Prevention

Pumping:

Lightly lubricate the flange with a moisturizer before pumping, such as coconut oil or breastmilk. Also, make sure you have the correct flange size, with only the nipple being pulled in during the suction and not the areola. Moreover, use a gentle setting that causes no discomfort when pumping, versus a higher suction setting.

Topical Remedy:

Medihoney makes a product that is safe for baby because it is from sterilized, medical grade honey. It cleans a wound, lifts dead tissue, and provides a moist healing environment. Following the protocol on Lactation Hub, first gently cleanse the nipple area with a warm cloth and then apply a small amount of Medihoney to the nipple and areola. Prior to nursing, remove any Medihoney with a warm cloth. Once the ointment is applied, you can place a dressing (such as a nursing pad) to protect the area and decrease chafing. 

Protection

Nipple Coverings:

These helped me the most when I had cracked nipples during pregnancy. Before applying them, you can rub a small amount of nipple moisturizer cream (I like Earth Mamma or Motherlove) or colostrum/breastmilk around the nipple and areola. Next, place the Silverette over the nipple area under your bra. Make sure to remove the Silverettes for a few minutes throughout the day to aerate to prevent any potential bacterial growth.

A word of caution: Lanolin is the most commonly provided nipple protection ointment provided to breastfeeding moms in the hospital, but it contains a common allergen and should be avoided if allergic to wool.

Soaked Cotton:

If you have a milk bleb, lightly soak an organic cotton pad in olive oil and let it rest on your nipple inside your bra. This will help soften the area and will eventually heal as the baby nurses and the extra skin is gently pulled off.

The post Life Saving Sore Nipple Remedies appeared first on Feeling Yum.

Tongue ties occur when the frenulum (the string of tissue attaching your tongue to the floor of your mouth) is too short, thick, or tight, therefore impacting the overall function of the tongue. Impaired tongue function can contribute to difficulties in breastfeeding and bottle feeding in babies. If left untreated, impaired tongue function could also contribute to difficulties with swallowing, speech, and breathing.

What are Lip-Ties and Buccal-Ties? 

A lip-tie or buccal (cheek) tie occurs when the labial or buccal frenula are too short, thick, or tight, or insert low into the gumline, impacting function of the mouth. Impaired lip-tie and buccal-ties can also contribute to difficulties with feeding. If a tongue-tie tie is present, it is increases the likelihood there will be a lip-tie or buccal-tie. 

Tongue-Ties in Babies

Ties are often undiagnosed so it is important to be aware of the signs so you can seek professional advice on how to proceed. Most commonly, ties show signs of dysfunction when the baby is young and having difficulty with breast or bottle feeding. Both mom and baby could show signs of ties, which are outlined below.

Baby Signs:

• Shallow latch
• Clamping or chomping on bottle or breast
• Clicking sounds at bottle or breast
• Decreased milk transfer, or poor weight gain
• Coughing/gulping during feeds
• Frequent feedings or long feedings (> 40 min.)
• Reflux, frequent spit-ups, or GI discomfort
• Sliding or popping off breast
• Fussiness or arching away from breast/nipple
• Gagging
• Baby lip blisters
• Loss of liquid during feeds from baby
• Milk tongue (white coating)

Mom Signs:

• Maternal nipple pain
• Misshapen nipples after nursing
• Recurrent breast engorgement or mastitis 
• Decreased milk supply

Tongue Ties in Infants

A baby may not show signs of ties until they become an infant and start eating solids. This could manifest in what looks like picky eating,  physiological problems or oral motor skill deficiencies. A baby may have also gone undiagnosed with ties and may have a history of breast or bottle feeding difficulties. Below is an outline of signs of ties to look for in infants.

Physiological Signs:

• Poor weight gain
• Constipation
• Gi discomfort 

Picky Eating Signs:

• Food refusal of certain textures
• Disinterest in trying new foods 
• Preference for only dry and crunchy foods 

Oral Motor Signs:

• Frequent coughing or choking 
• Drooling 
• Poor lip closure/anterior food loss
• Mashing foods anteriorly with a munching pattern vs chewing on molar surface 
• Difficulty transitioning to age appropriate food textures 
• Food pocketing 

Tongue-Ties in Older Children

Furthermore, if ties continue to go undiagnosed into toddlerhood, there may be signs of breathing difficulty, swallowing , or dental complications. In addition they could contribute to speech difficulties, which is outlined below.

Speech Signs:

• Poor articulation
• Interferes with speech sounds
• Sibilants and lingual sounds
• Pronouncing certain letters

It’s important to get ties looked at by a specialist so they can help with treatments and referrals. Seek advice on how to move forward before struggling with feeding for too long and the problems get worse for baby and Mom. It is important to keep feeding experiences positive from the very beginning of life to build a good foundation.

The post Does My Child Have a Tongue-Tie? appeared first on Feeling Yum.

Where to Start:

If you have a baby and are experiencing breastfeeding difficulties or pain when nursing, it would be most beneficial to first see a lactation consultant (IBCLC). An IBCLC can work on latch, positioning, stretches, pumping and many other breastfeeding needs. If you have an infant having feeding difficulties with a bottle or starting solids,  schedule an assessment with oral motor specialist, which would be an occupational therapist (OT) or speech therapist (SLP). Oral motor specialists can work on gag reflex, chewing, lip closure, tongue lateralization and many other mouth functions needed for feeding.

Pre and Post Procedural Care:

If one of the above practitioners or yourself suspects a tongue, lip and or buccal-ties, I’d suggest seeing one or more than of the bodywork specialists which could help address the tightness in the body’s mouth. Chiropractors can help with bone and nerve alignment to increase range of motion. Osteopathic doctors can help with tongue-tie through gentle manipulation to help relieve tension in the neck and jaw. In addition, occupational therapist, physical therapists or lactation consultants could be trained in bodywork treatments that could include  Cranialsacral Facial Therapy (CSF), Cranialsacral Therapy (CST) or Myofacial Release can also help with stretching the releasing restrictions in the body. 

If a Frenectomy is Needed:

Once it is identified that a release of the connective frenulum frenectomy could be beneficial, a consultation could be set up with an airway centric dentist or ear nose and throat doctor (ENT).

To Review, the specialists in each area are outlined below. 

Frenectomy:

• Airway centric dentist 
• Ear nose and throat doctor (ENT)

Bodywork:

• Occupational therapist (OT)
• Physical therapist (PT)
• Lactation consultant (IBCLC) 
• Chiropractor (DC)
• Osteopathic doctor (DO)

Oral Motor Therapists:

• Occupational therapist (OT)
• Speech and language specialist (SLP)

Lactation Support:

• International board certified lactation consultant (IBCLC)

The post I Think My Baby Has a Tongue-Tie. Now What? appeared first on Feeling Yum.

Did you know the size of your baby’s stomach will start as small as a cherry and grow as big as a cantaloupe within the first year? When thinking about your baby’s consumption and how often they are feeding, it is helpful to visualize the size of their stomach throughout the feeding journey. When they are newborns, they feed very frequently due to the small stomach size, but by one year, they can consume solid meals and sleep through the night without eating.

1 Day Old:

Your baby’s stomach is the size of a cherry. Your baby will be consuming ½ -1 teaspoon (5-7 ml) per feeding; 8-12 feedings daily.

3 Days Old:

Your baby’s stomach is the size of a walnut. Your baby will be consuming 4 teaspoons (5-7 ml) per feeding; 8-12 feedings daily.

1-3 Weeks Old:

Your baby’s stomach is the size of an apricot. Your baby will be consuming 1.5-3 oz. (45-00 ml) per feeding. Your baby’s milk intake will increase to 9-25 oz. (280-750 ml) a day by the end of the third week; 8-12 feedings daily.

1-3 Months Old:

Your baby’s stomach is the size of a an egg. Your baby will be consuming 3-5 oz  (80-150 ml) per feeding. Your baby’s milk intake will be in the range from 20-35 oz (750 – 1035 ml) per day; 6-8 feedings daily.

3-6 Months Old:

Your baby’s stomach is the size of a an orange. Your baby will be consuming 3-5 oz (80-150 ml) per feeding.  Your baby’s milk intake will be in the range from 24 to 32 fluid oz (710 to 946 ml) per day; 6-8 feedings daily. 

6-11 Months Old:

Your baby’s stomach is the of a grapefruit. Your baby will be consuming 5-8oz. (147-236 ml) Per feeding.  Your baby’s milk intake will be in the range from 20 to 30oz (591 to 887 ml) per da ; 4-8 feedings daily + 1-3 meals of solids.

12 Months +:

Your baby’s stomach is the size of a a cantaloupe. Your baby will be consuming anywhere from none to 14 to 20 fluid ounces (414 to 591 milliliters) feeding; up to 4 times daily + 3 meals and up to 2 snacks daily.

The post The Baby Tummy Size Guide appeared first on Feeling Yum.

I also included what output of diapers to expect so you have a marker on how much the baby is consuming. Your pediatrician will also measure the baby’s weight to make sure the baby is at least their birth weight by two weeks of age (since they typically loose weight the first few days after birth).

1 Day Old:

• Size: Your baby’s stomach is the size of a cherry. 
• Capacity: Your baby will be consuming ½ -1 teaspoon (5-7 ml) per feeding; 8-12 feedings daily.
• Output: Your baby will have 1 urine diaper and 1 stool diaper.

3 Days Old:

• Size: Your baby’s stomach is the size of a walnut.
• Capacity: Your baby will be consuming 4 teaspoons (5-7 ml) per feeding; 8-12 feedings daily.
• Output: Your baby will have 3-4 urine diapers and at least 3 stool diapers. 

One Week Old:

• Size: Your baby’s stomach is the size of an apricot. 
• Capacity: Your baby will be consuming 1.5-2 oz. (45-60 ml) per feeding. Your baby’s milk intake will increase to 9-20 oz. (280-576 ml) a day; 8-12 feedings daily.
• Output: Your baby will have 6+ urine diapers and at least 4 stool diapers 

2-3 Weeks Old:

• Size: Your baby’s stomach is the size of an apricot .
• Capacity: Your baby will be consuming 2-3 oz (60–90 ml) per feeding. Your baby milk intake will increase to 29-25 oz. ( 590-750 ml) per day by the end of the third week; 8-12 feedings daily.
• Output: Your baby will have 6+ urine diapers and at least 4 stool diapers.

One Month Old:

• Size: Your baby’s stomach is the size of a an egg.
• Capacity:  Your baby will be consuming 3-5 oz  (80-150 ml) per feeding. Your baby’s milk intake will be in the range from 20-35 oz (750 – 1035 ml) per day; 6-8 feedings daily.
• Output: Your baby will have 6+ urine diapers and 1 stool every day or 1 every few days.

The post How Much Should My Newborn Be Eating?  appeared first on Feeling Yum.

Lesson 1: Things may not go as planned. I had painted a beautiful picture of how I would experience the “golden hour” of skin-to-skin right after my baby’s birth. However, after some glorious moments of holding my baby girl in my arms after the delivery, I was quickly passing her off to my husband to hold her safely as my midwife focused on controlling my excessive bleeding. It took about an hour until I was able to hold her again. With the help of a labor and delivery nurse, Alana was able to be guided to the breast, latch on, and take her first feed. Alana was not provided the opportunity to find the breast herself, but she was nourished with colostrum as her first feed, which was most important.

Lesson 2: A deep latch is key. When it becomes time for skin-to-skin, the nurse helped me guide Alana to the breast, aligning her nose to my nipple to encourage her to open her mouth wide to get a deep latch. She also helped align her head straight (her neck was not turned, which would make swallowing milk more difficult)

Lesson 3: Help the baby find the breast. To help the baby find the breast, I was provided the tip to express some colostrum with gentle hand massages and squeezes before guiding the baby to the breast.  It also helped to hold the breast “like a sandwich” and hold it to the baby’s mouth until she latched on. 

Lesson 4: Take breaks from breastfeeding. I learned feeding “on demand” does not mean baby should be sucking indefinitely on one or both of the breasts. My nurse explained Alana was losing valuable calories being kept on the breast making non-nutritive sucks, meaning she was not gaining milk when sucking. To remove the baby from the breast, I was taught a to sweep the pinky finger in her mouth like a hook, which helped remove the nipple from her mouth without any pulling. 

Lesson 5:  Your baby won’t follow a strict schedule. Newborns eat 8-12 times a day, which is about every 2-3 hours. Feeds should last about 30 minutes, or 15 minutes per side. However, these feeding timelines are a guide and timing them with a clock or an app just caused added stress. Every mom and baby dyad are unique and feeding times may vary greatly. Babies may be full after a short 5 minute feed or require much longer feeds when they are very sleepy.

I hope these shared lessons can help you avoid some of my first difficult moments with feedings. Please share any tips you learned during you first week of feedings!

The post 5 Key Takeaways From My First Week of Breastfeeding appeared first on Feeling Yum.

What Are Tongue-Ties?

A small percentage of babies have a tongue that is tied so tightly down, they cannot latch or nurse well or may cause pain to their mother when nursing. In addition to tongue-ties, a baby may have a frenulum that ties their top lip close to their gums or buccal ties that tie their cheeks close to their gums. This tightness in the mouth can also potentially negatively impact bottle feeding or eating solids, due to their limited motion in the mouth.

Who Treats Tongue-Ties?

Often a midwife or lactation consultant will identify a tongue-tie when they see a mother having difficulty nursing. Ties can also go unidentified for many months or may not show up until there are issues with feeding when a baby starts solids. A specialized dentist, oral surgeon or ENT (ear nose and throat specialists) can perform the procedures to clip the ties with scissors or a laser. The procedures can range from $200-$1250+.

There are bodywork specialists who can help with the stretching of the mouth to help avoid having a frenectomy or to help co-treat with a procedure for better outcomes. These specialists include chiropractors who specialize in ties or craniosacral facial therapists (who are typically a lactation consultant, occupational therapist, or speech therapist).

The Rise of More Frequently Performed Frenectomy Procedures:

Some versions of clippings have been done for centuries by pediatricians and midwives, which consisted of a quick snip under the tongue to increase movement. These clippings often naturally healed with breastfeeding and there was little follow-up. With an increase in mothers nursing with campaigns such as “Breast is Best,” there has been a recent steep increase in these procedures (up to 800%). The New York Times article cited above, identified three driven forces in healthcare that are harming patients by performing procedures that may be unnecessary:

1. Doctors have financial incentives to perform the procedures. Doctors are not always paid a salary and part of their pay could be tied to the procedures they are performing.
2. There is a push for the medical device companies (such as the laser companies used for frenectomies) that make these procedures possible. The medical device companies often provide loans to help practitioners buy the equipment or lend them the money they need to help set up the clinic to perform the procedures.
3. There is a large information void for medical advice that many doctors take advantage of to perform these procedures.

Benefits and Risks of Frenectomies:

There is limited evidence-based research on the benefits of frenectomies on helping with babies nursing, but some evidence suggests they can help with the pain of the nursing mothers. However, every mother-baby dyad is unique and it is difficult to measure the benefits when there are so many factors involved in feeding. Personally and antidotally, I have seen babies’ latch for nursing and bottle feeding significantly improve after having a procedure. In addition, a mother’s soreness of nipples due to shallow latching could improve or the babies’ ability to explore and chew food could improve.

Risks involved include: babies developing oral aversions, malnourishment, or acquiring of a feeding tube. Some parents have reported the procedure leaving large sores in their baby’s mouth. A practitioner may also not explain pre-procedure or post0procedure stretches well, which could lead to re-attachment of the tissues and the procedure needing to be re-done.

In Conclusion:

If you are having difficulty nursing, schedule an appointment with a lactation specialist (IBCLC), occupational therapist or chiropractor, who could assess your unique situation. The main concern you should be treating is function (if your child is eating well and gaining the appropriate amount of weight). If the child is having difficulty feeding or the mother is in pain from nursing, try to have the practitioner help identify if a tie correction would be helpful.

Once you think you may be interested in a frenectomy, you can schedule a consult with a dentist, oral surgeon or ENT. Keep in mind the incentives the practitioner who performs the procedure may have and schedule a second opinion with a different practitioner if you would like to compare opinions. Knowledge is power, so gather all the information you can to make the best decision possible for you and your child.

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