Wed, 16 May 2012 07:47:22 -0800WeeblyWed, 16 May 2012 07:40:10 -0800http://breastfeedinghomevisitservices.weebly.com/5/post/2012/05/is-there-more-than-one-kind-of-tongue-tie.html      As babies reach gestational maturation, the tongue and mouth that were once fused start to separate, freeing the tongue.  In rare cases, a complete separation fails to happen and a small remnant of membrane remains.  A thin remnant can be seen tethering the tip of the tongue to the lower gum ridge.  It is most visible when baby is crying.  This remnant interferes with baby’s ability to extend the tongue to grasp and draw back the nipple in his mouth. This type of tongue tie is called Anterior Tongue Tie.   Anterior tongue ties are released (painless office procedure) in family practice, ENT, dental, lactation consultant and midwives offices.  Anterior tongue tie interferes with speech and feeding and what most people think of when they think of tongue tied.[1]

     A Posterior Tongue Tie is thicker membrane attaching the underside of the tongue to the bottom section of the floor of the mouth.  Although not seen as easily when baby opens his mouth, it can be felt.  Similar to an anterior tongue tie, a posterior tongue tie tethers the tongue down and restricts baby from extending his tongue.   It is also associated with a shallow latch and an inability for baby to open his mouth widely (gape), resulting in mother experiencing sore nipples and baby unable to maintain latch at the breast.[2]  Sometimes a tongue tie is not about the tongue at all but more about the lip!  Upper Lip Tie should be released as well as this interferes with seal at the breast and puts baby at risk for cavities on the surface of his teeth.[3]

     You may notice this little membrane right in the delivery room, as baby takes his first breath and screams loudly (that’s how I noticed my baby’s).  So what should you do?  Ask for an Internationally Certified Lactation Consultant (IBCLC) to work with you in the hospital.  She will examine your baby’s mouth to look and feel for tongue tie.  Not all tongue tie interferes immediately with breastfeeding but if a tongue tie is identified AND mother/baby are having problems related to the tongue tie, it should be released as close to birth as possible.[4]  She may use a Hazelbaker Assessment Tool to check the Function of the tongue.  This assists the IBCLC and parent in making a decision about the urgency of the tongue tie release.[5]

     In accompanying my patients, I have seen office procedures by Dr. Lawrence Kotlow and Dr. Cliff O’Callahan.  Dr. Kotlow is a pediatric dentist located in Albany, New York and Dr. O’Callahan is a family practice doctor located in Middletown, Connecticut.  Although Dr. Kotlow and Dr. O’Callahan both release anterior, posterior, and lip ties, Dr. Kotlow[6] uses a laser where Dr. O’Callahan[7] uses a scissor (snipping) technique.  In both cases, no general anesthesia is used to release lip/tongue ties. This way, “immediately after the frenotomy is done, the infant is placed back on the breast, and the latch adjusted.” According to the AAP Section on Breastfeeding, Congenital Tongue-Tie and Its Impact on Breastfeeding (Coryllos, Watson-Genna, Salloum, ), only rarely is a general anesthetic needed when a frenuplasty (transverse cutting and vertical repair) is needed rather than a simple anterior to posterior snip (frenotomy).”[8]

     Once the release is done, it is important to initiate suck training to encourage this once restricted tongue to move past the gum line.  Gentle jaw massage, as well as sweeping under the tongue and lips, relax the muscles and allow the baby to open wide (gape).[9] If you suspect that your baby has tongue tie, please call for an evaluation by an Internationally Board Certified Lactation Consultant (Find a Lactation Consultant http://www.ilca.org/i4a/pages/index.cfm?pageid=3432). The earlier a simple problem like tongue tie is identified, the sooner you and your baby will be able to enjoy your breastfeeding relationship.


[1] Bryson, P. (2008). Breastfeeding after breast reduction and tongue-tie. Retrieved from http://www.llli.org/nb/nbjulaug08p27a.html

[2] Genna Watson, C. (n.d.). Is my baby tongue-tied? Retrieved from http://www.cwgenna.com/qhcontent.html

[3] Knox, I. (2010, September). Tongue tie and frenotomy in the breastfeeding newborn. Retrieved from http://www.lunalactation.com/KnoxTT.pdf

[4] Fernando, C. (1998). What is tongue tie?. Retrieved from http://www.tonguetie.net/index.php?option=com_content&task=view&id=2&Itemid=2

[5] Pediatrics. (2002). Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Retrieved from http://pediatrics.aappublications.org/content/110/5/e63/T1.expansio

[6] Kotlow, L. Pediatric dental care. Retrieved from http://www.kiddsteeth.com/articles/websitettlnbew.pdf

[7] O'Callahan, C. Fit to be tied. Retrieved from http://www.ct-aap.org/111020/Dr.OCallahan-PowerPoint.pdf

[8] Coryllos, E., Watson Genna, C. & Salloum, A. (2004). Congential tongue-tie and its impact on breastfeeding. Retrieved from http://www2.aap.org/BREASTFEEDING/FILES/PDF/BBM-8-27 NEWSLETTER.PDF

[9] Vallone, S. (n.d.). Jaw & tongue home care instructions. Retrieved from http://www.kidspaceadaptiveplay.com/#!exercises

]]>Wed, 16 May 2012 05:49:53 -0800http://breastfeedinghomevisitservices.weebly.com/5/post/2012/05/what-is-an-ibclc-anyway-sounds-like-alphabet-soup.htmlWhat is an Internationally Board Certified Lactation Consultant?

IBCLCs have years of training and continuing study to enable them to inform, assist and support women during pregnancy, early days after birth and as the baby grows, including: getting off to a good start with breastfeeding, continuing to breastfeed after returning to work or school, breastfeeding a premature or sick infant, and preventing and managing challenges that might occur.

IBCLCs also train and support other health workers and educators so that they may assist mothers in the present and in the future. IBCLCs develop health programs and campaigns too.

According to Cathy Carothers, President of the International Lactation Consultant Association, “How an infant is fed can have a lifelong impact on their health. Mother’s milk helps develop a strong immune system that can respond to fight off infections. The rising incidence of obesity and diabetes will have a major impact on health, and both these conditions are more likely to develop in children and in mothers when babies are not breastfed. IBCLCs make an impact on the quality of breastfeeding care provided by health services where they are employed and thus an impact for children and mothers.”

As allied health care professionals with the only internationally-recognized certification for professional lactation services, IBCLCs work in hospitals, clinics, public health agencies, private practice, community settings, government agencies, education and in research. There are currently more than 25,000 IBCLCs in 90 countries worldwide who are certified by the International Board of Lactation Consultant Examiners (www.iblce.org) under the direction of the U.S. National Commission for Certifying Agencies.

Pregnant woman, parents or health workers can find an IBCLC near them by visiting the International Lactation Consultant Association’s website at www.ilca.org and follow the “Find a Lactation Consultant” link where they can search for an IBCLC by postal code, city and state, or country. The International Lactation Consultant Association (ILCA) is the professional association for IBCLCs and other health care professionals who care for breastfeeding families.

ILCA’s mission is to advance the profession of lactation consulting worldwide through leadership, advocacy, professional development, and research. With the vision of a worldwide network of lactation professionals, ILCA provides members with numerous resources and professional development opportunities that enhance their ability to provide optimal care to breastfeeding families.  

For more information about ILCA, visit the website at www.ilca.orgor contact the ILCA Office at            +1 919 861 5577       or info@ilca.org.For more information about IBLCE, visit www.iblce.org 


Appeared in the Patch on 3/7/12]]>Wed, 16 May 2012 05:48:05 -0800http://breastfeedinghomevisitservices.weebly.com/5/post/2012/05/why-cant-we-play-nice-in-the-sandbox.htmlHamden Patch, North Branford Patch and Branford Patch collectively did something for women last week that I have never seen before.  They publicly displayed the Universal Breastfeeding Symbol and wrote in support of breastfeeding.

One blog, Nursing No-No by Doreen Currie and It's Ok, Feed Your Baby by yours truly, were coincidentally featured on the same week.  Most comments came out in support of a woman's right to breastfeed in public or on Facebook. Some did not. 

The most noticeable argument was not about whether or not a woman should breastfeed but about HOW she should breastfeed – cover up, stay inside, let people stare etc.  It started me thinking about how freely judmental we can be about how others parent their children. 

This applies not only to the choice of breastfeeding but other decisions parents have to make.  Cloth vs disposable, organic homemade vs jarred store-bought, vaccines or anti-vaccine, medications or diet. 

According to Irene S. Levine, Ph.D, a psychologist and award-winning freelance journalist: 

"Unfortunately, some mean girls never grow up, continuing similar behaviors as adults. So the insidious practice of woman-on-woman bullying – often used to dominate and control subordinates or colleagues – is common in the workplace. Similarly, stay-at-home moms are still victimized by frenemies and neighbors. They and their kids become the subject of gossip, and are systematically excluded from play dates, playgroups and birthday parties. This is a particularly pernicious form of bullying because it attacks not only a grown woman but also her child." (Psychology Today Aug 13, 2010)

I wonder if the same phenomenom happens amongst fathers. Do they whisper about the clothes other children are wearing or if a baby has gone to long without giving up his binky?

When we first become pregnant, we start planning on how WE are going to parent? But can every way be the right way?  Or are there too many "children" the sandbox?


Appeared 3/1/2012 in the Patch http://branford.patch.com/blog_posts/why-cant-we-play-nice-in-the-sandbox 
]]>Mon, 20 Feb 2012 14:53:55 -0800http://breastfeedinghomevisitservices.weebly.com/5/post/2012/02/first-post.html As I was scanning through posts and pictures on Facebook, I found an image that looked like many women I know.  Many women just like me. Educated, hard-working, trying to do-it-all Mothers.  Two women breastfeeding their babies while trying to get ready for a photo shoot for a magazine. I was intrigued by the casual matter-of-fact tone to this campaign and decided to share it with an audience of facebook viewers that were not my "friends."

     I posted this picture on WTNHs wall on 2/10/12 http://www.facebook.com/photo.php?fbid=10150514122946324&set=o.48010180735&&ref=nf. I was suprised when at one week's time, there are over 70 comments, 135 shares and 320 likes.  Some commented on whether or not breast was showing. Some commented on the ages of the babies.  Most comments were support of a woman's right to breastfeed in public.

     According to Louisa Currie (with her then 19 month old son Zac on the right), "the image that's been used came about because we were having some shots done for a magazine article on Mums in Business (or Mumpreneurs as we call ourselves) and both our boys wanted to have a feed. Originally the shot was only ever going to be for our private albums but on compiling the survey results we just felt compelled to do something to reassure other Mums that it really is ok to feed your baby, whenever they need to be fed!" http://bellybeyond.blogspot.co.nz/2010/08/extended-breastfeeding-shot-makes-it.html

     According to The American Academy of Pediatrics, "Newborns should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing, or rooting" and "It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired. AMERICAN ACADEMY OF PEDIATRICS, Work Group on Breastfeeding Breastfeeding and the Use of Human Milk (1997)

     So you may say, but that's in New Zealand.  A country known to be breastfeeding friendly.  But here in Connecticut, USA, we just recently celebrated the 4th CT hospital to receive the Baby Friendly Hospital Initiative.  That seems like a good start on a road to becoming a breastfeeding friendly state.  We even have laws to protect woman from being harrassed while breastfeeding in public.  But is protecting a woman from harrassment for public breastfeeding the same as APPLAUDING her for breastfeeding in public?

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