The majority of my breastfeeding journey was a struggle. After 4 months of triple feeding (breastfeeding, pumping, then bottle feeding) my son finally took to breastfeeding. I tried triple feeding my daughter for about 5 months until I accepted that my mental and physical health needed to be considered for our family well-being too. Why triple feeding? It most definitely was not my first choice. My little ones both had a lot of trouble breastfeeding. Both of my children were diagnosed with tongue and lip ties, which lead to a lot of oral dysfunctions. With a tongue tie in utero, the baby may be unable to properly learn the suck/swallow mechanism. Even if a tongue tie is released many infants have to relearn how to use their tongue and other muscles. Most infants with tongue ties have muscle dysregulation and tension throughout the body, which can lead to difficulty with movements like rolling, crawling, and even turning their head. To bypass my personal experience, and jump to my recommendations, scroll down!
The tongue tie diagnosis seems to be missed quite frequently. Even when identified, the release itself is controversial; several of study results yield either no change in feeding, or suggest the procedure may not have been necessary if other measures had been taken. For my son we unfortunately had his initial release revised, meaning his first release either wasn’t deep enough or he healed too quickly. The second release was successful for us. I can’t say for sure whether the difference was related to using an Ear, Nose, and Throat (ENT) vs a dentist, or that the ENT used a cauterizing device vs the laser used by the dentist. I can say I didn’t see any changes after his release with the ENT, and that we had wonderful improvements after the release by the dentist using a laser.
With my first child we didn’t identify the problem for a few weeks. Somehow he was able to maintain weight, but he was extremely drowsy, never really latched, would attempt nursing for 40+ minutes, lots of biting, and milk dripped out the sides of his mouth.
We saw multiple lactation consultants, and were referred to an ENT for the release. After no improvement in feedings we were referred to a speech therapist, and working with her was life-changing. She made wonderful suggestions for improving feeds. Although breastfeeding still wasn’t going well, we at least saw improvements in bottle feeds. Our son was able to take breast milk from a bottle without coughing, gagging, or taking so long to feed. We kept working at both the breast and bottle. When he was around 4 months old we still saw no improvement with breastfeeding. We were referred to a dentist to consider another lip and tongue tie release.
The second procedure was a bit traumatic for our family as we sat outside the room and heard our son screaming. He was pale after the procedure, which gave us quite a scare. He was back to his normal self about 30 minutes later. We completed the tongue lifts and lip stretches as recommended to prevent early healing/re-attachment. These were challenging as he would also cry during the stretches and exercises, but recovered within a minute. Within 10 days he was able to nurse from my breast, and we didn’t have any issues after.
Click here for the exercises we followed.
My daughter showed similar symptoms from her first day on earth. We were immediately introduced to a nipple shield. She clicked, couldn’t stay latched, would attempt to feed for prolonged periods, biting, and milk dribbling from her mouth.
The nipple shield was a nightmare, and didn’t do much to improve feedings.
I immediately scheduled her tongue and lip tie evaluation, and release with the same dentist when she was 2 weeks old.
The procedure went well, and we did the exercises recommended. Bottle feedings improved, but nothing changed with nursing. We worked with a lactation consultant, chiropractor, speech therapist, and occupational therapist with still no changes in breastfeeding. I kept hoping things would get better. We returned to the same wonderful team with the Kennedy Krieger Institute Tethered Oral Tissues Program (TOTs,) but unfortunately they weren’t able to make miracles happen either. They were happy to provide advice and work with us to continue to try breastfeeding, but ultimately it wasn’t what was best for us.
For others out there who deeply want breastfeeding to work, but are struggling… I feel you. I feel your heartbreak, your sense of failure, your anxiety and frustration. I wanted to breastfeed both of my babies so badly. I wanted that connection, I wanted my babies to get “the best,” and I must admit I wanted it because it can be easier. Little or no bottle washing, preparation, cost, and less time.
I’ve read that the time a mom takes breastfeeding the first year is comparable to a full-time job if you take vacation time into account. Triple feeding too at least twice as long, so PROPS to all the mamas out there trying to make it work.
When I say I had to consider my mental and physical health, I mean that continuing to try breastfeeding a baby who seemed unable to breastfeed was defeating. The tears, screaming, crying, and biting from my little ones made me cry, and certainly want to scream. Then there was the time. Those first few months of baby’s life leave mama very little sleep, and to reduce that by any amount brings about quite the challenge. Sleep is so important. Without it is also mentally and physically damaging. We endure sleepless nights because our little ones need us, depend on us, but everyone has a breaking point.
Challenges with breastfeeding are common, but may not be normal. I highly recommend early intervention with a lactation consultant, and follow up. If you continue to have feeding struggles, don't ignore it as it may indicate an underlying issue that could present problematic later in little one's life journey. If you don't get answers or help, advocate for you and your baby and consider a second opinion.
Appropriate infant weight gain is one of the most important signs of a healthy baby. If your newborn/infant is gaining weight as expected as a clinician I would always consider feeding issues as a possible cause. Be sure to discuss concerns with your pediatrician.
I want others to know that there is no right or wrong in deciding what is best for your little one. I also want other mamas to factor in themselves when deciding what's best for their family. Without a functional mama a lot of other things fall apart. Your breastfeeding journey is your own, and only you can decide what works. I did want to share some recommendations I received along the way that really made a difference for us…
What worked for our family:
-Lactation consultation - You’ll have many options. You can see them after delivery, and/or have someone come to your home.
-Speech therapy - We required this because our kiddos had trouble with sucking, swallowing, oral and tongue muscles. It was the most effective part of our treatment.
-Physical therapy - Most tongue tied babies have muscle tension, oral and musculoskeletal dysfunctions. Our babies were initially treated because of Torticollis (presents as a head tilt or side preference.) Watch for this if your baby tends to keep one ear closer to one shoulder than the other, or prefers to look in one direction vs another… this can lead to plagiocephaly (misshaped head) For more info on plagiocephaly click here
-Tummy time often and early - Use a mirror to encourage lifting the head. Move the mirror to alternate sides to discourage side preference.
< 1 month: Aim for 1-3 minutes 2-3x/day
1-2 months: Aim for 3-5 minutes 3-5x/day
2-4 months: Aim for 1.5 hrs/day divided
4-6 months: Aim for at least 1-2 hrs/day divided
-Teamwork - My husband was extremely supportive. He did most of the bottle and pump washing, and would give bottles when necessary.
-Patience - Easier said than done!
-Feedings in dimmed or dark, and quiet rooms with little distraction
-Comfort - I loved my extra padded Boppy that had a waist strap
-Tongue tie release via laser with an experienced dentist
-Support groups - There are some in-person, but I liked the groups I found on Facebook for breastfeeding, and tongue ties
-Wearable pumps - I personally LOVED my Willow GO. It seems reviews are variable for all of the wearable pumps. As an overproducer and someone who haaaaates pumping, the Willow GO worked wonderfully for me, and made pumping more bearable. You can usually get is on sale for around $280, and qualifies for most FSA/HSA programs.
-Dr Brown’s bottles - These specifically were recommended by speech therapy. Supposedly these are one of the only bottles that baby has to actually suck, and can’t get milk by biting.
-Preemie nipples - Slow flow more comparable to the flow from the breast. These are marked with a “P.” You can then go to transitional nipples marked with a “T” before proceeding to level 1 nipple, which is what most of the bottles come with.
I also highly recommend following these women on Instagram:
@tummytimemethod
@infantinsights
@infant.feeding.specialist
@tonguetiebabies
@milestones.and.motherhood
@bridgingchilddevelopment
What didn’t work for our family:
-Syringe feeds
-Chiropractic care (but I’ve heart this was wonderful for others)
-Softer nipples (EvenFlo, Avent bottles) - my kiddos would just bite these nipples
General breastfeeding tips:
-Start early
-It takes time to get it right… you’re both learning
-There is no such thing as nipple confusion. There is absolutely nipple preference, and it takes less work to get milk from a bottle, than the breast. For this reason I recommend delaying bottle feeds if possible. But it is not always avoidable. Try preemie nipples on Dr Brown’s bottles as noted above.
-Sandwich the breast into a hamburger, nipple-to-nose for latching
-Crossbody position was my favorite, but many people love the football hold
See more positions here
Additional breastfeeding resources:
HealthyChildren: https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/default.aspx
La Leche League International: https://llli.org/breastfeeding-info/tips/
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