Baby’s first instinct is to nurse. In fact a healthy newborn placed on mom’s chest skin to skin will turn toward the breast (they prefer unwashed breasts as they are drawn to mom’s scent and the lure of milk) and may attempt the breast crawl to reach the breast. Many babies latch onto mom’s nipple without difficulty. Breastfeeding should not be painful or difficult (at least not after a few days). Though many mothers and babies flow into nursing easily, other moms discover that it can take time and patience to establish breastfeeding.
The breasts begin preparation for nursing early in pregnancy. Some mothers have an overabundance of milk, some not enough and others have just the right amount to satisfy the baby. A healthy diet and plenty of fluids are essential for mom. It is good to drink a glass of water every time you nurse or pump in addition to what you usually drink.
A nipple shield can be helpful if you have inverted, flat or short nipples. Premature babies may not be strong enough to successfully nurse and a nipple shield may make it easier for them. If your baby has difficulty latching which may be due to a tongue-tie, tongue thrust or retracted tongue, a shield can be helpful as these issues are assessed. A lactation consultant can help with breastfeeding issues and an osteopathic physician can assess and treat related structural issues. Tongue function is important for feeding, eating, swallowing, speaking and breathing as well as the developing face. Anatomic issues and functional issues have to be assessed together.
What about Tongue Ties?
Everyone has a lip and tongue frenulum, a band of tissue that connects the tongue to the floor of the mouth and the lip to the gums. You can lift your upper lip and tongue to observe yours. Frenums develop early in pregnancy and should regress enough that the tongue is not tethered and the upper lip can flange so the baby can grasp not only the nipple but the areola as well. The areola contains milk in the sinuses so baby needs to be able to include this area to get the most milk. When a baby can only grasp the nipple, it can cause breastfeeding to be painful.
A difficult birth can affect the nerves that feed the tongue, affecting breastfeeding. Compression in the area of the vagus nerve can lead to excessive spitting up.
The tongue’s ability to reach the roof of the mouth is important for breastfeeding and for the development of the mid and lower face.
Infant signs of a tongue tie:
- Inability to latch onto the breast or to latch deeply
- Difficulty maintaining a latch that forms a seal so milk dribbles
- Baby tends to slide off the nipple, and is unable to use a pacifier
- Long feeding times without feeling full, poor weight gain or excessive weight gain (this can depend on how much milk mom produces)
- Falling asleep while nursing without completing the feed, poor sleep
- Gums, bites or chews the nipple
- Gulps, swallows air leading to gas and stomach pain, excessive fussiness
- Lip ties can also contribute to the above and may prevent the upper lip from flipping leading to a shallow latch, as well as preventing the mouth from opening widely
Tongue tie breast challenges for mom:
- Sore nipples (lipstick shaped nipples, blanched, sore, cracked or blistered nipples)
- Severe pain with nursing
- Incomplete emptying of the breast which can lead to mastitis
- Infected nipples, thrush
- Poor milk production or flow
Lip and tongue tie issues often require a team effort to resolve. All newborns benefit from an osteopathic evaluation to relieve issues from positioning in the womb as well as any birth trauma.
For babies that would benefit from a frenectomy, the Osteopathic physician can address structural and functional issues before and after the procedure with gentle osteopathic manual medicine.