Breastfeeding always hurt for first- time breastfeeder, Tina. She was given a nipple shield to help with the pain. And it did help. Even so, she knew a nipple shield was not a long-term solution. She kept trying to get rid of the shield. She hated the thing! But every time baby latched without it it, it resulted in intense nipple pain and wounds—her nipple was painfully creased after feedings as well. So, understandably, she continued to nurse with the shield.
Meanwhile, baby Carolyn wasn’t gaining weight well. At every appointment she was gaining about ½ of expected weight gain. Baby was breastfeeding frequently—over 10x/day and still not gaining appropriately. She was having infrequent bowel movements, was gassy, and uncomfortable. Tina felt that something was very wrong. Continue reading →
Your baby has had a frenotomy/frenectomy (frenectomy is the term for laser frenulum release and frenotomy for scissors) and the last thing you want is for it to heal incorrectly–possibly requiring a second procedure. You probably got a handout with instructions for aftercare. It sounded simple when your IBCLC was discussing it with you. But now that you’re home with baby, it all seems so confusing. What are all these “stretches” and “exercises” people are talking about?
Your provider might call them “stretches,” or “sweeps” or “exercises”. Whatever they are called, there is one purpose–to ensure that the frenotomy site heals as open as possible; which, in turn, will give baby more mobility (movement) of his tongue. We want that beautiful diamond that was created with the frenotomy or frenectomy to stay a beautiful diamond. Just like the one below.
This photo was taken just a few days after a laser frenectomy. The color of the diamond is normal. It will be white or yellowish for a few days before it fades to pink.
Doing effective aftercare means you have to get your fingers in your baby’s mouth. You’re not used to it. It feels strange. And baby likely won’t be thrilled about it either. Keep in mind, however, that there are probably a lot of things that your baby objects to, but you do it anyway, right? You change her diapers, bathe her and put clothes on her–all with some degree of protest from baby.
A few pointers to make this easier for both you and baby. Ask permission–verbally or by gently tapping on mouth with your fingers. Be matter-of-fact about the process and let baby know what you’re doing. Keep it short. Lastly, no need to be rough–you can be gentle and still be effective.
Here’s a short video of a tongue tied baby who is graciously helping to demonstrate aftercare. Most babies–including this one–really dislike anything under the tongue. She lets us know that she is not happy about the “forklift” maneuver, but she is not in any pain. Note: This is before the frenectomy so the frenulum is still present.
The photo below shows the forklift maneuver from the perspective of the parent. Note that the IBCLC in the picture is approaching from the top of the baby’s head. This is the most effective way to get complete separation of tongue and the floor of the mouth. The middle fingers are holding the chin to get separation–not merely a lift of the tongue. If you only lift the tongue, the jaw will follow and separation will not occur.
Gloves are not required if you are the baby’s parent! But some parents do use gloves to do the aftercare because of concerns about fingernails. It’s up to you. Do whatever works for you to ensure that these “exercises” happen at least 6 times per day.
Finally, whether laser or scissors, please schedule a follow up with your IBCLC and your frenotomy/frenectomy provider about 5-7 days post procedure. You and your baby will benefit most from the procedure with timely follow up.
This post was co-written by Renee Beebe and sister IBCLC Jessica Altemara. Thank you Jessica for your inspiration and professionalism!
Some lactation professionals have been trying to address a lack of understanding regarding tongue ties and lip ties for many years. They wanted it better known that tethered oral tissue (term used to refer to all types of “ties”) can negatively impact breastfeeding. But now, with the advent of instant-access social media, we are seeing a trend that is a bit disturbing to these same advocates. We see mothers diagnosing their babies’ tongue ties based on images they see on a Facebook group. We see professionals saying to mothers: “That baby needs a frenotomy,” based on a picture posted to Facebook. Continue reading →
When a mom is experiencing difficulty making enough milk for her baby, the usual suggestion from well meaning professionals is often, “Nurse your baby more —your body will rally and you will make more milk in just a few days.” This suggestion is based on the law of supply and demand. When more milk is removed from the breast, the breast will respond by making more milk. While this advice can be legitimate in some situations, many times it can result in an exhausted baby who, despite mom’s best efforts, can’t get enough milk to gain well. Continue reading →
This story was sent to me by an incredibly determined mom. Thank you, Erin B. for sharing with the world!
My daughter had been nursing exclusively until she was 4 months old. She was always colicky, hard to nurse, and would arch her back and scream during feedings. My nipples were constantly sore. She was diagnosed with acid reflux and put on medication, but it never really helped. We had to start her on solids early at 4 months because she always seemed hungry. Then, at 5 months, she flat out refused to nurse. This time, I knew it was more than just “reflux,” and decided to go digging.
I searched high and low and came across some information regarding tongue ties and lip ties. I immediately made an appointment with our pediatrician to have our daughter checked. He told us that she did not have a tongue tie, and that her lip tie shouldn’t affect feeding, but I had a gut feeling about it and talked to other moms and eventually found Renee–an experienced lactation consultant. (IBCLC)
Even though Renee practiced in another city, an hour away, I made an appointment and went to see her as she has experience in identifying ankyloglossia (tongue tie). It was a wonderful experience. Finally someone listened to me! She was able to identify my daughter’s lip and tongue ties, and help me figure out how to nurse her comfortably, without pain, while waiting to have her ties revised. Renee also contacted my OB and our daughter’s pediatrician to fill them in, and helped us find a wonderful body worker (Michael Hahn) to take our daughter to after her revisions. (Note: Body work is often needed after the ties are revised to resolve any residual tightness in the jaw and other areas.)
We had both the tongue and lip ties clipped. We saw an immediate difference. A few days after the procedure we took our baby for a session of body work with Michael which helped our baby even more. I can’t even begin to describe the difference in my baby since her ties were released, but the short of it is that she is a much more settled, content, happy baby who is gaining weight and growing much more efficiently. For the first time, I have seen her content to nurse and know what “milk drunk” looks like. Her reflux and spitting up have also vanished.
I am forever grateful to have found someone to listen to me and help me figure out how to continue to breastfeed my sweet girl. I will not hesitate to seek help again with any breastfeeding issues, and when we have our next baby, I am absolutely hiring Renee to come to the hospital!
Note from Renee: I refer most of my local clients to Dr. Chenelle Roberts for tongue and/or lip tie releases. If you’re not local to Seattle, that’s ok! I can help you identify tongue tie with a virtual consultation and can locate a provider local to you for the release.