breastfeeding, chestfeeding

Feeding Difficulties: Perspective from an SLP Mom who had a Baby with Tongue Tie

Alexa Blake, CCC-SLP, has been working for the last two and a half years to develop and grow an infant feeding and swallowing program that serves Linn and Benton counties. She works at Samaritan Lebanon Community Hospital and considers it her passion project to serve these little warrior humans and their parents, optimizing feeding safety and function and meeting the goals of the family. She works with infants who have feeding difficulty from prematurity, tongue tie, torticollis, and general oral motor weakness, using a variety of oral motor and sensory based techniques to meet the unique needs of each patient. The thing that makes her work even more special to her, though, is her own experience with nursing difficulty with her son who was born with a tongue tie.

Here’s her perspective:

I began working with infants prior to having my own child, and I really enjoyed it. It was a unique challenge and very different from any other kind of patient population I’d worked with previously. So when it came time to feed my own child, I figured I had a leg up on how to make it successful for both of us. Once he arrived however, it was a whole different ball game.

My son was born health and happy at 39 weeks, and I weathered my birth experience just fine. All things considered, we were off to a great start. The first time he nursed, just about half an hour after he came in to this world, he ate for a full 80 minutes and I was proud of this accomplishment, taking that as a sign he was hungry and ready to eat. Nursing did not feel great, but compared to childbirth it was nominal pain. The discomfort persisted and worsened over the first several days and my nipples became bruised, chapped, bloodied, and so on. It got to the point that I could not nurse him without tears streaming down my face from the pain. My son was colicky and screamed at all the things everyone said would make him happy (baby swing, I’m looking at you), had frequent and aggressive spit up out his nose, gas, and was a sleepy eater. I did not know how to fix our feeding difficulties or any of the other resultant challenges we were having.

Teddy and Alexa

 I went to three different lactation consultants over the next week to try and solve my nursing pain, and each of them hinted at a posterior tongue tie. Initially, I was offended. I was a new feeding therapist, how could my child have a tongue tie? And even more, how could I not have been the one to figure it out? I had been given holding techniques to try, nipple shiels, creams, etc. to address our feeding struggles and nothing was working. I felt scared and frustrated. I wanted to nurse so badly and felt I would’ve failed my son to do otherwise.

At 11 days old, I took my son to an ENT who laser beamed my son’s tongue to release the tethered tissue. I thought that would be the end of it and things would get better. I was instructed to stretch his wound 6 times a day for a whole month to help it heal properly. To me, in the throws of a post-partum hormone crash with a colicky baby, those stretches were pure torture for both myself and my newborn son. I loathed them, and yet, I was fearful that if I did not do them it would all be for naught.

It was at this point that I asked for help from anyone and everyone I could think of who would help my baby’s mouth and keep us nursing. We went to OMT, we had a home visit from my PT superwoman coworker Patsy Yelsa, I consulted fellow feeding therapists on what an SLP could do, I saw lactation. It was my mission to turn this experience around. And slowly but surely, we did just that. I found a combination of frenotomy stretches and oral motor exercises that allowed my son to do rehab without causing me to feel I was hurting him. We addressed my baby’s whole body experience with his tongue tie, not just his mouth. We worked hard on tummy time, proper positioning, and latch. My nursing pain subsided and my supply stabilized. It took the first 8 weeks of his life before I felt like we both knew what we were doing. It took a whole team of people and professionals help us be successful. He continued to grow, his colic subsided, his reflux improved, and I felt capable of sustaining him with my own milk.

Our nursing journey concluded 15 months after he was born, slowly and on both our terms, when he was ready to move on to bigger and better toddler things. The experience of nursing my child has been one of the greatest treasures I’ve ever had and I’m so thankful we were able to continue for as long as worked for both of us.

My experience with tongue tie has also been invaluable for my clinical practice as I have really been able to incorporate that compassion and first-hand understanding of what it feels like to be a mom with a baby who just can’t eat properly into my therapy. I know better now what is reasonable to ask of new mom’s/parents, I know what consistency and determination can do. I also know that my journey is not everyone’s journey and that finding a way to help moms’ meet their goals for feeding their children must be central to any therapy I do. I love my job, I love working with babies, and I am so privileged to get to walk alongside families on their feeding journeys.

breastfeeding, chestfeeding, reflux, supplementing

Reflux…regurgitation…spit up

Whatever you call it, it’s pretty common for newborns. When our babies spit up often or forcefully it can be worrisome. We wonder if we ate something which is upsetting baby. Are we burping the right way and long enough? Should we change something about how we are feeding baby?

Let’s set the record straight with some facts about infant reflux:

Reflux is common and not a problem for most newborns.

  • About half of babies aged 2 weeks to 4 months have reflux (which just means they spit up once or more times per day). 
  • Most babies outgrow reflux by 6 months. 
  • Reflux is more common if your baby was born prematurely, has Down syndrome, or other conditions which affect neuromuscular function.
  • Symptoms peak at 4 months and gradually get better.
  • Very few infants have GERD (uncomfortable or painful reflux with additional symptoms like weight gain difficulty, crying, etc)
Newborn looking into the camera, blowing bubbles with their tongue sticking out.

Okay, so what causes it?

Overfeeding is one of the most common causes. Many parents are told to feed their babies every 3 hours which is less often than what most babies would like. Spacing out feeds means that baby may be taking larger volumes than their stomach can comfortably hold.

Laying baby down after a feed puts pressure on the stomach. Because the sphincter (a ring of muscle at the top of the stomach) is immature laying baby down after feeding or putting pressure on their belly can cause spit up.

Diet While most babies are not sensitive to anything in the parent’s milk, they can have spit up more frequently with formula feeding. Using the right formula which baby can digest more easily helps reduce the frequency of reflux.

Crying We all know that babies cry and sometimes it’s unavoidable like when you are driving and can’t comfort baby. And sometimes you can comfort baby but it seems like nothing is working…it happens to us all. Excessive crying can make reflux worse so talk with your provider to get to cause of baby’s discomfort.

Sometimes parents think baby is crying because of the spit up but it’s usually the other way around. Unlike adults, baby has a very acid in their stomach so it doesn’t burn or hurt when they spit up most of the time.

It’s developmentally normal. Spitting up that doesn’t bother baby or cause any problems with growth and development isn’t something to worry about medically.

What can we do to reduce it?

•Get a great latch! Have your baby’s latch and suck assessed by an experienced Lactation Consultant.

•Keep baby upright without abdominal pressure for 30 minutes after feeds. Babywearing works great!

•If you need to lay baby down and you can keep an eye on them try laying them on their left side. If you are doing tummy time, use a prop like a nursing pillow under their chest to keep pressure off the belly

Frequent burping, after each breast

•Frequent, unscheduled feeds.  Responsive feeding

•If using formula, use a hydrolyzed whey formula

•If using a bottle, use paced feeding techniques

As always, check in with your Lactation Consultant for tips and tricks! We are here to help!

❤ Megan Dunn, IBCLC

breastfeeding

5 Signs Your Baby May Need Help With Feeding

Baby sleeping on the parent’s chest.
  1. Sleep problems

    Baby sleep is undoubtedly very different from adult sleep. Their sleep patterns involve a lot more light sleep than we see in older children and adults. They have shorter sleep cycles and need a ton more sleep than we do!

    Babies need to nap frequently (about every 45min up to 3hrs) and they should sleep about 90 minutes to 3 hours. After 8 weeks some babies are ready for longer sleep stretches lasting 4-5 hours at night.

    If your baby isn’t napping well or is sleeping much longer stretches it can indicate feeding difficulties.

  2. Lots of spit up

    While spit up under 4 months is pretty common in newborns, it should just be a dribble most of the time. If baby is having big spit ups after most or every feed or they tend to launch it across the room, a visit with your Lactation Consultant should be considered!

  3. Not pooping every day

    After 1 month, baby may poop less frequently but we should still be seeing about 1-4 stools per day.

    I remember being told about my own baby that breastmilk was such good stuff that they absorbed it all and there was no waste. That’s just not how digestion works. There are always products left over and if baby isn’t stooling every day they may not be getting enough milk or they might have a digestion problem which is slowing down the process or even constipating them.

    There’s plenty we can do to get baby pooping regularly! You can try these exercises to help with gassiness and pooping!

  4. You notice they tend to turn their head only one direction

    You might also notice they prefer to breast/chestfeed on one side and not the other. This can be a sign of tight muscles on one side of the body. You can try doing some baby massage or see a provider who does bodywork for infants.

  5. Leaking or dribbling while eating

    If baby is “springing a leak” while eating it lets us know they haven’t formed a good seal on the nipple. This can be due to lip tone or tongue movements. If you are bottlefeeding it could be that we need to try a different bottle or we need to switch to paced bottle feeding.

If you notice any of these signs, it’s time to check in with your Lactation Consultant for an evaluation. We’d be happy to help ❤

Megan Dunn, IBCLC

breastfeeding

Breast Cancer and Breast/chestfeeding

October is famously breast cancer awareness month. We see everything from t-shirts to yogurt donning a pink ribbon to promote the big messages of the month:

-Risk reduction (eg. not using tobacco products)
-Monthly self exam
-Annual checks with your provider

You may already know that breastfeeding reduces your risk of developing breast cancer long term. Did you know it takes about 20 years to see the protective effect?

People who become pregnant also have a lowered risk, long term, of developing breast cancer. Basically, the fewer menstrual cycles you have, the lower your risk of breast cancer. In the short term, however, people who have been pregnant may be at risk for cancer.

Because of that risk, recommendations for screenings including mammograms may change depending on your personal and family history.

While we should all be doing monthly breast self exams, we may also need to check with our providers regarding more frequent medical exams and mammograms.

Screening mammograms are well known to improve survival in breast cancer, and this impact is most significant for women 40 to 50 years old. 

The American College of Radiology (ACR) recommends considering yearly screening during pregnancy and lactation for the following women:

  • under the age of 30 who are at high risk for breast cancer
  • 30-39 who are intermediate to high risk of breast cancer
  • over the age of 40 at average risk for breast cancer

Mammograms are totally safe to do while pregnant and lactating! You should express your milk before the procedure but there’s not need to “pump and dump” after.

As always, check with your provider if you have concerns or notice any changes to your breasts.

❤ Megan Dunn, IBCLC

breastfeeding, milk supply

Why I don’t recommend lactation cookies

Over the last few years it seems like everyone is jumping on the lactation cookie trend. New pre-made products have been popping up online and in stores all with strong claims about how they will help.
I love a cookie as much as any one (warm oatmeal or spicy snickerdoodle…yes, please!) but I don’t recommend them as a Lactation Consultant for milk production.

Image: Betty Crocker

This is for a few reasons. I have noticed that lots of my patients come to me already trying to take herbs and alter their diet to support milk supply. They invest hundreds of dollars sometimes without really knowing the exact cause of their milk supply problems. Often the issue is low milk supply perception without an actual issue but when there is a problem, it needs to be addressed by a medical provider who can investigate the source and give you personalized recommendations.

Different problems need different solutions.

A thorough assessment and history taking can often pinpoint the problem and then we can give you the right “medicine” for what’s really going on. Otherwise, it’s like throwing a dart in the dark. It might hit the target, it might get close, but it’s probably just a random shot.

Milk supply is governed by milk removal. When we take supplements to boost our milk supply there may be some effect but it might also temporarily boost our supply without setting us up for good long term habits. At the beginning, prolactin hormone brings in our supply and transitions milk from colostrum to mature milk. Oxytocin hormone is the main reason that milk sprays and drips out. Over time, our breasts become less sensitive to these hormones and what we need for continued supply is a baby who can breastfeed well!

Which brings us to the next issue. If we take herbs or eat cookies that artificially boost our supply it can mask baby feeding problems. If your baby’s suck is weak or uncoordinated, I want to know that right away and get you on the path to healing! We can work with suck training, a physical therapist, or occupational therapist to make sure your baby is thriving. We don’t want to miss those early signs .

Homemade baked goods are about the most delicious thing I can think of but sometimes the ingredients might actually lower supply. Many recipes call for a fair amount of sugar so if the milk supply problem is created by insulin resistance it won’t be supportive. Some of the other herbal ingredients might also lower supply. Some of the most common herbal ingredients for milk supply are not compatible with the medical conditions which are most likely to impact supply!

And lastly, I think it’s important to consider that we do not need to eat a special or different diet while breastfeeding. Our milk can be plentiful and super healthy following standard recommendations for adults. Our diets may need to be altered for medical reasons and if so, ask your provider to help you come up with a plan. Many of the ingredients in lactation cookies are expensive and hard to find. I’d rather see you snuggled up in bed nibbling on a grocery store oatmeal cookie than driving from store to store for specialty ingredients.

As always, take what works for you and leave the rest behind. Know that this Lactation Consultant won’t judge or tell you what to do. We are here to support you. And if you sister or kind neighbor brings you lactation cookies, feel free to eat them if they work for you and you want to. Just know you don’t *have* to eat them to make lots of milk.

If you are experiencing low milk supply check out our local Lactation Consultants for support and up-to-date information.

<3Megan Dunn, IBCLC

breastfeeding, supplementing

Paced Bottle Feeding

What is Paced Bottle Feeding?
Paced Bottle Feeding is a method of bottle feeding that allows the infant to be more in control of the pace of the feeding. This method slows down the flow of milk, allowing the baby to eat more slowly and take breaks. Paced feeding reduces the risk of overfeeding that may result in discomfort to the baby. This feeding method is recommended for any baby that receives bottles.

Many parents are worried about baby swallowing air or getting gassy with bottle feeding. The old-school way of bottle feeding often increases gas and air swallowing because the flow is simply too fast! Baby doesn’t have time to follow their suck-swallow-breath pattern and ends up accidentally swallowing air.

Just like you and I take breaks when we are drinking, baby needs them, too. Using a slower paced feeding method also teaches parents to recognize baby’s communication cues. Overall, the feeding is a lot more pleasant for everyone!

Caretakers and grandparents may need a refresher on how to give bottles in a way that respects baby’s needs. There are lots of videos on YouTube, Vimeo, etc which show how to do paced feeding. They all vary a little but this is how I teach it:

Paced Bottle Feeding Steps:
1. Choose a small, 4 oz. bottle and a slow flow nipple. Pick something baby can latch onto deeply, with fully flanged out lips.
2. Hold baby in your lap in a semi-upright position, supporting the head and neck.
3. When baby shows hunger cues, touch the nipple to baby’s lip so he opens his mouth wide.
4. Insert nipple into baby’s mouth, making sure the baby has a deep latch with the lips turned outward.
5. Hold the bottle flat (horizontal to the floor).
6. Let the baby begin sucking on the nipple with the bottle angled just enough to fill the nipple about halfway with milk.
7. Watch baby during the feeding: cues that baby may need a break can include leaking milk, hands held with the fingers wide apart, a creased brow, wide open eyes that look startled, gulping, or clicking noises
8. Every 2 minutes or if you notice any stress cues, tip the bottle down and remove it from baby’s mouth keeping the nipple just touching baby’s lips.
9. After a few seconds baby will try to latch back onto the nipple.
10. Continue this Paced Feeding until baby shows fullness signs – no longer sucking after the break, turning away or pushing away from the nipple.

After several days of Paced Feeding, babies often start to learn to pace on their own. You will notice them taking their own breaks, and then returning to feeding. Positioning the baby upright and holding the bottle in a flat position helps babies be in control of their own feeding.

Part 2 here!

Megan Dunn, IBCLC

breastfeeding

Does my baby need water on hot days?

No!

Baby does need to breastfeed often and keep cool in a shady place though. Baby may want to breastfeed more often during very hot weather. Offer unrestricted access to the breast to keep baby hydrated.

Your milk will adjust and increase water volume to keep baby well hydrated if you feed as often as baby wants.

Signs of dehydration to watch out for:

  • Urinates less frequently (for infants, fewer than six wet diapers per day)
  • Parched, dry mouth.
  • Fewer tears when crying.
  • Sunken soft spot of the head in an infant or toddler.

If baby exhibits any of these symptoms contact their doctor or visit the hospital right away.

The American Academy of Pediatrics (AAP) recommend keeping newborns and infants younger than 6 months out of direct sunlight. The best protection from the sun for these infants is to stay in the shade. Look for shade under a tree or bring an umbrella or sun-blocking tent for outdoor play.
In most cases, infant’s skin is too sensitive for sunblock so your best bet is to stay indoors or keep baby completely shaded.

breastfeeding, milk supply

Top 3 Things To Do for Breastfeeding Success

  1. Start hand expression at 36 weeks if you are not at risk for preterm delivery

This builds up hormone receptors which help you to make the most milk!  It also gets you familiar with the technique which is super helpful to do at least 5 times a day after birth (for the first 2 weeks).  If you hand express into a clean container you can store the colostrum (early milk) in the freezer and bring it with you in case your baby needs a supplement after birth.

2. Golden Hour

Hold your baby skin-to-skin after delivery until baby has had their first meal.
It takes time to adjust to the outside world!  It’s so bright and loud and cold!  Let baby find their way to the breast and attach on their own –they can do it if we give them time.
Our bodies are also primed from labor to transfer the most colostrum in the first few hours, so make the most of it!

3. Have a Nursing Marathon for 3 days after birth

Feed often (at least 10 times per 24 hours) especially when baby is awake and calm, hold baby skin-to-skin as much as you can, and do hand expression at least 5 times per day after feeds.  This tells your body to make lots of milk and helps prevents swelling (which is also called engorgement).
Keeping baby close by will help everyone rest and recover. Snuggling baby often also reduces crying!

Megan Dunn, IBCLC