“One tip we want expecting parents to know and how Little Nursing Company can help!”

TIP 1: Don’t expect breastfeeding to come easily or “naturally”!

No matter what you see from social media, movies, moms at the mall, your friends and family- breastfeeding is generally a learned skill.  It takes practice and usually requires assistance. Put money aside prenatally to hire a private International Board-Certified Lactation Consultant (an IBCLC has the highest level of knowledge with breastfeeding issues). Or ask for gift cards to a private IBCLC from grandparents, family or friends.

If you do not have the resources, there is free breastfeeding help. Edmonton has a few publicly funded breastfeeding clinics plus the La Leche League.  Most likely you will need your family doctor to refer you for a free breastfeeding clinic, and unfortunately the wait time can be weeks to months.  In our experience, breastfeeding concerns need immediate attention.  When you do go to your appointment, you need to pack up and drive, haul the carseat and sometimes wait in a waiting room. Based on the allotted time for the appointment, you may or may not get to show the Lactation consultant or Doctor a full feed, especially if you had to feed while waiting.  The space is not what you are used to. A different chair, maybe no breastfeeding pillow, distractions for your baby. Your setup and environment play a big part in your and your baby’s comfort.

With Little Nursing Company, we come to you. In any room that you are comfortable feeding in. Sometimes we are in bed with you, sometimes we are in the living room and sometimes in the nursery. We go where you are comfortable.  We watch an entire feed and suggest different positions or latch techniques. We do a pre/post feed weight to see what the baby transferred from you (so many minds find confidence in numbers!).  We have specific training in oral restrictions/tongue/lip ties and do assessments on all babies. If we do see something concerning we refer you to other professionals for proper care and revision. Being in the home we get to see where the baby sleeps (we’ll discuss safe sleep) and we see breast pump parts (which leads to discussing pumping) and we get to talk about it all without the rush!! Any questions you have! You can easily book on our website and we can guarantee you will see us within 24-48 hours of booking. If you have insurance through Sun Life and Blue Cross you can submit our receipts for reimbursement. When you book a package with us we keep in touch with you through text, which most moms find the most helpful! Check out our Google Reviews

We look forward to meeting you and easing your transition into breastfeeding

Can my stress affect lactation?

Simply said, stress and breastfeeding don’t mix well.

When you are scared, stressed or anxious, the adrenaline release by your system can inhibit oxytocin. And since oxytocin is what causes your milk to “let down” that adrenaline messes with your milk flowing freely from your breasts. 

“Let down” or the “Milk Ejection Reflex” (MER), is governed mostly by the hormone oxytocin.  When the mothers nipple is stimulated, smooth muscles surrounding the alveoli contract and milk is then ejected. Moms usually have more than one MER in a feeding.  Some moms are aware of their MER, some are not.  Most moms seem to be aware of a MER when their breasts are fuller.  

In the infant, you’ll notice a change in rate of suckling.  Going from more frequent little sucks to a pattern of longer, slower, more rhythmic sucks followed by swallowing. In the mother, sometimes she’ll experience breast tingling or a “pins and needles” sensation, dripping from the other breast, sense of calm and tranquility, relaxation, drowsiness and thirst!! (always have a big glass of water near you before you sit down to feed!)

So now what? 

Most new, dare I say ALL mothers have some stress…

Here are some ways to increase MER

• Drink warm liquids- tea, coffee, hot toddy..(just kidding)

• Use warm moist heat directly on the breasts- warm washcloth, warm packs (2 to 3 minutes) have a shower/bath

• Warm the flange of the breast pump before applying 

• Before your baby is ready for a feed, get yourself comfortable.  Find your most relaxing place in the house- warm up the room,  dim the lights, light candles,  find your favourite essential oil, your favourite music, look at pictures of relaxing memories or visualize a relaxing place that you visited, meditate.  Have your partner bring you the baby before he/she is starving and screaming!

• Do lots of skin to skin with baby before feeding

• Use the fingertips to massage the breasts toward the nipple to raise oxytocin levels

• There is such a thing as exogenous oxytocin nasal spray out there in the world.  I have never seen it and I'm pretty sure we can’t get it in Canada.  But if you dig deep enough you could probably find it.

• Laugh! Find something that makes you laugh- a movie, something on your phone, a picture, maybe you have a funny husband! Laughter does so much good for our tension!

#1 Most Important thing to do: PROTECT YOUR MILK SUPPLY

Empty those breasts! 8 to 12 times in 24 hours (depending on your baby’s age). Full breasts don’t make milk. Your milk supply is driven by supply and demand. 

Check out this video:

How To Increase Milk Supply - Relaxing Breastfeeding Meditation

Resource

Marie Biancuzzo. Breastfeeding the Newborn Clinical Strategies for Nurses. Second Edition. 2001

Is My Baby Getting Enough Breast Milk?!

There are so many amazing things about a woman's body. Mainly the intense, miraculous, overwhelming, amazing world of reproduction. We get pregnant, we anticipate for 9(+) months, we manage to gently ease these little angels into the world (eye-roll, maniacal laughter, sarcastic snort here- your choice) and then the “dot, dot, dot”. 

The story of how we got from there to here is as individual as snowflakes but I’m pretty sure I can say all of us, not long after having those little bundles of joy, start the never ending question period that is, AM I DOING THIS RIGHT??? 

We read books, look up websites, we talk to our mothers, sisters, (dare to even ask the mother in law?!) we cry with friends and snap at our partners and we stress! We didn't have a lot of control during that incubation time but now we are in the driver's seat and it is scary! But we do it, one day at a time, one NIGHT at a time, one feed at a time. And with those feeds, while we sit and “relax” we think, how, on Earth, do I know if this little lovey is getting what he/she needs from me? IS MY BABY GETTING ENOUGH MILK? Well mama, let us tell you a few signs to watch for to ease your mind and help those shoulders come down a notch.

The 3 main areas to pay attention to are weight gain, feeding technique and behaviour, and output/diapers.

During a postpartum visit with your doctor or midwife, they will weigh your baby and compare it to the birth weight. Now there is a bit of number play here but the general idea is that your baby will lose a bit of weight (5-7-10% depending on who you talk to) in the first 4 days after birth. By day 5, your baby should be gaining weight (20-35 grams/day) instead of losing and have regained that lost weight by 10 days to 2 weeks of age.  After 2 weeks, your baby will gain 120-240grams/week. 

Personal story, my third and heaviest baby did not regain her birth weight back by two weeks and I felt like a failure. It was my job to do this “one” main thing. So I started drinking the suggested teas and took a shot of something that tasted terrible every day (don't ask what, I have no clue what it was now) and I pumped and bottle fed just so I could see how much she was getting then I supplemented with formula (I just had to know she was getting enough!) and fed any time I thought she might be hungry and I stressed. This was my third, I should know what to do, right?! Then her chiropractor asked me how I was during a visit, as I complained about my tea, and she said, “Do you think there is a problem?” and I frustratingly replied “No! She looks fine and acts fine and I'm spraying her in the face for goodness sake!” She said, “Stop with the tea, you are doing a great job.”. For whatever reason I needed permission to listen to my gut and from then on her weight wasn't a problem. Which brings me to feeding.

Once you have established a good latch, there are a few things to look for that show your baby is getting enough milk. At the start of the feed your baby's eyes should be open and  baby alert. During the suck their mouth should be wide and have slower periods with intermittent  pauses while the milk is going in. The longer the pause, the more milk is going in, so fast “open, close” sucks are taking in less milk. It is drinking vs sucking (or sipping!). Imagine chugging through a straw and what happens in your mouth. That’s a bit difficult to put into words but there are great videos on youtube. Here’s one of them:  Good Drinking At Breast

During the first 2-3 days pauses are difficult to detect as they are quite short due to colostrum having less volume than milk. Feeding times should be approximately less than 30 minutes (can vary) and end with softer breasts and a content baby. Baby may be gently falling asleep and have limp hands or an unworried expression, this is that “milk drunk” state we all love and miss!   MINIMUM breastfeeds are 8x in 24 hours but in the first few weeks it is more like 10-12x/24hrs.  Don’t forget those very important night time feeds-at least 2-3x.  Babies have tiny tummies that hold a small volume and breastmilk is easily digested - which is why they feed ALOT! And that is normal.   

If what goes up must come down, we know what goes in must come out! Since we can't visualize the precise volume the baby is taking in, we monitor their diapers. After the meconium (sticky tarry first poops) have cleared the baby's system, usually around day 3-4,  the colour and consistency changes to a seedy yellow/brown stool. See below. To tell if the amount in each stool is adequate we use the “O-K” method, as in make the O-K 👌🏼👌🏾👌🏿 sign with your hand and the amount in the “O” (forefinger to thumb) is considered one good poop! This amount is what you watch for during the first month. Now it's difficult to monitor wet diapers amongst all of this colourful solid waste but ample stools generally translate to ample milk and also wet diapers, see below. Very concentrated urine during the first few days of life can contain urate crystals (uric acid crystals). These urate crystals can cause a pink, red, or orange-colored, powdery stain in your baby's diaper called brick dust. Tell your care provider as this is a sign of not enough milk and find someone to help you with breastfeeding/formula feeding, like an IBCLC! 

Day 1- 1 Wet/ At least 1-2 black or dark green poops

Day 2- 2 Wets/ 1-2 black or dark green poops

Day 3- 3 Wets/ 2-3 brown, green or yellow poops

Day 4- 4 Wets/2-3 brown, green or yellow poops

Day 5-7- At least 5 wets/ 2-3 soft and seedy, yellow poops

2 weeks on- 6 wets/2-3 soft, seedy, yellow poops

Breastfeeding My Baby Guide is a helpful guide of “How do I know if my baby is getting enough breast milk?”

The first 24 hrs are different for all babies. Give yourself time to snuggle and celebrate and rest. Have a water bottle handy because you will be thirsty with all of this milk making! 

TIP: From day 1- Keep a very simple log: one column for pees, one column for poops, checks when you change!” If you have more questions or comments, let us know!

Get some extra “milk drunk” cuddles in for us! 

Here is a list of some of our favourite links:

Is Baby Getting Enough Milk? • KellyMom.com

Attaching Your Baby at the Breast

Resources

La Leche League International. The Womanly Art of Breastfeeding 8th Edition. 2010

Dr Jack Newman & Teresa Pitman. Dr. Jack Newmans Guide to Breastfeeding Revised Edition. 2014.

British Columbia Ministry of Health. Breastfeeding my Baby.

Introduction to solids: What the heck should can I feed my baby?

Helping mamas thrive in motherhood is my passion and because I have a background in nutrition, health & wellness, mamas will often ask about the introduction of solids for their babies. I’ve decided to address this question in a brief blog post for mamas.  My hope in doing so is that mamas will gain some knowledge and can feel empowered and ultimately thrive in motherhood while raising their little ones. Introducing solids can be stressful and as such, I hope this will help mamas by giving them some insight on a very important topic that is often not spoken about in their well visits with their family physician or paediatrician which is gastrointestinal (gut) health.

Most mamas are advised after 6 months that their breastmilk (if choosing to breastfeed) cannot provide the appropriate amount of iron needed for the development of their babe. While this is absolutely true, mamas are often told the best way to optimize this critical mineral for brain development is through iron fortified cereal. There are a few issues with this suggestion and I will go through them briefly.

Whenever we want to obtain nutrients from our diet for our body to absorb, we must not only consider the quantity of the nutrient in our diet but also the quality of the nutrient within the foods we choose to give our babies and whether the body can absorb these nutrients efficiently. Unfortunately, iron fortified cereals often contain heavy metals such as arsenic and lead in exceeding amounts which are both neurotoxins and affect brain development. A national study in 2017,  found 95% of baby foods that were tested contained toxic chemicals that lower babies’ IQ. The easiest and simplest way to reduce the impact of chemical and neurotoxin exposure to our young babies is to provide them with unprocessed, organic wholesome food.

What does unprocessed, organic wholesome food really mean?

For babies starting solid foods, this means choosing (to the best of your ability) organic foods as these foods will have significantly less chemicals and toxins as they are not sprayed with pesticides, herbicides or other chemicals such as the well known glyphosate (roundup). This is crucial in the first few years of life because heavy toxic exposure on the developing body systems and organs can impact the overall health and wellness as they grow. 

Wholesome foods, for me, refers to the most natural and unrefined state. When introducing foods to your little, think about how much processing has occurred before it hits your baby’s mouth. The processing of food not only removes important nutrients but it usually adds preservatives, sugar, unhealthy fats and other potential chemicals that are not important or healthy for a developing baby. In a time where each bite counts in optimizing their nutritional intake, choosing unrefined whole food increases their nutritional demand for certain nutrients. 

So what about gut health and introduction to solid food?

Heavy toxic exposure through processed foods not only impacts brain development but also impacts our guts. Babies are naturally born with “open guts” which allows antibodies from mom’s milk to pass through the gut lining and reach the baby’s bloodstream. This is a good thing as this is one of the ways that breastmilk provides babies with immune support and protection; however, we want to reduce the amount of other potential proteins that can slip through their “open guts” and create an unwanted inflammatory or immune response. This can create food allergies.  Often, moms will see skin reactions which can be an indicator of a food allergy as the body will create a response to the allergen and it will present on the skin. 

Our skin health can be a good indicator of the integrity of our gut lining as our skin is the largest organ of elimination and detoxification. Our body will push out toxins through the skin and this can be evident in children with food allergies and skin irritations as the body has mounted an immune response to that type of food protein that the body has determined to be a threat as it slipped through the intestinal wall. While this maturing of the gut lining starts to happen after 6 months; being careful with the introduction of solids can reduce the risk of immune responses to certain food proteins.

Additionally, the research has now proven that our gut health plays a significant role on our overall health and wellness but it has now been determined that our gut microbiome is set within the first 2-3 years of life. 

What does this really mean for babies? 

I like to explain this like an ecosystem. We are all born with certain bugs within our guts, our lungs, our skin, etc. and this is determined  how we are birthed into the world (vaginal vs c-section and mother’s flora). An ecosystem that has varying species thrives compared to an ecosystem with very little species. We are made up of way more viruses, bacteria, fungi and protozoa than human cells and just like an ecosystem, diversity is key in flourishing. Our ecosystem can have different “bugs” as we age but they will be transient (meaning they will not colonize and stay in our gut). The exception to this is in the beginning years of development where we can influence “the ecosystem”, or our gut microbiome by introducing as many species as we can to set in a powerful and diversified gut. This is crucial for our babies as we can literally set the stage for their health by influencing their gut and creating a broad spectrum of gut bugs to help them thrive in life. Once that window closes, we cannot change the terrain. 

Science has found a link between the gut bacteria in little ones and the prevalence in health conditions such as asthma, eczema, allergies, ear aches, colds, inflammatory bowel disease to name a few. In my opinion, this is fascinating and although the research in nutrition and the gut microbiome is only scratching the surface, it makes sense to include foods high in probiotics, prebiotics (feed the gut bugs) and foods that nourish the gut lining along with adequate iron, protein and healthy fats as first foods for babies. 

So what is an alternative to iron fortified cereal as a first food for baby?

Instead of iron fortified cereal which only has a 4% absorption rate for iron, moms can choose animal protein foods such as liver. The iron in liver will be much better absorbed since baby’s readily make the enzyme necessary to digest protein and fat once introduction to solids begin compared to the starch enzyme, amylase which is not readily available for babies to fully digest starch until later on (closer to 8-12 months or when the first molars come in which is much later). 

Bone broth is another gold star for baby’s first foods. It provides an abundance of nutritional support; however, one main important role is its ability to nourish the gut lining. Without a doubt, I’d encourage moms to introduce fermented foods such a raw unpasteurized sauerkraut to their babies early on. Moms can slowly introduce by giving a tiny amount of the juice from the sauerkraut and the continue with whole sauerkraut. A little amount goes a long way in helping establish a wide range of gut bugs. 

Cod liver oil is also a superfood for babies as it provides healthy DHA for brain health and  nervous system support. It  also provides anti-inflammatory support for the gut lining  and helps colonizes probiotics in the gut. Always ensure it is a high quality supplement when purchasing by looking at the ingredients, the purity and testing of the product. Cod liver oil also naturally provides vitamin A and D. 

Some tips when introducing solid foods the wholesome way:

• Freeze raw liver in small batches, grate frozen liver and add to other animal protein while cooking. Adding breastmilk or bone broth after cooking for desired consistency can help.

• Put homemade bone broth in a cup or sippy cup at meal time instead of water all the time.

• When giving vegetables, ensure they are steamed well and add healthy fats such as butter, ghee, coconut oil or other animal fat to help with absorption and fat intake.

For any moms reading this, my intention is not to place any sort of guilt if this is not the way you have introduced solids to your little ones. What we do not know, we cannot possibly understand and we make choices based on the information we have at hand. When we know better, we do better as cliche as it may sound. So, mama the best thing you can do for your little one is NOT TO STRESS about the introduction of solids as stress greatly impacts our gut health and as I mentioned above, my passion is in helping mama’s thrive in motherhood. Trust your gut and if you have any reservations, questions or doubt, do not hesitate to reach out to your healthcare professional.

Wishing you an abundance of love, peace, health and happiness as you journey through motherhood and get into the messy food stage!

Xo

Karla, BScN, C.H.N.C

Website: https://www.nourishingyoukindly.com/

Instagram: @karla_nourishing_you_kindly

***Karla is a certified holistic nutritional consultant and Registered Nurse with additional training in maternal mental health and owner of Nourishing You Kindly (NYK). NYK is not providing information as a medical doctor, naturopath, psychologist, herbalist or dietitian. The information provided is for educational purposes only with the intent to encourage, empower and teach you how to nourish your little one.***

References

Anderson, S. C., Cryan, J. F., Dinan, T., (2017). The Psychobiotic Revolution. Washington, DC: National Geographic Partners.

Erlich, K. Genzlinger, K. (2018). Super Nutrition for babies: The best to nourish your baby from brith to 24 months. Beverly, MA: Quatro Publishing Group USA Inc.

Houlihan, J. Brody, C. (October 2019) What’s in my baby’s food? Retrieved from: https://www.healthybabyfood.org/sites/healthybabyfoods.org/files/2019-10/BabyFoodReport_FULLREPORT_ENGLISH_R5b.pdf

Walker, A., (May 2019). Microbiome: The first 1000 days. Retrieved from 

https://www.health.harvard.edu/blog/microbiome-the-first-1000-days-2019051516627?fbclid=IwAR1zfR9Gfg34wrrbkX9qsRKZiYtwV3XiiofuZVBka4sQEZ1iYWuNu_ysP4o

a definition of colic is: 

• Crying for more than 3 hours a day

• More than 3 days a week

• Over 3 weeks straight

Colic affects approximately 10 to 40% of infants.  It is associated with high pitched, inconsolable crying, especially in the evening. Colic makes feeding and sleeping VERY challenging, if not impossible.  Colic typically begins in the first few weeks of life and usually resolves by three to six months of age.

Some possible causes of colic include: 

• Stress including prenatal stressors 

• Underfed/overfed

• Overstimulated/overtired

• Altered gut flora leading to cramping and bloating 

• Trapped gas 

Improving feeding techniques can help improve the infant’s comfort and decrease crying. 

A few strategies to try with colic:

• Frequent burping during a feed

• “Paced bottle” feeding

• Remain in an upright position for 20 to 30 minutes following feeds

• Feeding on demand

• Feeding with early cues such as, mouth opening, stirring, turning head/stirring

• Improving latch at the breast

• Ensuring bottles and equipment are sterilized 

To help soothe a crying baby 

• Warm baths

• “Tiger in a tree” positioning (holding baby facing outwards, with your hand on their tummy for pressure)

• Massage

• Frequent, small feeds instead of large feeds infrequently

• Loosen clothing around abdomen

• Burping frequently during breastfeeds (every few minutes with a fast let-down) 

• Change burping positions

• Multi-sensory techniques such as shushing, rocking, sucking and swaddling

• Optimizing naps and paying close attention to “early” sleep cues 

• Try lying them on his/her back, bend the knees and legs toward the abdomen and apply gentle pressure to help pass gas.

I hope that this information helps bring some comfort, even just a little bit. The first year can be a very stressful time. Remember to breath. You will make it through this. Check out our Community Page for a quick access to trained Edmonton healthcare professionals who specialize in infant care.

Just a quick reminder, you are amazing!

Mychelle RN, IBCLC

Hope you enjoyed your summer! We have had some great times together since the “self isolation” rules were set in place. I’m looking forward to the kids back in school and a little nervous about it, all at the same time. The house is going to be quiet.

I thought I’d talk a bit about oral restricted tissues or “tongue ties”. I feel like we see this as an issue in about 75% of our home visits.  Unfortunately in Edmonton right now there are very few specially trained practitioners that do a FULL release (anterior and posterior).  It’s not only about the appearance but about the function of the tongue. There are tongue ties that aren’t visible to the eye but are present and cause problems.  There are also obvious tongue ties that anyone can see by looking but if the function of the tongue is normal there is no need to intervene.  

Tongue ties can be controversial.  Please note that an International Board Certified Lactation Consultant (IBCLC) can NOT diagnose a tongue tie! We can only assess oral function and refer to a healthcare professional. 

Mychelle and I have extensive training with assessing normal oral function and identifying tethered oral tissues.  One of the assessment tools we always use is the The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF).  We were trained to use the HATLFF by Dr. Hazelbaker herself! We do, however, use multiple assessment tools to do a complete oral exam at each visit.  

From personal experience, when my son was born 10 years ago I didn’t really know about tongue ties.  I had enough knowledge as a Labour and Delivery Registered Nurse to know what a good latch was and how to achieve various breastfeeding positions. Breastfeeding was something I knew I wanted to do but I had so much pain. Toe curling pain.  The pain was so bad I dreaded the next feed. I tried all the nipple creams available. At one point we thought it could be yeast. I don’t recall if anyone looked in his mouth.  I wish I had the knowledge that I do now! However I persevered, breastfeeding my son until he was 18 months old because I am stubborn and I wanted him to have breastmilk.  I would never wish that pain on anyone.  So how did I find out he has a tongue tie? His orthodontist recently said, “He has quite a tongue tie!!!!!” My mouth dropped.

What is a frenulum?

A frenulum is the membrane underneath the tongue connecting it to the bottom of the mouth.  

What is a tongue tie?

A tongue tie is when the frenulum is too short, which affects tongue movement.  A baby needs to be able to stick their tongue out and move it high enough to breastfeed effectively, otherwise it is almost impossible to breastfeed.  

Signs of a tongue tie

• Shallow latch

• Your nipples are painful

• Gassy baby/reflux

• You feel as though you aren’t making enough milk 

• Slow weight gain

• Frequent feeding

• Baby might latch well then slide off

• Short feeds that are tiring for them  

• Very long feeds in order to get enough milk

• Persistent, painful feeds often described as chomping, grinding

• After feeds your nipple may look flattened or lipstick-shaped

• Tongue may be heart-shaped or forked in appearance

• Baby can’t open wide to latch to the breast

• Clicking/smacking sound while breast or bottle feeding

• Cough or choke on the “letdown”

• Frustration at the breast if milk supply is low or if flow slows

It is so important to work with an IBCLC before and after treatment of a tongue tie. If you choose to have your baby diagnosed we will refer you to the most trusted and experienced professionals in the city. While you are awaiting your appointment, your number one priority is protecting your milk supply, We will give you advice on how to best do that.  Mychelle and I will teach oral exercises to be done before and after treatment and ensure you are prepared for the treatment day by reviewing the procedure.  After a tongue tie release, babies need to learn how to use their “new” tongues and often you are starting from the beginning with latch and positioning.  We will be there for you after the treatment to ensure latch, positioning and post care exercises are done correctly and also to teach suck training exercises.  

It is important to note that not all babies treated for tongue tie will breastfeed with ease!  Keep it in the back of your mind that it might not work and be prepared to explore other avenues if need be (we have suggestions for that too). If this is something you have been anxious about or have struggled with previous babies, you are not alone! Many other moms struggle with this “under discussed” issue and we have the information you need to support and assist you!

Melissa, RN, IBCLC

Guest Blog Article

By Dr. James Thomas, DDS, MS
Founder of the ​health:latch circle​ and the ​health:latch clinic

Dr. James Thomas, DDS, MS

Dear Moms,

We know how painful it can be, both physically and emotionally, if you and your baby are struggling with breastfeeding.

You may have heard about tongue tie and are wondering whether an oral restriction could be at the root of your breastfeeding challenges.

As a pediatric dentist who specializes in diagnosing and releasing oral restrictions in babies, I have had the honor of collaborating with amazing lactation consultants to support thousands of mothers and infants on their breastfeeding journeys.

This article will help you understand the basics of ​oral restrictions​ such as ​tongue tie​, how they can impact ​breastfeeding​, and ​what to do next​ if you suspect your baby could have an oral restriction.

What is an oral restriction?
Tongue tie is the common term for a medical condition called ​ankyloglossia​ that restricts the tongue’s range of motion. The most common types of oral restrictions are ​tongue tie, lip tie, and buccal tie. These conditions are conditions present at birth and impact the normal movement and function of the tongue and mouth​.

●  A ​tongue tie​ is when the band of tissue connecting the tongue to the bottom of the mouth is too short, too thick, or too tight, restricting the tongue’s normal range of motion.

●  A ​lip tie ​is when the tissue connecting the upper lip to the gum is too stiff or too thick, preventing the upper lip from moving freely.

●  A​ buccal tie ​refers to tissues that attach the inside of the cheeks to the gums, restricting normal movement.

How can an oral restriction affect breastfeeding?

Many oral restrictions are discovered and diagnosed due to difficulties with breastfeeding. An oral restriction can impair a baby’s ability to properly latch, suck, and swallow. If you are having issues such as mastitis, decreasing milk supply, or clogged ducts, or if your baby is having difficulty latching or losing weight, it is a great idea to check if your infant has an oral restriction.

What signs should I look for?

An oral restriction can hamper your baby’s ability to breastfeed, leading to important symptoms for both you and your baby.

You may notice that your baby is:

• acting irritable or fussy during or after feeding

• experiencing gassiness or frequently spitting up

• having difficulty creating a secure latch during nursing

• losing weight or having poor weight gain

• falling off the breast frequently during nursing

• frequent feedings without feeling “satisfied”

If you are nursing your baby, you may notice:

• breast pain

• plugged milk ducts (which can lead to mastitis)

• engorgement

•  cracked or blistered nipples

•  a feeling that your baby is chewing or biting on the breast

• recurrent thrush or infections

Of course, not all breastfeeding issues are related to an oral restriction. Your lactation consultant can help you find solutions to issues such as milk supply, positioning, shallow latch, inverted or flat nipples etc.

What does tongue tie look like in a baby?

When it comes to oral restrictions, there’s no “one size fits all” presentation. Oral restrictions are diverse in their appearance, which is why it is important to seek care from a healthcare professional who is knowledgeable about this condition.

How common is tongue tie?

It’s hard to say for sure because more research and better statistics are needed. Some research indicates that up to 10 percent of babies are born with an oral restriction and up to 25 percent of nursing infants can be affected by shallow latch caused by this condition. Many oral restrictions go undiagnosed even into adulthood, mainly because of the lack of education among healthcare professionals about this condition.

What is the treatment for an oral restriction?

Oral restrictions can be treated​ with a quick outpatient procedure to release the tie, sometimes referred to as a tongue tie surgery.

A release procedure known as ​frenectomy​ is usually done with a laser and may completely eliminate (“ablate”) the tissue restricting the tongue or lip. This differs from a ​frenotomy​, which is usually done with sterile scissors and involves “clipping” or “snipping” the tissue.

What types of healthcare professionals can help my tongue tied baby?

Lactation consultants are often the first to notice breastfeeding-related symptoms that could point to an oral restriction. Although they cannot diagnose, your lactation consultant can help you by referring you to a Proceduralist who can identify and treat the condition.

Proceduralists​ are trained and licensed to diagnose oral restrictions and perform the release procedure. They include dentists, doctors, naturopaths, nurse practitioners, and oral surgeons.

When is the best time to diagnose and treat an oral restriction?

As soon as possible! In the best of circumstances, a tongue tied baby can be diagnosed and treated shortly after birth. The longer we wait, the more problems can arise. For example, if a baby’s oral muscles are restricted and they compensate by using other muscles not intended for suck and swallow, the brain quickly memorizes these dysfunctional patterns. Thankfully, with the right support from healthcare professionals, after a release procedure babies can learn healthy suck and swallow patterns. Lactation consultants can provide critical support after a release procedure by helping you adjust your feeding plan and breastfeeding technique.

What causes oral restrictions?

As a fetus develops in the womb, tissue forms to anchor the tongue to the base of the mouth. Usually, this tissue dissolves naturally over time. At around the 12th week of pregnancy all that is left is a small, flexible tether. For reasons that have yet to be fully understood, in some fetuses, this tissue does not dissolve. These babies are born with an oral tether that is especially short, tight or thick.

Although much research is needed to better understand what causes oral restrictions, some evidence points to a genetic mutation known as MTHFR (​methylenetetrahydrofolate reductase)​.

Oral restrictions:

•  are conditions present at birth

•  appear to be hereditary

•  are common in babies who are born prematurely

• are common in babies who are born with other mid-line traits like “stork bite” birthmarks

What are the possible long-term effects of tongue tie?

Even small components (such as the tiny tether under your tongue) can affect the entire body over time. Oral restrictions can be indirectly related to a cascade of developmental issues in the mouth and even in the rest of the body.

If left untreated​, oral restrictions may affect your child’s:

• airway development

• breathing

• eating

• sleeping

• chewing

• tooth and jaw development

• oral hygiene

Much research needed to understand the long term effects of oral restrictions. Some specialists suspect that oral restrictions could play a role in serious, chronic conditions in adulthood such as sleep apnea, asthma and heart problems.

Trust your instincts

It is very common for parents to be dismissed, have their concerns be minimized, or told their baby is not tongue tied because their practitioner lacked specific training and experience in diagnosing oral restrictions.

At the ​health:latch circle​ ​we are advocates for parents and patients. We believe you know your body and your baby better than anyone. Listen to your gut and continue to ask questions until you are satisfied with the answers.

Next steps

As soon as you suspect that tongue tie is a possibility, or even better, if you just want a preventative evaluation - it's time to gather together resources and prepare for the decisions that you will have to make.

You need caring, kind, and knowledgeable professionals who can guide and advise you through the sometimes bumpy road of education, examination, diagnosis, treatment, and follow-up therapy.

Creating your circle of support

We created the health:latch circle as a place for parents like you to surround yourself with support and for providers to connect with parents.

The ​health:latch circle​ is a radically kind, community-based online platform that allows interested parents and professionals to learn together and connect to trusted professionals who are committed to helping families thrive.

Learn more about the health:latch circle and create your free parent account ​here.

Today we are delighted to talk about breastfeeding, formula feeding and sleep. We all love our sleep, right!? Probably the hardest thing about becoming a new parent is losing sleep and having to function the next day….and this can go on for weeks, months or even years! It’s no surprise that parents are desperate to find ways to increase the amount of their little ones sleep.

Parents often ask us the question, “if I give my baby formula, will they sleep through the night?”. They get advice from their formula feeding friends, grandparents and other relatives that they should “give them formula; they’ll sleep longer.” And if you do a google search you can find plenty of people backing this belief up. This results in many sleep deprived, desperate parents prematurely giving up breastfeeding or night weaning altogether, just in the hope of more sleep. So is this advice accurate - does formula feeding mean more sleep? This article aims to give you the facts so that you can make an informed choice that is right for you and your family. 

Firstly, let’s look at what biologically normal  sleep looks like. All children, and adults, sleep in cycles, and as they enter the light phase at the end of each cycle they may partially or fully wake. So no-one actually ‘sleeps through the night’ ever! As adults if we have a need then we can attend to it ourselves - but if a baby is hungry or thirsty (or has any other need) then they will signal to an adult to help them. And so until a baby is able to sustain a full nights sleep without needing food, they will wake and signal to their parent. The point at which this is varies from child to child, but the evidence suggests that many babies need food at night up to 18 months old. And so if your child is waking up and feeding several times a night, whether via breast or bottle, they are behaving completely normally, and you are not creating bad habits by feeding them.

So next let’s look at whether giving formula will mean that babies will wake less.  Formula fed babies can often take larger volumes per feed than breastfed babies, and this milk also takes longer to digest than breast milk . For this reason, some formula-fed babies do sleep for slightly longer stretches than breastfed babies. However, research confirms that although breastfed babies wake more frequently, breastfeeding mothers actually get more overall sleep. This is because of a combination of factors. Firstly, breast milk is full or hormones that help a baby feel both satisfied and tired - it is basically mother nature’s amazing tool to get babies back to sleep quickly and easily. Secondly, making up bottles is a bigger job for the mother - they have to get out of bed, go downstairs, make the bottle etc. This means that it often takes longer, and wakes the mother and baby more, than breastfeeding, which, as we’ve said can be very quick and easy. 

Remember also that babies wake for more reasons than just hunger - feeling cold, needing a diaper change, needing a cuddle - so even if you are bottle feeding, it doesn’t not necessarily mean they will sleep longer as if they have another need they will still wake up. 

Here are some other interesting points about breastmilk and sleep:

* Tryptophan is in breast milk and helps develop a babies’ circadian rhythm. This will help your newborn learn day from night. 

* Breastfed infants have more Non-Rapid Eye Movement (NREM) sleep than formula fed infants. NREM sleep, known as lighter sleep, is thought to protect infants from Sudden Infant Death Syndrome (SIDS). 

* Night feeds, in the early weeks, are especially important to build milk supply. 

* In cultures where co-sleeping is the norm, babies feed lots at night. Sometimes up to 4 times per night; taking in almost half of their daily amount of milk.  

So, in the end, if your baby is breastfeeding and this is working for you then, adding a bottle of formula isn’t guaranteed to help her or you sleep any better, in fact it can sometimes make things harder. But ultimately the decision as to how to feed your baby is yours, and you should do what is right for your family given the facts. Never feel pressured into giving up breastfeeding before you are ready, instead work on establishing good, healthy sleep habits with your baby.

Melissa Alexander RN, IBCLC

Sarah Mabbutt | Baby Sleep Well Program

Photography credit: Littles and Lenses

In 2017, I had my first baby, Lucca. He struggled to latch and I nursed hourly around the clock. By day 5, my milk still didn't seem to have come in despite nursing on demand and pumping. My midwife referred me to a lactation consultant and I was then diagnosed with Breast Hypoplasia, also known as Insufficient Glandular Tissue (IGT). This meant that I would never be able to make enough milk to feed my babies, no matter what I did. I was beyond devastated. Luckily, I had lots of support, he received a tongue tie revision and I had access to donor milk, so I was able to successfully nurse him until he was 8 months old, with supplementation, medication and an supplemental nursing system (SNS).

Photography credit: Littles and Lenses

Fast forward to 2019, I had my second son, Matteo. I was much more empowered with information (as I was now a Certified Lactation Educator and Birth Doula at Beautiful Blessings) and had 500+ oz of frozen donor milk ready to go (thanks to two amazing mothers in my life), had expressed colostrum in the freezer, an SNS and a robust nursing and supplementation plan. When Matteo was born, he had a tongue tie which was corrected on day 10 and I was able to start my medications immediately. I supplemented until day 5 with my own frozen colostrum on a spoon. From there, I continued to feed on demand and offer donor milk and formula, as needed. We went on to experience challenges including issues with him having a high palate and a horrible, month long bout of mastitis, but we pulled through.

I am so proud to say that I am still nursing Matteo at almost 13 months old, with no medication and little to no supplementation. I am now working towards becoming a Le Leche Leader as I am very passionate about supporting breastfeeding/chestfeeding individuals, particularly if they are dealing with low supply or hypoplasia.

“I am happy that I reached my breastfeeding goals and I am excited to continue our journey”

- Lauren Calleja Birth Doula, CLE

Photography credit: Jillian Henry Photography

With having had 3 kids I can say that my experience breast feeding them was as different as they are. Before having kids I had a bit of an advantage, or so I thought, having had 2 older sisters with 6 kids between them and 4 years of labour and delivery experience as a nurse. I was encouraging and teaching new moms how to make this unique connection before I had gone through the steps myself.

I knew I wanted to give breastfeeding my all because it was what I knew the most about. I knew it had many benefits for my baby and hopefully me! I wanted the connection, the weight loss, the immunity for my baby and the lack of expense (vs formula feeding).

My first baby threw all my confidence out the window by coming early. Once he was born I was given a pump and told how to use it, clean it and encouraged to pump every 2-4 hours to bring my milk in and have a supply the nurses could use to feed my son through his naso-gastric tube. His blood sugars were low at birth so they needed him to start eating. His first feeds of formula he rejected making me strangely proud! My milk came in (and didn’t stop!) with all of my pumping and my son kept it down and increased feeds just as expected. I was given a nipple shield that I had never seen before, the next addition to my challenges! I had to learn how this big chunk of plastic was supposed to fit into my premies mouth (and function without choking him when it filled up!) while learning how and when to hold him, when to pump, when to go home and when be at the hospital…

The first lesson for me in motherhood was to keep my expectations very flexible!

I had not prepared for anything I was facing and had to use all the help I could get which was difficult to accept with my independent (controlling?) personality. As for the benefits I had hoped for, the “bond” was there from birth and it would have been regardless of what I fed him. His health was good though every “cold” was a cough or wheeze and I’ll never know if that might have been different if he had been full term. I did lose the weight and saved money without needing formula that first 8 (?) months. He did start to nurse without the shield after a few months and after that all ran smoothly but during those months I did a mix of previously pumped and frozen milk and the nipple shield.  I also pumped and brought a bottle to places that I thought would just be easier to keep my shirt on!

I felt protective of my new little love. I liked that when he cried I was the one with the answer. We went to some BBQs that summer and family events I intentionally did not bring a pumped bottle just so he would have to be with me. I felt like I missed out on so many tiny moments in those first few weeks that I wanted him in my arms as much as possible (see..control..).

Looking back on it all, and especially after having two more kids, I wish I could go back and tell myself “Just do what works for you!”. I spent so much time worrying if I was doing the right or best thing and I could have saved myself so much stress if I just relaxed and did what worked, what felt right.  Those were the most empowering actions that brought me so much pride. That and watching those babies chunk up from all that milk! 

After note- all my kids ate every 1.5-2 hrs. It was embarrassing that in one visit I had to feed…again. People would say “Didn’t you just feed him/her?” Sometimes I would leave early just to avoid the possible judgement.

Breastfeeding is a small action with a steep learning curve and a huge weight of expectation. Your mental health is as important as your baby’s physical health. What would that look like on a growth curve??! What percentile is your mental health in?

Lindy Akins