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I’m delighted to be on the planning committee of a two-day conference geared to those helping breastfeeding families during the first month of life. “Breastfeeding the Neonate” includes some of my favorite speakers—Nils Bergman, Diane Wiessinger, Catherine Watson Genna—and to make it even more wonderful, it will be held in Orlando this coming February 8 and 9.  As a Chicago native I’m thrilled to have a chance to hear some of the best speakers in our field while enjoying a little warmth and sunshine.  How about you?

If you’re feeling tempted, don’t wait to register. There are only 200 seats available, and with this amazing roster of speakers, I expect these 200 seats to fill quickly. All of the conference details are available HERE. This event page also includes links to online registration. You may download the conference brochure HERE.

As another huge plus, we’ve been fortunate to secure an affordable venue that offers:

• An in-season hotel room rate of only $139 per night (until January 16, 2016)
• Complimentary airport shuttle
• Complimentary wi-fi
• Complimentary parking                                                                                                                                      

12.25 L CERPs have been awarded for this event by the International Board of Lactation Consultant Examiners, and this activity has been submitted to the Ohio Nurses Association (OBN-001-91) for approval to award contact hours.  The Ohio Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Conference registration also includes a Dessert Reception with the Speakers on Monday evening to give you special one-on-one time with these incredible people. This conference is sponsored by Family Health Coaching, a wellness organization run by Dr. Theresa Nesbitt, the obstetrician who appears in many of the videos on my YouTube channel HERE. Dr. Theresa will also be speaking on the Neurology of the Newborn and joining me for two other talks.

Take a break from winter to update your breastfeeding skills and knowledge.  What makes a breastfeeding newborn different from an older nursing baby? How should these differences inform our approach? Based on the most current research and clinical insights, our international experts will share practical and effective strategies for the initiation and continuation of breastfeeding during the neonatal period. We hope you can make it!

Reading different milk storage guidelines from different sources can be crazy making! Which guidelines are right? Why don't the experts agree? What do you really need to know?

The good news is that there are logical explanations for these differences. And once you know them, you can store and use your milk with confidence.

 Ideal Versus Okay

In the guidelines provided at the end of this post, some storage times for refrigerated and frozen milk are labeled “Okay” while others are labeled “Ideal.” Within the “Okay” times, expressed milk should not spoil. Between "Ideal" and "Okay," the milk is still good, but more vitamins, antioxidants, and other factors are lost. Some health organizations, like the Academy of Breastfeeding Medicine, recommend the shorter "Ideal" times because they prefer you use your milk before this loss occurs. 

It is always better to use your milk sooner rather than later, but your milk should not spoil within the "Okay" time frames. Milk found in the back of the fridge after 8 days will still be far better for your baby than formula. 

What Temperature Is Your Room?

Some milk storage guidelines also vary because they define room temperature differently. If you live in a tropical or subtropical climate, the higher room-temperature range in the guidelines below may better fit your reality. In the temperate zones, the lower range may better fit yours, at least during colder seasons.

Previously Frozen or Not?

Storage times for fresh and refrigerated milk are longer than for previously frozen milk. Freezing kills live cells in the milk, which protect milk from spoilage. When the milk's live cells are dead, it spoils faster. When in doubt, smell or taste it. Spoiled milk smells spoiled.

Your Situation Makes a Difference

If you’re still in doubt about which guidelines to follow and how best to store your milk, ask yourself the following questions.

Is your baby healthy?  These guidelines are intended for full-term, healthy babies at home. If your baby is hospitalized, your hospital’s milk storage guidelines are likely shorter than these. Preterm and sick babies are more vulnerable to illness, so pumping and storing recommendations may be stricter.

How much expressed milk does your baby get?  If your baby gets most of her milk directly from your breasts, you don’t need to worry about whether the small amount of expressed milk she gets is fresh, refrigerated, or previously frozen. If a large percentage of your baby’s milk intake is pumped milk, consider your choices more carefully. Freezing kills antibodies, so rather than freezing all of your pumped milk, feed as much fresh or refrigerated milk as possible. But even without the antibodies, frozen milk is still a far healthier choice than formula.

Milk Storage Times for Full-term Healthy Babies at Home

Room Temperature (66°F-72°F/19°C-22°C)

• Fresh, never frozen: 6-10 hr

• Frozen then thawed: 4 hr

• Frozen then thawed, warmed but not fed: Until feeding ends

• Frozen then thawed, warmed and fed: Until feeding ends

Room Temperature (73°F–77°F/23°C–25°C)

• Fresh, never frozen: 4 hr

• Frozen then thawed: 4 hr

• Frozen and thawed, warmed but not fed: Until feeding ends

• Frozen then thawed, warmed and fed: Until feeding ends

Insulated Cooler with Ice Packs

• Fresh, never frozen: 24 hr

• Frozen, thawed: Do not store

• Frozen then thawed, warmed but not fed: Do not store

• Frozen then thawed, warmed and fed: Do not store

Refrigerator (39°F/4°C)

• Fresh, never frozen: Ideal: 72 hr, Okay: 8 days

• Frozen then thawed: 24 hr

• Frozen then thawed, warmed but not fed: 4 hr

• Frozen then thawed, warmed and fed: Discard

Refrigerator Freezer (variable 0°F/-18°C)

• Fresh, never frozen: 3-4 mo. 

• Frozen then thawed: Do not refreeze

• Frozen then thawed, warmed but not fed: Do not refreeze

• Frozen then thawed, warmed and fed: Discard

Separate Deep Freeze (0°F/-18°C)

• Fresh, never frozen: Ideal: 6 mo, Okay: 12 mo. 

• Frozen then thawed: Do not refreeze

• Frozen then thawed, warmed but not fed: Do not refreeze

• Frozen then thawed, warmed and fed: Discard

 References

Jones, F. Best Practices for Expressing, Storing and Handling Human Milk, 3rd edition. Raleigh, NC: Human Milk Banking Association of North America, 2011.

Mohrbacher, N. Breastfeeding Answers Made Simple. Amarillo, TX: Hale Publishing, 2010.

Want to give friends and loved ones with Apple devices the gift of breastfeeding confidence? Just follow the simple steps above. The Breastfeeding Solutions app--my antidote to Dr. Google--is a great starting point for any breastfeeding question or concern.  Unlike a book, it's always on hand and once downloaded, users automatically receive updates as new information is added.

Now it's easy to share the gift of confidence.

"Latch Issue Solved! (5 star review): BFing had been going great up until the last week. Thankfully this app has helped baby & I to regain our wonderful BFing experience! I can't wait to read through all of the helpful tools." --Vti10

KellyMom.com: "Need a great breastfeeding app? The Breastfeeding Solutions app by Nancy Mohrbacher, IBCLC, FILCA is it! I installed it as soon as it was available, and have found it to be easy to use, and full of excellent information."

Nursing parents are commonly warned: “Don’t let your baby use you as a pacifier.” Although often said, this is an incredibly curious statement. After all, which came first, nursing or the pacifier?  Nursing, of course, long predates the pacifier (aka “dummy”), a man-made device designed late in human history to soothe babies as a nursing substitute.

If the pacifier is indeed a breast substitute, then what on earth could it possibly mean to let your baby “use you as a pacifier?”

What Is the Real Message?

The assumption underlying this advice is that baby’s desire to nurse is unreasonable. After all, if the baby’s need for milk was legitimate, the pacifier would never do. By definition, no milk flows from a pacifier. The point seems to be that if the baby nursed “long enough” (and the number of acceptable minutes varies by adviser), the baby no longer needs milk, so sucking on a pacifier should be good enough. However, as explained in THIS POST, some babies are fast feeders and others are slow feeders. The number of minutes a baby nurses tells us nothing about the volume of milk consumed.

Do babies sometimes nurse without taking milk? It does happen. Every so often you may notice your baby softly mouthing your nipple while mostly asleep. In this case, your baby may indeed be sucking but not drinking. Is this what those who say “Don’t let your baby use you as a pacifier” are referring to?

I don’t think so. This advice usually follows a weary parent’s report of a marathon nursing session, a common occurrence in the early weeks.  “Cluster nursing,” or bunching feedings close together during part of the day, is a fast-growing baby’s way of boosting milk production when needed. This works because “drained breasts make milk faster.”

However, if a nursing parent regularly substitutes a pacifier for nursing at these times, this can short-circuit her baby’s efforts to increase milk production. That’s why the American Academy of Pediatrics (AAP) recommends babies be fed on cue (see the 2012 AAP policy statement HERE). The AAP encourages parents to feed their babies whenever they show feeding cues (increased activity, rooting, mouthing), no matter how often these cues appear.

Babies’ feeding cues are never unreasonable, according to the AAP. In fact, during the first month, while milk supply is being established, the AAP specifically recommends avoiding pacifier use precisely because too-frequent use of this “breast substitute” can undermine the establishment of a healthy milk supply.   

Can Your Baby Be Trusted?

But there’s another aspect to this “Don’t let your baby use you as a pacifier” advice that is positively insidious. The idea that parents must be careful not to let their baby “use them” has the potential to undermine their trust in their baby, driving a wedge between them and preventing them from getting in sync the way nature intended. This curious warning is the not-too-distant cousin of the indefensible Western myth that newborns can “manipulate” their parents, even before they have the mental ability to do so.

As a case in point, a mother recently said to me at a peer-support meeting that her baby girl didn’t really need to nurse whenever she showed feeding cues because she was mostly doing “non-nutritive sucking.” This mother was struggling with her baby’s slow weight gain and had recently started nursing more often instead of sticking to the feeding schedule she had first adopted. Because this baby was nursing more, her weight gain had improved.

I asked this mother how she knew her baby was getting no milk during her time at the breast (which is what happens during “non-nutritive sucking”). I could see the realization dawn in her eyes. Smiling, this mother admitted that she really didn’t know if her baby was getting milk then or not.  I told her that I always assume during nursing a baby is getting milk.

At that moment, this mother realized that second-guessing her baby had been counterproductive for them both. She understood that to fully resolve her baby’s weight-gain issues she had to trust her baby to know what she needed, when she needed it, and for how long. (Her baby was full term and healthy, so she could follow her baby’s lead with confidence.) When she made the decision to trust her baby, it became her baby’s job—not hers—to know when to nurse. While I watched these mental wheels turn, this mother visibly relaxed as she felt her burden lifted.

Who Needs This World of Hurt?

What does it mean for your baby to “use you as a pacifier?” When you think it through in terms of how nursing works, it is actually total nonsense. But if parents buy into the assumptions that underlie this advice, it opens them up to a world of hurt. Believing that they have to guard against their baby “using them” has the potential to undermine nursing, their relationship with their baby, and indeed their whole outlook on parenthood. Who needs this kind of negative take on their baby? Even without it, new parenthood is challenging enough.

Where did this odd outlook come from? I’m guessing it stems from formula-feeding norms. After all, when babies are bottle-fed, overfeeding is a genuine risk. Milk from a bottle flows so fast and consistently that babies have little control over their milk intake. During nursing, on the other hand, due to the alternating fast-then-slow milk flow from letdowns, nursing automatically teaches our babies healthy self-regulation. (For more on how nursing and bottle-feeding affect risk of overfeeding and obesity, see THIS 2012 study.)

To prevent overfeeding during bottle-feeding, it may actually make sense to stop a feed before baby appears to be done and give him a nursing substitute to suck on so that his appetite control mechanism has a chance to activate. (Giving a baby regular breaks from fast milk flow while being bottle-fed is one way to prevent overfeeding and is one aspect of the paced bottle-feeding described HERE.) But even though this strategy may be good during bottle-feeding, it is definitely not good when nursing.

Babies know what they need. A happy and satisfying nursing relationship is built on parents’ trust in their baby. Only in places where formula-feeding norms are still alive in the cultural memory could the “Don’t let your baby use you as a pacifier” advice take root and gain traction. If we want to make our world more nursing friendly, part of our job must be to discredit this kind of misguided advice.  

The clock looms large in the lives of many breastfeeding families. When a new baby is born, some parents are told or make assumptions about:

• How many minutes their baby should breastfeed

• How long their baby should be satisfied between feedings

• The longest stretch of time their baby should sleep

Does it make sense to focus on time during the early weeks of breastfeeding? Let’s take a closer look.

What Do Number of Minutes Spent Breastfeeding Tell Us?

One common recommendation is to make sure newborns feed at least 10-15 minutes on each breast and take both breasts at each feeding. But that’s not always possible.

One mother and baby I saw in my private practice stand out in my mind. This mother called me with concerns about her 5-day-old daughter. The baby was born at just 5 pounds and she would only take one breast for 5 minutes before completely shutting down. She also refused one breast completely. I scheduled a home visit and brought my trusty scale. Unlike scales for sale at baby stores, this one was so accurate (to 2 grams) that it could reliably measure baby’s milk intake at the breast.

First I weighed her little girl with her clothes on for a “before” weight. With some small tweaks in positioning, we convinced her to take the breast she had previously refused. I watched her as she nursed. I didn’t see much jaw movement, and I didn’t hear any swallowing. Sure enough, after 5 minutes, she came off her mother’s breast and was unwilling to continue.

I put her back on the scale and to my amazement discovered she had taken 2 oz. (60 mL) of milk, way more milk than most babies this age take during a breastfeeding. (At 5 days, average milk intake per feeding is more like 1 oz., or 30 mL.) When this mother realized that her baby was such a fast, effective feeder, she relaxed. Her baby was doing fine.

Later that day, I saw another mother and her 10-day-old baby boy. This mother was worried because her little guy was spending more time nursing than she was told was normal, around 55 minutes at each feeding. This time my scale showed that he consumed the same amount of milk (2 oz. or 60 mL) in 55 minutes as the baby girl had taken earlier in the day in 5 minutes. Rather than being a fast eater, like the little girl, this baby boy was a slow eater.

How many minutes should a baby breastfeed? There’s not a simple answer. Just like adults, some babies are fast eaters and others are slow eaters. The number of minutes your baby feeds does not tell you anything about how much milk he consumed. On average, it takes most newborns somewhere between 5 and 55 minutes to finish a breastfeed. Both fast and slow nursers usually have periods of wide jaw movements along with some pauses. Over time, most babies get faster and more efficient at breastfeeding, so as they grow, the slow eaters usually speed up and get the same amount of milk (or even more milk) in less time.

Also like adults, your baby may be hungrier at one feed than another, so feeding longer or shorter at different feedings is not a cause for concern. This is perfectly normal. Being finished after one breast at some feedings and wanting both breasts at some feedings is also perfectly normal.

Does the Number of Minutes Between Feeds Mean Anything?

Not really. The most important thing to focus on is how many times each day your newborn breastfeeds. (Count one feeding as any amount of breastfeeding from one or both breasts followed by at least a 30-minute break.)

Most tiny babies need to breastfeed at least 8 to 12 times every 24 hours, but many parents do the math and assume this means they should expect their baby to be satisfied for 2 to 3 hours between feedings. Until your baby is a little older, usually after about the first 40 days or so, regular feeding times are uncommon. This 2-minute YouTube video from my YoutTube channel explains what to expect during the first 40 days.

As it describes, in the beginning, most breastfed newborns bunch their feedings together during wakeful times or “cluster nurse.” For this reason, it’s not helpful to focus on when baby fed last. Whenever baby shows feeding cues (increased activity, rooting, mouthing), assume it’s time to breastfeed again. Yes, even if it’s only been 10 minutes. If baby seems hungry again soon after feeding, don’t worry about overfeeding and don’t consider it a reflection of your milk production. It’s just what newborns do. This is how your baby helps you build a healthy milk supply.

There is no value whatsoever in trying to convince your baby to go for longer stretches between feeds. Newborns have no sense of time, and putting your baby off only adds stress to your life. If your baby seems interested in feeding or is fussy, try nursing first, and if that doesn’t help, move on to other comfort techniques. As your baby grows and matures (and his stomach grows and can hold more milk), he will naturally become more regular in his feeding patterns. You don’t have to do anything to make this happen.

How Long Is It Okay for a Newborn to Sleep?

Beginning on about second night after birth, don’t be surprised if your newborn goes into a feeding frenzy just about the time you’re thinking about going to bed. Most babies are born with their days and nights mixed up. That’s why it’s best for the sake of your own rest and recovery to sleep when your baby sleeps so that you’re rested and ready for more feedings at night.

It’s not uncommon for a brand-new baby to have one 4- to 5-hour sleep stretch, but it is often during the day. As long as your baby fits in at least 8 feedings every 24 hours and is gaining weight well (after Day 4, an average of about 1 oz. or 30 g per day), there’s no reason to wake your baby to feed.

It usually takes a few weeks for your baby’s body clock to get closer to yours. To speed up this process, try keeping stimulation to a minimum at night (lights low, sounds low, no diaper changes unless baby has a stool). Make daytimes full of light, sound, diaper changes, and before you know it, baby will be taking her longer sleep stretch at night.

Gaining Confidence in your Milk Production

Your baby’s feeding patterns are not a reflection of your milk production. But there are other ways you will know that your baby is getting the milk she needs. Her stool color is one sign. If breastfeeding is going well, your baby’s stool will turn from black to green by about Day 3 and green to yellow by Day 4 or 5. Weight gain is the best way to gauge your baby’s milk intake and your supply. Once baby reaches her low weight on Day 3 or 4, expect a weight gain of about 1 oz. or 30 g per day. Weight gain is the gold standard of healthy milk intake and milk production.

When it comes to breastfeeding and the clock, keep in mind that breastfeeding has been around much longer than clocks. In other words, you don’t need a clock to make breastfeeding work. Sometimes too much focus on the clock can even cause problems by shifting your focus away from what really matters.

Your baby will tell you everything you need to know. The American Academy of Pediatrics recommends breastfeeding babies on cue rather than on a schedule. (See its 2012 policy statement HERE). Don’t be distracted by the clock. Instead, watch (and trust) your baby.

Happy World Breastfeeding Week (WBW)! In my last post I described some of my new creations that relate to this year’s WBW theme, “Breastfeeding and Work: Making It Work!” In the US, WBW starts today. I also have a few other offerings related to this theme that are free or almost free.

On this newly designed website, I now have a Handouts section, which includes two handouts (no surprise!) available to download freely and distribute widely. The first is a two-sided sheet, For the Caregiver of a Breastfed Baby. It describes how to avoid overfeeding and ways to support breastfeeding mothers. The second, When Stored Milk Smells Soapy or Rancid, contains essential information for any woman planning to store her expressed milk. It describes high-lipase milk (which often develops a soapy taste and smell during storage), and if you have it, what to do to ensure in the months ahead that your baby will accept your stored milk.

Another free resource is my webinar, Working and Breastfeeding Made Simple, which was chosen as the free bonus talk for the month of August 2015 on the website iMothering.com. Please share this link with any mothers with an interest in this topic.

Like last year, I’ve also slashed the price of my Breastfeeding Solutions app. Usually $4.99 USD, only from August 1 to August 7 this go-everywhere source of breastfeeding info and help will be available at LESS THAN HALF PRICE: $1.99 USD. Please take advantage of this special deal to get it on the phones of many more pregnant women, new mothers, and breastfeeding supporters worldwide.

Have a great week! And let me know how you’ll be celebrating.

"Breastfeeding and Work: Let’s Make It Work!" is the 2015 theme for World Breastfeeding Week (WBW), which in my part of the world happens August 1-7. The official WBW materials are now available at worldbreastfeedingweek.org.

As you make your WBW plans, if you like my “Made Simple” approach to breastfeeding, please consider some of my creations. If you’re looking for books for giveaways, my 2014 Working and Breastfeeding Made Simple—available in paperback and e-formats—is the most up-to-date resource for employed mothers. You can hear me talk about its approach on my latest podcast here. Want details on bulk discounts? Contact scott@praeclaruspress.com.

Brand new last week from Noodle Soup (and perfect for busy millennial moms) is my Working and Breastfeeding infographic (left), available in tear pads of 50 for $10. One side is English, the other side Spanish. You can order it online here.

Also available through Noodle Soup is my brand-new low-literacy brochure, Ten Tips for Working and Breastfeeding (right), which you can order online here. At $0.22 each, it is the newest addition to Noodle Soup’s Ten Tips series.

I always love hearing about the many ways you celebrate WBW. Have a great one!

All mammals are born with responses that Mother Nature builds in to enable them to get to their food source and feed. Yet today, the way most mothers are taught to breastfeed ignores what our babies bring to the table, making early breastfeeding harder than it needs to be. It’s no wonder then that during the first week after birth, 92% of the nursing mothers in one study reported major breastfeeding challenges.

Instead of tackling individually each breastfeeding issue—latching struggles, milk supply concerns, sore nipples--what if there was a single way to address many challenges at once? That’s what Natural Breastfeeding is all about.

What are the roots of this innovative new approach to early breastfeeding? To create the Natural Breastfeeding program, obstetrician Theresa Nesbitt (“Dr. Theresa”) and I drew from the work of many: the Swedish breast-crawl researchers, UK scientist Dr. Suzanne Colson, international brain-science experts, the Prague School, and Americans Dr. Christina Smillie and Dr. Brian Palmer. When we put together these diverse-but-related puzzle pieces, what emerged was our new prenatal preparation program, Natural Breastfeeding: For an Easier Start.

Every baby is born with her own internal GPS, so baby knows where she is and what to do. If a mother knows how to activate and use her baby’s GPS, she can avoid many common early breastfeeding struggles. At the same time, Natural Breastfeeding allows a mother to relax completely, so she can nurse in comfort and rest while baby feeds. In most cases, she can even breastfeed hands free. By taking full advantage of an infant's inborn feeding behaviors, even a brand-new baby can be the active breastfeeding partner Mother Nature intended.

The Natural Breastfeeding program prepares pregnant women for breastfeeding with more than 60 short videos and 100 images of diverse women learning about and using Natural Breastfeeding. This interactive program, which mothers can access on their tablets, computers, and smartphones, is mother-friendly, jargon-free, and fun.

Amazingly, science has already weighed in on this 21st century innovation. One 2015 study found that tablet-based prenatal breastfeeding education can increase breastfeeding initiation, duration, and exclusivity. In other words, this modern, high-tech approach works and can help more mothers reach their breastfeeding goals.

Before a pregnant woman gives birth, the demonstration videos and simple exercises in the Natural Breastfeeding program make its concepts clear and integrate its moves into her body memory. Even if her birth attendants are unfamiliar with this approach, after completing this program, a mother should be able to make it work on her own.

Natural Breastfeeding is like the training wheels on a bicycle. While mother and baby are learning, it helps them avoid unnecessary pain, strain, and struggle. By making the most of what baby can do, Natural Breastfeeding helps mothers use the behaviors built in by Mother Nature to successfully feed and nurture their newborn.

Intrigued? To view some of our basic videos, go to my YouTube playlist HERE, our "How-Tos" Prezi HERE, or browse the videos on my YouTube channel HERE.

If a pregnant woman wants to prepare for breastfeeding rather than just planning to breastfeed, she can download this program at www.NaturalBreastfeeding.com.

Please help us spread the word.

Tongue and lip ties are red-hot issues. There’s no doubt that tongue tie causes suffering for some breastfeeding mothers and babies when baby’s "lingual frenulum" (the membrane under the tongue that connects it to the floor of the mouth) prevents normal tongue movement. Also known as ankyloglossia, ultrasound research (link HERE) shows that restricted tongue movement in a breastfeeding baby can lead to nipple pain and/or poor milk intake. When tongue tie is the root cause of a breastfeeding problem, this needs to be addressed pronto.

What is a lip tie? This refers to restricted lip movement from a tight "labial frenulum," the membrane that connects baby's upper lip to her gums. To tell the difference between a normal labial frenulum and one that can cause problems, see this online article (link HERE) by Oregon ear, nose, and throat (ENT) surgeon Bobby Ghaheri.

An Epidemic?

What started as a problem for a small percentage of babies seems now to be an epidemic. Health-care providers report increasing numbers of breastfeeding mothers self-diagnosing tongue and lip ties in their babies, often based on online information, and asking for a tongue- or lip-tie revision, a minor office procedure to release the tie. Some mothers describe taking their babies for multiple revisions with no pain relief or improved milk intake during breastfeeding.

There is very little that is "right" or "wrong" about breastfeeding choices. What matters is whether a strategy brings a mother closer to meeting her breastfeeding goal or moves her further away from it. If self-diagnosis corrects the problem, great. But if it doesn't--if the self-diagnosis is a red herring--it can prolong suffering and lead to complications, making getting back on track more difficult.

Studying Tongue Tie

A recent study (link HERE) offers a new perspective on the tongue-tie epidemic. It found that tongue tie is NOT a common source of breastfeeding problems and reinforced what we’ve always known. When a mother is in pain or the baby’s weight gain is low, the best place to start is by focusing on basic breastfeeding dynamics, such as how the baby latches and baby’s feeding patterns.

What did this new study find? One of the doctor-researchers trained the others to identify infant tongue tie using the Coryllos tongue-tie classification system, which defines four types, including posterior tongue tie. After making sure everyone was using the same definitions, they began visually examining the tongues of 200 healthy babies during their first 3 days of life and used a gloved finger to feel the frenulum under their tongue. During the study, the researchers were blinded to any breastfeeding problems.

What Are the Odds?

Amazingly, 199 of the 200 babies were identified with 1 of the 4 types of tongue tie. However, only 3.5% (7 babies) had breastfeeding problems related to tongue restriction. A tongue-tie revision solved the breastfeeding problem in 5 of these 7 babies.

As a result of these findings, the authors suggested we change our terms. “Short frenulum,” they said, should be abolished, because the frenulum can’t be accurately measured. They suggested the term “asymptomatic tongue tie” for the vast majority of babies (192 out of 199) who had an identified tongue tie and no breastfeeding problems and “symptomatic tongue tie” for the few (7 of 199) in whom the tongue restrictions affected breastfeeding. Clearly, even if a baby has an obvious tongue tie, we should not assume it is the root cause of a mother’s nipple pain or baby’s weight-gain issues. It makes sense in these cases to see if other interventions may help alleviate the problem.

Just to be clear, this study included mothers and babies without breastfeeding problems as well as those with breastfeeding problems. Obviously, among mothers and babies having breastfeeding problems (those seen by most lactation consultants), the percentage of babies with symptomatic tongue tie would be higher.

Why Does It Matter?

If tongue-tie and lip-tie revisions are minor office procedures, why do unnecessary revisions matter? As the researchers point out, complications are rare, but sometimes excess bleeding can occur. Also, the procedure can cost parents hundreds of dollars out of pocket.

But there is an even more important reason this matters. When mothers focus only on tongue or lip tie, other issues may be overlooked and problems can continue for weeks or months. When adjusting to life with a newborn, no family needs this kind of unnecessary stress. In one study, long-term, ongoing nipple pain was linked to depression and sleep problems in mothers. A U.S. lactation consultant colleague who works in a large, breastfeeding-friendly pediatric practice put it this way:

I appreciate the growing awareness of tongue- and lip-tie issues and health providers willing to do interventions. Yet often the diagnosis is coming from friends, Dr. Google, and Facebook discussions. It has become so widespread that many mothers look first to a possible tie and other issues get buried. I now encounter the following scenarios frequently:

1. Mothers who believe their baby has a tongue or lip tie and consider this the primary cause of low supply, failure to latch consistently, weight gain issues, mastitis, nipple pain, etc., etc. They may spend so much time pursuing tongue tie as the root cause that they fail to address other possible causes and find themselves in a bigger jam. They may be dealing with a tongue tie plus something else, but addressing only the tongue tie will not fix things completely. Sometimes there is no tie at all.

2. Mothers with well-gaining, happy, exclusively breastfed babies who experience no discomfort yet feel their baby has a tie that needs to be revised. Some mothers schedule consults for this with me after seeing an ENT doctor who has told them there is no issue. Many say that ENTs and other doctors don't know what they're doing with tongue ties, which in some cases may be true. Yet their ongoing search for a “cure” in the absence of an issue makes breastfeeding fraught with worry, rather than the satisfying and empowering experience it should be.

One Mother’s Story

During my visit to Ireland 18 months ago, I attended a La Leche League meeting. Also attending was an Irish mother coming for the first time. She had taken her 3-month-old baby to the doctor for a tongue-tie revision but was still experiencing nipple pain. The group’s leaders asked me to talk with her. As she breastfed, I noticed an obvious shallow latch. No wonder she was sore!

I asked this mother if she had ever seen a breastfeeding supporter about her pain. She said no. She had gone online, done some reading, and assumed her problem was tongue tie. She then went to the doctor and asked for a tongue-tie revision. Throughout all this, she was breastfeeding shallowly and that hadn’t changed. With a shallow latch, her nipple was compressed against her baby’s hard palate, causing pain. I told her I thought that a small tweak in how her baby latched to her breast was probably all she needed to make breastfeeding comfortable. I explained that there is a place in her baby’s mouth called the “comfort zone,” and when the nipple gets there, there is no friction or pressure.

#1 Cause of Nipple Pain

How often does a deeper latch solve breastfeeding problems? A French lactation consultant checked the records of her private practice during a 6-week period and found that of the 37 mothers who came to her with nipple pain, a deeper latched resolved the pain completely in 65% (Darmangeat, V. The frequency and resolution of nipple pain when latch is improved in a private practice. Clinical Lactation 2011; 2(3):227-24). Other causes of pain included bacterial and yeast infections, skin conditions, and yes, tongue tie.

During my 10 years in private practice, getting a deeper latch resolved pain in about 85% of the mothers I saw. A deeper latch can also improve baby’s milk transfer, giving baby more milk with every suck.

Don’t Assume, Seek Help

Is tongue- or lip-tie revision the right thing to do for some breastfeeding mothers and babies? No question! But because tongue tie is the root cause of the problem for a minority of babies, it is a terrible place for most mothers to start. When nipple pain or weight-gain issues occur, a much better starting point is to contact someone who can help adjust baby’s latch and evaluate baby’s feeding pattern.

Free breastfeeding services are available in most areas through volunteer mother-to-mother support organizations and public health departments. Another option is to see a board-certified lactation consultant (link HERE). Make it a number-one priority to quickly find and address the root cause of the problem. Trying to live with an ongoing, unsolved breastfeeding problem is a type of misery no woman should have to endure. Don't go it alone. Seek help, and always start with the basics.

Mother's question: "I need help! My daughter is a week old tomorrow and I can’t seem to get my milk flow under control. It just pours out and she chokes. What do I do to make it easier for her?"

During the early weeks, while your milk supply is adjusting to your baby’s needs, your feeding position can make all the difference. If you sit straight up during feedings, your milk flows downhill into your baby’s mouth, which makes coping with milk flow more difficult for her. Instead, use positions like those pictured here. Move your hips forward and lean back with baby’s whole body resting on yours so your baby’s head is higher than the breast. In these positions, gravity makes milk flow easier for her to manage. Many mothers also find these positions much more comfortable.

You can read more about these positions at this post.

Lying on your side to breastfeed can also help because baby can let overflow milk dribble out of her mouth rather than having to swallow fast to prevent choking. (Lay a towel under baby first!)

Most important is never to hold your baby’s head to your breast when she wants to pull off and catch her breath. Fingers crossed these tips help!

Here is the latest translation of my Breast Storage Capacity infographic. Thanks to Alison Velasco for her excellent work! French, Bulgarian, and basic Chinese translations of this infographic are also available in the Multimedia section of this website. Just click on this link and scroll down. You have my permission to use them freely. --Nancy