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