Recently a client sent me a nice note with a generous check. She had been feeling gratitude for the help she received to breastfeed her son. There were multiple lactation consultations in her home, a frenotomy (the procedure to release a tongue tie) and body work for baby. There were many up-front costs–some of which were not covered by insurance. Here’s what she wrote: Continue reading
You may be wondering… why is a lactation consultant writing about formula? Because in my world of breastfeeding difficulties including chronic low milk supply, mothers often find they need to supplement breastfeeding with another source of nutrition. Sometimes that’s donor milk from another mother, sometimes banked human milk. But most often it is commercially available formula.
All formulas are not created equal. There are pros and cons to various brands. There are milk-based formulas, soy formulas, organic, non-organic and special formulas. But the most important distinction in my mind is liquid vs powder. Why is this so important?
It turns out that powdered infant formula (PIF) is not sterile. The manufacturing process does not allow for elimination of all germs. In addition, preparation of the product in the home can lead to further contamination. The most concerning bacteria found in PIF is called Cronobacter bacteria.
Cronobacter bacteria is an organism that thrives in dry conditions and it’s very prevalent. The bacteria is found in dry herbs and spices, herbal teas, dry milk manufacturing facilities and household vacuum cleaners. It has also been found in waste water. It can thrive on plastics, rubber and silicone bottle nipples. Clearly it is difficult to avoid this little beast.
Becoming sick from Cronobacter is a rare event, but it can be deadly in young infants. Premature babies and infants younger than 2 months are most vulnerable to Cronobacter illness. Cronobacter illness can lead to blood infections or meningitis. According to The Center for Disease Control (CDC) there are about 4-6 reported cases of Cronobacter illness in infants per year, but it may be under-reported. Recently more awareness has led to higher reported numbers. There were 13 known cases in 2011.
Breastfeeding is the best protection against Cronobacter infection. If possible, provide your baby with breast milk—especially for the first 2 months. “Almost no cases of Cronobacter infection have been reported among infants who were being exclusively breastfed.” (Center for Disease Control and Prevention website).
If your baby uses formula, choose formula that is sold as a liquid. Liquid formula is sterile so is less likely to transmit the bacteria. This is especially important for very young or premature babies.
If you choose to use powdered formula, please do so safely with good hygiene in mind.
- Always wash your hands prior to preparing formula.
- Use clean tongs to fish the scoop out of the container. Wash the scoop after every use.
- Clean bottles in hot dishwasher or hot soapy water plus sterilization.
- Use only clean work surfaces when preparing the bottles.
- Use hot water to prepare the powdered formula—at least 158 degrees F(70 degrees C) This temperature is necessary to kill the bacteria. Cool to room temperature before feeding to baby by placing closed bottle in ice bath.
- If you make the formula ahead of time, refrigerate it immediately and use it within 24 hours.
The Center for Disease Control and Prevention: has more information on this topic. The World Health Organization (WHO) has created a PDF in several different languages that includes guidelines regarding formula and breastfeeding.
The medical term for tongue tie is “ankyloglossia” which literally means “anchored tongue.”
Most health care professionals and many lactation consultants do not know how to evaluate for ankyloglossia.
Obvious does not mean severe. “Obvious” simply means the frenulum is attached near the tip of the tongue making it clearly visible.
An anterior tongue tie refers to attachment near the tip of the tongue. Posterior tongue tie refers to attachment at the base of the tongue.
If the frenulum is attached to the back of the tongue (posterior) it can cause even more restriction than if it’s attached to the front of the tongue (anterior)
There is no such thing as a mild tongue tie. Usually if someone says the tongue tie is mild, that means that the person doing the evaluation isn’t sure if it’s causing a restriction.
Tongue ties affect much more than breastfeeding.
Where the frenulum attaches at the floor of the mouth can have as much or more impact than where it attaches to the tongue.
Sometimes the frenulum can be attached to the back of the lower gum ridge as well as the floor of the mouth.
The frenulum does not stretch.
No one “grows out of” ankyloglossia.
The procedure to revise the frenulum so the tongue can move properly is called a frenotomy. It’s also commonly referred to as a revision. (It may be called different things in different parts of the world.)
The frenotomy can be done in about 2 seconds by clipping the tissue. If laser is used, it’s a little longer. It is never too late for a frenotomy!
The frenulum is NOT part of the tongue—the tongue will not be clipped during a frenotomy.
The frenulum usually has few nerves and blood vessels.
You can’t tell by looking if baby needs frenotomy.
A frenulum can not “grow back” once it’s clipped. It can, however, heal in such a way that it continues to restrict the movement of the tongue. It is important to keep the wound open during the healing process.
The frenotomy is often just the beginning of the path to full tongue function. Body work and time to learn new skills are often necessary.
There are no documented reports of any complications from a frenotomy.
In some parts of the world, ankyloglossia is commonly remedied with a long fingernail!
I am often asked, “How long should I breastfeed my baby?” My standard answer is “As long as both of you desire!” But sometimes parents are looking for more details about what is normal and what is the expected age of weaning. I usually quote from one of the leading experts on this topic, Dr. Katherine Dettwyler. Dr. Dettwyler is an Anthropologist who, among other things, studies breastfeeding from an anthropological perspective. Her research has been a gift to our profession and to mothers and babies all over the world.
Since I am asked this question so frequently, I decided to write a post about the subject. And since I see no need to re-invent the wheel, I asked Dr. Dettwyler for her permission to post this excerpt from her paper, “A Natural Age of Weaning.” Thank you, Dr. Dettwyler, for your gracious permission to reprint a portion of your paper here: Continue reading
Lactation consultants are not only interested in what goes into your baby; we’re also interested in what comes out! We like to see very frequent stooling that is yellowish in color with lots of chunky white curds. That is normal breastfed baby poop. If baby is not pooping frequently, or poop is a different color, that is not normal and we want to know why. Continue reading