and forth between the breast and artificial nipples is associated with breastfeeding problems such as poor suckling technique and damage to the mother’s nipple. A poster used at Texas Health Huguley Hospital to support their change efforts. A poster used at Texas Health Huguley Hospital to support their change efforts. Sharing this education with mothers has made all the difference. Providence Hospital’s Bilingual Parent Educator, Soledad Sheppley, RN, describes the education that mothers receive on pacifier use both prenatally and as inpatients as pretty extensive. And so far, it’s helped to reduce the number of mothers asking for pacifiers. Ragan Steelman, RN, IBCLC, a member of a team at Texas Health Huguley Hospital participating in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, says when mothers at Huguley ask for pacifiers, staff first provide evidence-based education about the risks of pacifier use, including how it masks infants’ signs of hunger, reduces the number of feedings at the breast, interferes with effective feeding, delays milk production, reduces the volume of milk, and may contribute to painful latches. When it came time to make the shift at Texas Health Huguley, the team started with a few small tests to gain confidence and momentum for the change. “Staff support helps a lot in making a large-scale change like this,” says Steelman. “We start small by getting a few team members to be advocates and by finding supportive leaders to help push along those who weren’t quite as receptive.” Providence did the same. The team started with a test group and a small sample. It monitored the results for a few days, made adjustments and then expanded the test group. Providence Hospital’s Nurse Educator Lisa Cleveland, RN, says it didn’t take long for word of mouth about the change to start happening, so when the unit was ready to officially adopt the practice of no pacifiers, the job was easier. “Peers were communicating to each other about what they are doing and the excitement around the effort,” reflects Cleveland. “Using the small tests of change process has made our job more effective.” When the change was ready to be scaled up across the unit at Huguley, Steelman and her team made a pacifier discard bucket right near the circumcision table, one of two places a pacifier is allowed because it is used for pain management. The second place is in a unit for infants requiring higher levels of care. The team also put up “no pacifier zone” signs that reminded staff if they have one to throw it away. “Know that what you’re doing is improving the well-being of moms and babies. Be persistent and consistent,” recommends Steelman. To test the success of removing artificial teats at Providence, McMillian occasionally goes to the postpartum unit or the nursery and asks for pacifiers, even insisting there is a secret stash. Her efforts are quickly rebuffed, as staff reminds her there are no pacifiers anymore. “I was pleasantly surprised by how easy it was to remove the pacifiers once staff were educated and we took the time to scale up the change,” says McMillian. For more stories, sign up for NICHQ's monthly e-newsletter and follow NICHQ on Facebook and Twitter.

Should nursing Moms avoid certain foods?

Should breast-feeding moms avoid certain foods? Here are some tips to put nursing moms and their babies on the right track. By Chanie Kirschner Fri, Aug 02 2013 at 2:15 PM Related Topics: Healthy Eating, Raising Healthy Kids breast-feeding foods Photo: Oksana Kuzmina/Shutterstock Breast-feeding is a wonderful gift you can give your baby. And while you should always maintain a balanced diet, what you eat while you’re a nursing mom is especially important since the foods you eat are nourishing your baby as well. So what should you avoid while breast-feeding? “There are no foods that mothers ought to avoid while breast-feeding,” says Dr. Nancy Brent, noted pediatrician, lactation consultant and medical director at the Breastfeeding Center of Pittsburgh. “In fact, most mothers can eat anything they want while breast-feeding. However, if your baby is fussy and you’re noticing other unusual gastrointestinal symptoms, such as bloody or mucus-y stools, try cutting out dairy and then soy.” If you eat something and notice that two feedings later (about the time for that food to enter your breast milk) your baby is especially fussy, you might try cutting out that food and seeing how your baby responds. “Then, after two weeks, gradually add that food back into your diet and see if your baby tolerates it,” Brent advises. She’s quick to add, though, that without any gastrointestinal symptoms, infant fussiness is likely not the result of maternal diet, and can be a sign of overtiredness, colic or acid reflux. Though foods mentioned above may or may not have an effect on your breast milk, there are certain things you should avoid while you’re breast-feeding to ensure your baby’s health. First item on the list? Alcohol. The American Academy of Pediatrics says that an occasional drink for a breast-feeding mom is OK, and Brent agrees. “Generally, a woman can have one drink of beer or wine two to three times a week. She should time it immediately after a feeding. If she's feeling the effects, then the alcohol is in her milk. If she's still feeling a little drunk when it's time to nurse next, she needs to give a bottle of previously expressed milk or formula.” You can “pump and dump” the milk to avoid engorgement and clogged milk ducts. Either way, too much alcohol can harm your baby, and it’s important to monitor your intake. Another thing to avoid while you’re breast-feeding is caffeine. While a morning cup of coffee is OK, experts say to limit your daily intake to no more than 300 mg a day. That’s generally one cup of fresh-brewed coffee, though actual amounts of caffeine may vary a little. If you’re like me and you just like the taste, feel free to go crazy on instant decaf — there’s only 2 mg of caffeine in a cup. Be watchful of other things that contain caffeine, such as chocolate or caffeinated tea. (If you’re unsure how much caffeine that certain food items have, check out this chart.) Finally, trim your seafood intake while you’re breast-feeding, especially if white tuna, swordfish or mackerel is your thing. That’s because these types of seafood are known to contain high levels of mercury, which could potentially harm your baby’s nervous system in high doses. If you do like seafood, choose fish that are typically low in mercury, such as wild-caught Alaskan salmon. Salmon is also high in omega-3s and protein, two essential nutrients for breast-feeding moms. You don’t need to go crazy to avoid specific foods while you’re breast-feeding. Just be smart about your intake and feel confident knowing you’re doing the best you can for you and your baby. Happy nursing! Related breast-feeding stories on MNN: •What not to eat when you're pregnant •More U.S. mothers breast-feeding, CDC says •Breast-feeding mama gets happy surprise at restaurant

How to be the Best Post-Partum Visitor in 15 Minutes or Less

Resources How To Be The Best Post Partum Visitor In 15 Minutes Or Less How To Be The Best Post Partum Visitor In 15 Minutes Or Less Have a friend who had a baby and you're on the roster to drop off a meal? Here's everything they want you to know and do, but are too shy and polite to say and ask. They are tired. Breastfeeding is still awkward and having people around makes it more awkward. The mother is recovering physically, either from a surgical birth, or from the equivalent of a triathlon where the prize was a grapefuit sized head flying out of her vagina. Either of these things makes you sore and tired. They would like to see you, but don't want to be tired out by a long visit. You are not going to stay longer than 15 minutes, no matter how polite the parents are in saying you can stay longer. If your visit/meal drop off scheduled for 5.30. BE ON TIME. Make plans for 6:15 so that you HAVE to leave. Read More Before you walk in the door, put your game face on. Set a timer, on your phone or watch for 15 minutes. When it goes off, get out of there! Remember that you are going to be a quiet, productive blessing. This visit is NOT about you. It is not about the parents hosting you and putting on a cup of tea so you can sit and visit and hold the baby. Think about how you would feel if you had either had surgery or ran a triathlon. What would you want people to do for you? This visit is about blessing the parents and making their life a little bit easier. Your prize is getting a quick peek at the cute new human. Here's how to play out your 15 minute visit: 1. Bring a healthy meal. Include a salad or fresh vegetables. Only use disposable dishes. There is nothing more annoying than a) having to wash more dishes when you have a new baby and b) having to try to return dishes to all sorts of random people when you have a new baby 2. In addition to your meal, bring cut up veggies and fruit, unsalted trail mix or nuts, or other such healthy snacks for daytime munching for mom to eat while she's nursing. 3. Go into the kitchen and spend 5 minutes clearing off a counter, washing a sink-full of dishes, loading the dishwasher etc. Don't ask permission, just do it. Then set the table for their dinner. 4. Before you leave your house, put some paper towels and some powdered bathroom cleaner like Commet or Ajax in a baggie. Stick it in your purse. While you are at the house, go and use the washroom...and while in there do a three minute bathroom shine-up, using your paper towels and cleaner. 5. Coo over the baby, but wash your hands before touching it. 6. If they want to eat right then, heat the food up and put it on the table, give everybody kisses and then leave. 7. Take the garbage out when you go. In and out. This will be the best visit the parents will have had. They will love you and you will be awesome in their books forever. You can come back and have a longer visit when the parents have adjusted to their new normal.

Preparing for your newborn: Learning the basics of breastfeeding

Preparing for your newborn: Learning the basics of breastfeeding