Nipple Shields

Nipple shields are a shaped, thin silicone breastfeeding tool that goes over the mother’s nipple and some or all of the areola, creating a barrier between the breast and the baby’s mouth. The aim is to help breastfeeding continue in situations that either make it difficult for the baby to latch/feed, or cause pain and discomfort for the mother.

According to The Breastfeeding Atlas 5th Edition (Barbara Wilson-Clay and Kay Hoover), written descriptions of nipple shields appeared over 500 years ago – so they are not necessarily a modern invention.

Some studies suggest that nipple shields don’t alter infant sucking patterns (Woolridge 1980), but the fit of the shield in both height (Drazin 1998) and diameter (Zeimer 1993, Stark 1994, Zeimer 1995, Ramsay 2005) is important to the success of use – both needing to be taken in to account to get a good fit for the baby’s anatomy as well as the mother’s breast and nipple shape. A study of preterm infants (Meier et al 2002) showed that milk transfer with a nipple shield was significantly higher than without.  Using a nipple shield can help a baby transition from bottle to breastfeeding, and can “buy time” for a mother who is ready to wean due to breastfeeding problems. A small study (Chertok 2009) showed that 67% of the women said that using shields allowed them to continue breastfeeding, and that there was no statistical difference in weight gain over 2 months. However, according to Dr Jack Newman’s Guide to Breastfeeding, nipple shields create more problems than they fix and decrease milk supply; he believes mothers would be better to give expressed milk in a bottle.

Either way, a nipple shield should not be the first intervention used for problems with breastfeeding, but rather a tool for consideration after other suggestions have been tried. Nipple shields have been shown to be useful in situations such as flat or inverted nipples, disorganised suck and sore nipples (Powers & Tapia 2004).

Which one?
There are a few brands and shapes of nipple shields available. Often the selection comes down to what works and is easily available in local stores. Most are very similar in design. Some a circular silicon “base” that sits over the areola, while others have a cut out section on one or more sides.

Above are four common styles of nipple shield from three different brands. Each brand has it’s own range of sizes; some available in small (15mm) or standard (21mm), others in medium (20mm) and large (24mm), or simply 16mm, 20mm or 24mm. The size is the measurement at the base of the nipple shape, where it joins the base. However, from the pictures above, it is fairly easy to see that the nipple shape and size varies from brand to brand as well. It’s important to pick a shape that will fit your nipple AND your baby’s mouth as well as possible. Your nipple should not feel squeezed across the width or be rubbing against the end of the shield.

What to avoid
The aim of a nipple shield is to provide some protection to the mother’s nipple from trauma caused by the way the baby is feeding, or to assist a baby to latch better than they can naturally, while a solution is found to the cause of the trauma. The shield is there to provide assistance and protect breastfeeding, however some nipple shields are designed specifically to keep the baby’s mouth as far away from the nipple and breast as possible. These types of shields do not support breastfeeding at all, and can lead to the rapid end of breastfeeding. To remove milk efficiently, the baby must take the nipple and a good mouthful of breast tissue in their mouth. A nipple shield that prevents the baby from doing this should not be used. Nipple shields that look similar to those in the pictures above are usually supportive of breastfeeding, however if the shield looks different from these, or similar to a bottle teat on top of a base, then seek further advice from your lactation consultant or breastfeeding support specialist first.

How to apply the shield
It can be a bit of trial and error to see what works best for you and your baby. It can be frustrating to get a shield applied and then have it fall off as soon as your baby gets close! There are a few ways, some people find applying a little breastmilk to the underside of the base of the shield can help it stick a little, others prefer warm water. Two ways that seem to generally work well are shown in the video here:

The first is to simply turn the base area of the shield upside down so the shield looks a little like a sombrero. Hold the tip of the nipple part, centrally position the nipple part over your nipple, pushing the shield down quite firmly over and around the edges of your nipple, and then with the other hand, smooth down the base area over the areola/breast.

The other way is similar, but the nipple shield is turned part way inside out, with the base area being turned further up the sides of the nipple shaped part. Apply the shield centrally over your nipple, pushing down quite firmly over and around the edges of your nipple. Use your other hand to smooth down the base of the shield over the areola/breast.

It can sound a little tricky, but once you’ve done it a few times, it will become easier.

Feeding with the shield
The same “rules” apply when feeding with shield as they do without. Your baby needs to be close to you, your baby’s tummy facing your tummy, starting with your nipple just above the baby’s top lip, waiting for a wide gape, and then bringing your baby tight into your breast to latch with their chin touching your breast first: tummy to mummy, nearly nose to nipple, chin first. If you are having trouble latching your baby or your nipple shield prevents your baby from having a deep latching and being close to your breast, speak to your midwife, well child nurse, lactation consultant or other breastfeeding support specialist. You may also find these links helpful:

Cleaning and storage
Most of the shields come with a small storage container, but if not, any small container will do fine. When you have finished feeding, if it’s not comfortable to leave the shield in place for a few minutes, it can be a good idea to put the shield in the container just in case your baby decides they would like a little top up before they finish. Once you know your baby has finished feeding, you can wash the shield in warm soapy water and air dry. When you are out and about, it should be fine to wash the shield in warm soapy water, rinse well and store in its container for use again until you are home and able to re-wash and air dry.  You don’t need to have several packs of shields for days out. Providing your baby is generally healthy, not premature, and doesn’t have any health issues, it should be safe not to sterilise, however if you decide to sterilise nipple shields, do not use solutions such as Milton as it concentrates in the silicone.

Is it working?
The easiest ways to know your baby is getting enough milk is by weight gain and nappy output! If your baby is gaining good weight, they are getting enough milk. If your baby is having lots of wet and dirty nappies, then they must be getting milk too. If your baby’s weight gain has been a concern prior to using nipple shields, then it might be worth arranging with your midwife or well child nurse to weigh your baby in a couple of days to see how things are going. If you have been concerned about milk supply, then it can be useful to express after feeds for a few days until you feel your supply has increased and your baby’s feeding has improved. When your baby is feeding well with the shield you should see evidence of milk in the shield, your breasts should feel softer and emptier after feeding, and your baby should finish the feed looking relaxed and satisfied, often their hands will be soft and relaxed by that point.

If you are concerned that your baby is still not getting enough milk, speak to your midwife, lactation consultant or other breastfeeding support specialist. Expressing and feeding your baby with expressed milk can help your baby’s weight gain in the interim, giving them more energy to attempt breastfeeding again in a few days, at the same time helping to maintain your supply.

What next?
If your baby is feeding well with the shield – good weight gain and milk supply not compromised in any way – there is no need to rush to stop using them. The most important thing is that your baby has a good deep latch when feeding, and doesn’t use the shield like a straw or teat, with a shallow latch; this can lead to low weight gain and a reduction in milk supply. The shield will not fix whatever was the problem in the first place, it is simply a tool to help maintain breastfeeding while the source of the problem is resolved.

If your baby had a shallow latch that caused damage to your breasts leading to the use of the shield, then the shallow latch still needs to be resolved. Removing the shield without solving the issue will lead to the same problems returning.

Once you feel that feeding is going well and issues have been resolved, you can start to see if your baby is happy to feed without the shield. Some babies are happy to do so, others take more time, and some will happily continue with the shield for their entire time of breastfeeding – even if that is months or years. Some tips to try when weaning from a nipple shield are:

  • Have lots of skin to skin contact when feeding your baby, allowing your baby to use their natural instincts to find the breast
  • Remove the shield part way through the feed
  • Feed your baby as soon as he wakes
  • Feed at the earliest feeding cues while he is still calm
  • Try feeding in a different position, or even standing up and walking around
  • Express a few drops of breastmilk so your baby can taste milk immediately

If an attempt to feed without a nipple shield is not successful, try not to feel stressed or anxious, stay calm and continue the feed with the shield. Attempts to persist and force your baby to feed without the shield makes feeding stressful and unsuccessful for both of you.

The Breastfeeding Atlas 5th Edition 2013 Barbara Wilson-Clay, Kay Hoover
Guide to Breastfeeding 2014 Dr Jack Newman
Counselling the Nursing Mother – a Lactation Consultant’s Guide 5th Edition
Breastfeeding Answers Made Simple 2010 Nancy Mohrbacher

Going back to work or study? How’s that going to work?!

Returning to work or study and having to leave your baby with someone else can be a hard decision, and having to work out how, or if, you can continue to provide your baby with breastmilk can be an added worry, that at times can almost seem one thing too many to have to work out.

If you have time to plan for your return to work or study, then that can be helpful from both a practical and emotional point of view. After the first few weeks a mother’s milk supply is generally well established and therefore more robust and able to cope with changes to feeding routines.

So what can you do to make the transition as easy as possible?

  • Talking to your employer before you go on maternity leave is a great idea. Although you may not be certain that you are going to breastfeed at all at this stage, if you make the assumption you are going to, and plan accordingly, then you will have set the stage for a return to work/study as a breastfeeding mother. This can give both your employer and you time to think about what you would need when you return to work: breaks to express or go and feed your baby, somewhere to feed/express, and somewhere to store breastmilk are a few things you might want to consider.
  • Talk to friends who have returned to work or study while breastfeeding their baby. What did or didn’t work for them? What could you do differently that might help it work for you?
  • Think about who is going to look after your baby for you, and where that is in relation to where you are working/studying. Is the childcare facility close enough to work that you can go there to feed your baby or will you need to provide expressed milk to be given to your baby? Can your baby be brought to you during the day so that you can feed your baby at work/study?
  • If you are not going to be able to be breastfeed your baby directly during breaks, how is your baby going to be fed your expressed milk? If your baby is quite young, then you are likely to want your baby to be fed with a bottle, however if your baby is a bit older, then you may find that they are able to drink milk from a cup.   Feeding a baby from a bottle is a bit different than breastfeeding, but there are tips for bottle feeding babies in a breastfeeding friendly fashion: letting the baby have control over when they stop/start, giving them breaks, feeding them held on both the left and right sides… just as they would do when breastfeeding. More information can be found about this here:
  • Some mothers find it useful to have a trial run. Go out for a few hours just as if you were going to be at work and let someone else feed your baby your expressed milk. This will give you the opportunity to see how your breasts cope with your expected expressing routine. Sometimes the trial can work really well, but if your baby decides that they are not going to take expressed milk without a little protest, it can end up making things feel even more difficult! Some babies will hold out for breastfeeding and will take enough expressed milk to stay hydrated and comfortable, and then feed lots and lots when they are back with their mum. Older babies can be given expressed milk mixed with food too, or frozen into little ice blocks. If your baby does seem a little reluctant to take expressed milk, it can be useful to provide expressed milk in small quantities; this enables the carer to heat just a small amount of milk each time rather than prepare a larger quantity only to throw it away!
  • It can be useful to start expressing before you return to work or study. This can help you get used to expressing – even with copious quantities of milk, it can be hard to express. It can also be useful to have some extra milk in the freezer in case your baby drinks more than you expected, and to cope with growth spurts if you are unable to express extra at work. It is common for babies to take more from a bottle than they would necessarily have when drinking from the breast. This is due to the faster and easier flow of the milk from even a slow flow teat.
  • Think about what you need to take to work with you to make expressing as easy as possible. Sometimes having a picture of your baby, or one of their small blankets can help; thinking of your baby, thinking of them feeding, thinking about milk flowing… all these things can help when you express. In the first few days back to work you may feel more engorged than usual, and you may leak breastmilk, even if you haven’t done for a while… especially if you think of your baby. Taking extra breast pads to work may be useful, or even having a spare top with you just in case! Wearing dark tops helps hide any damp patches too!
  • Aim to feed your baby as soon as you wake up (you may need to get up a bit earlier than usual), even if your baby is still sleepy. Feed again if you can before you leave home, otherwise at your baby’s daycare before you go to start your workday.   If you are able to, go to your baby to feed them at lunchtime. Feed your baby again at daycare when you collect them at the end of your day, then on demand when you are at home. This can help to maintain supply and minimize the amount of expressing you need to do during the day.
  • Make sure you continue to eat healthily and drink to thirst – there is no need to drink extra water. It can be easy to forget in the rush to get to work, express, do your work and get back to your baby.
  • Over time, you may feel that your supply is dropping. However, it is likely that when you are with your baby you will have plenty of milk to breastfeed. Effective expressing when you are away from your baby will help to minimize the risk of a drop in supply. It can help to use a combination of expressing with a pump and by hand – often, extra milk can be removed by hand after using a pump. Once your supply is well established it can be quite resilient and over time can adjust to breastfeeding more on certain days of the week than others. So even if you feel your supply has dropped, it may be that it is reduced on work/study days, but perfectly adequate at the times you are with your baby, especially if you are able to feed on demand when you are with your baby.

Keep talking to your employer once you have had your baby.  If you feel uncomfortable about starting the conversation, it can be helpful to send an email with your ideas and thoughts about how you would like things to work.  It may be that you can make the move back to work or study in stages so that you can start with shorter or less days per week, gradually working up to the hours you will be working long term.

Working and Breastfeeding

The thought of having to go back to work is enough to make many women think really hard about whether the effort sometimes needed to get breastfeeding going is worth it… for those who have to go back to work in the first 3 months it can seem that as soon as things start to settle down, the whole thing has to change again to fit in with work.

For those who struggle in the first weeks of breastfeeding, it can seem that it’s just not worth the pain and turmoil.

Some mothers are lucky enough to be able to take 6 months or even a year or more off before they have to go back to work.  But even then, once breastfeeding is well established and it becomes the way of mothering your baby in all situations, it can be hard to know how it’s all going to work once you have to leave your baby with someone else…

Should you give expressed milk?   Can you even express enough for your baby?  What if your baby won’t take a bottle?  What if your baby takes a bottle but then refuses to breastfeed?   What if you have to give formula – which one should you use?  What if your baby doesn’t like formula?

I don’t think there is an easy answer to any of these questions – every baby and mother is unique, and even in the same family I think most mothers find that each of their babies is a little different and has their own cute personality and way of doing things.

The theme for this year’s World Breastfeeding Week is “Breastfeeding and Work – Let’s Make it Work!”

There is more information here but I’m really hoping that the theme this year will get lots of people talking about the normality of breastfeeding, and how important it is to work better to accommodate mothers who will be returning to work while still breastfeeding their baby.

Our local health and breastfeeding networks are going to be speaking to employers and mothers about how things could be improved and hope to have some great stories to share nearer the time.


Was that a diagnosis I heard?!

I’ve heard a few people getting quite hot under the collar because individuals are “diagnosing” conditions in mothers and babies who are just not qualified to do so.  But I can’t help wondering – are those people really making a diagnosis or are they just talking openly to parents about a variety of situations and conditions before suggesting that they visit a GP or other medical professional to get a diagnosis?

Imagine you are a stressed/tired/anxious (all of the above) parent of a baby and things are just not going well.  You visit your well-child provider, peer supporter, LLL group, breastfeeding counsellor, a n other person, and talk about what’s going on.  They listen well, they encourage you to explore how you are feeling, what’s happening now, what happened prior to the current situation, they show empathy and understanding of how you are feeling, they discuss things that could be going on with you and/or your baby, and suggest you go to your GP/other medical professional to find out one way or the other if a particular condition exists.

So, you go away feeling relieved that it’s not all in your head or because you are doing something wrong.  You visit your GP/medical professional and they say “oh yes, that thing you discussed with that person – yes, that’s what’s happening, we can fix that”.

Yay!  Someone who listened suggested a couple of things to you and that enabled you to have a discussion with a medical professional about the situation, who then pinpointed the problem and helped you fix it.  Thank goodness that lovely person who helped you first could tell you what was wrong… thank goodness they were able to diagnose the colic/reflux/thrush/vasospasm/tongue tie/lip tie/food intolerance etc….

But they didn’t actually diagnose anything.  They listened, they discussed options, they gave you some space to air your concerns and talked about the things that can sometimes happen.

I don’t know how many times I’ve heard a parent say “but they told me I have to do xxx, and it’s not working” or “she said that my baby should be sleeping xx hours/feeding xx times/putting on xx grams…”

We humans sometimes hear things in a way that wasn’t intended when it was said.  Sometimes that’s due to poor communication skills and sometimes because different words mean different things to different people.  Most people try to clarify understanding when they are working with parents, but even then there can still be misunderstanding.

Next time you hear or think someone diagnosed something when they shouldn’t have done – maybe they didn’t.  If, like me, you are working with mothers, remember that what you say isn’t always what is heard… and accept that sometimes you can’t do anything about that, but be aware and just keep trying… I try to remind myself often, but I bet I often get it wrong too 🙂

This is a fabulous article written by Diane Wiessinger in 1996.  It’s all about the language used in relation to breastfeeding – Watch Your Language


So you’re going to be a grandparent…

A new baby on the way? Congratulations! Of course you are going to want the very best for this new member of your family, as well as for your daughter, daughter-in-law or son’s partner too. No matter whether you are becoming a grandparent, step grandparent, great grandparent, great aunt or uncle for the first or the fourth time, you will be feeling very proud and excited about having an important role to play in this little person’s life.

You are probably reading this because you know the baby is going to be breastfed. Perhaps breastfeeding isn’t something you know much about, or maybe you didn’t breastfeed your own children. It’s likely that lots of things have changed since you had your babies… perhaps they were born in a different country, your children may have a different lifestyle to your own, perhaps they have partners from different cultures, religious backgrounds or speak other languages… it can be a lot to take in! And now there is a new baby too, you might find you have even more different ideas!

After the baby is born

In the first few days after birth a baby will want to breastfeed every time he’s awake. At this point in time, a mother may only have time to feed the baby, eat and sleep. This is normal and a mum and her baby will want to spend all their time together. The mother needs to be close to her baby at all times in order to feed often, and the hormones of a breastfeeding mother means there is an intense emotional and physical connection between mother and baby. By meeting their baby’s needs immediately a mother helps her baby to develop a secure attachment with her which helps him to grown into a confident child.

Why breastfeed?

Breastmilk is normal – human milk is made for human babies, formula milk is artificial.

Although formula milk is adequate for babies it is not equal to breastmilk. Breastmilk contains many things that cannot be made in a factory: living cells, antibodies, hormones, active enzymes… breastmilk changes to meet the growing needs of the baby and the environment the baby is in. If the baby or mother is exposed to an illness, then the mother’s breastmilk will contain antibodies to help protect the baby. Breastmilk changes throughout the day and contains flavours from the mother’s diet. Formula just can’t do these things – it is a static product. Human babies are born with immature brains that need to grow rapidly, whilst physical growth is much slower. Breastmilk contains all the ingredients necessary to achieve this. Cow’s milk, on the other hand, is designed for the fast physical and muscular growth required by calves.

Even in the modern western world we live in, babies who are fed formula milk are more likely to be hospitalized due to gastroenteritis, and are at higher risk of developing diabetes, cancers, obesity and other modern diseases as children and adults. 

Baby led attachment and skin to skin

In recent years research has shown that babies have an inborn ability to move and attach themselves to their mother’s breast – baby led attachment. Whether the baby is born in hospital or at home, it is likely that the baby will be placed on the mother’s bare chest immediately or soon after birth and allowed to spend some time resting and getting to know his mother – this is called skin to skin and helps to triggers the baby’s natural reflex to feed. You will often see the baby bobbing his head around, falling, crawling or even throwing himself towards his mother’s breast. The baby uses his sense of smell and his cheeks to help find his mother’s breast. These instincts remain strong for several months after the baby is born. The baby’s sense of smell is the most developed sense at birth, so it is important for the baby and his parents to stay close in the first 24-48 hours to get to know each other – the smells of other people can be confusing at this time, and you may find that for the first day or two, new parents don’t want anyone else to hold their baby… including you. This may feel frustrating and unnecessary to you, but try to remember it is only for a day or two and then you have a whole lifetime of cuddles and fun to enjoy. Perhaps you can stay close by and give the new mother and father a hug while they hold their baby until the time is right for you to have that precious, first cuddle.

Feeding on demand

New breastfed babies often seem to be feeding often, with little thought of routine or spacing feeds. This could be quite different to the way you were shown to feed your baby, especially if formula was part of your baby’s diet. In the early days a mother’s milk supply is mainly controlled by hormones. Over a few weeks this gradually switches to being controlled by the breasts. The process of supply is managed based on how much milk is removed from the breast and how often. It’s important to feed to meet the babies demand as this allows the breasts to work to produce milk to match each individual baby’s hunger and feeding pattern.   As the baby grows he may go through phases of feeding more often for a day or two. This is the baby’s way of telling the supply process that he is hungrier and needs more milk to meet his growing needs. The breasts respond to the increased demand by increasing the quantity of milk being made. When you think of how this supply and demand process works, it’s easy to see why many women in the past found a 4 hourly feeding routine could lead to milk supply not being adequate to meet their baby’s needs. If your grandchild seems to need feeding often you can help support your daughter (in law) by encouraging her to trust her body’s ability to nurture her baby and feed as often as she needs to. You might be able to help by putting on a load of washing, cooking meals or helping with older siblings. 


Having a new baby is very tiring, as you will remember yourself. All babies wake at night and often continue to do so for several moths. Breastfeeding at night helps maintain milk supply, helps with bonding and can be a time for quiet, peaceful breastfeeds. Hormones produced in breastmilk and in the mother herself help baby and mum get back to sleep more quickly after breastfeeding. Encouraging a new mum to sleep or rest during the day when her baby naps is a good way for new mums to catch up on a little rest in the early days and weeks. This can be hard for many new mothers to do, but if you are able to help with keeping the house clean and tidy, do some shopping and cooking, then it can be easier for your daughter (in law) to rest when her baby does. 


The action of breastfeeding is quite different to the sucking action when using a bottle or pacifier. Some babies are confused by the different sucking action. It is better for the baby and mum if breastfeeding is well established before considering giving bottles or other teats. Once the baby is breastfeeding well (usually after a couple of months), then it may be possible to give the baby a bottle of expressed breastmilk. If a baby is encouraged to suck a pacifier to settle it can lead to less milk being taken from the breasts leading to a reduction in milk supply. Many mothers choose to soothe and comfort their baby by breastfeeding rather than with pacifiers. Being able to offer the breast as a way of comforting and soothing an upset baby or child is a wonderful parenting tool that many mothers come to cherish as time goes on. 

Feeding in public

These days women are able to feed their baby pretty much anywhere they want to. Once a new mum has had a bit of practice feeding her baby it is quite possible to feed comfortably while out and about, however it can be a daunting prospect the first few times! If your daughter (in law) feels she has your support then she will feel comfortable feeding in front of you and other family members. Once your daughter (in law) feels ready to go out with her baby you could offer to go with her to give her some moral support while breastfeeding in public. Mothers usually notice as soon as their baby starts to show feeding cues and are able to start feeding before their baby becomes upset. This means that most of the time people only notice a mum and baby snuggled up together – often they don’t even realize the mother is breastfeeding.






Tongue Ties – what’s it all about?

Tongue Ties – or ankyloglossia – just what are they and why do they cause problems for some mothers and babies, and not others?

As soon as you start to talk to people about tongue ties you realise that it’s a bit of a contentious topic; some people think they are over-diagnosed, others think they don’t exist, others have never heard of them.  So why the confusion?

What is a Tongue Tie?
Between the 4th and 7th weeks of development a baby’s oral cavity develops and tissue in the mouth (and other areas of the anatomy) goes through a process of growth and regression. During this process the tongue forms and separates from the floor of the mouth leaving the frenulum – the piece of skin that attaches the tongue to the bottom of the mouth. In some babies the frenulum doesn’t separate as much as it could do, potentially resulting in a tongue tie.

If the frenulum is too tight  it impacts the baby’s ability to use his tongue to feed effectively – this can impact breastfeeding and and to some extent bottle feeding as well, potentially causing future problems with oral health and development, speech, digestive problems, and others.

A visible frenulum is quite normal, but if it is too short or thick, or attached to the floor of the mouth in a less than ideal position, it may cause problems – but every baby and mother needs to be assessed on an individual basis, in person. Ties cannot be assessed simply by looking at a photograph of the inside of the baby’s mouth, or just by looking at what the baby looks like when feeding. Assessment is a combination of many factors.

Why do they occur?
There doesn’t seem to be a consensus of opinion on this.  There has been discussion about a gene that may be responsible, and whether or not folic acid has a role to play. There does seem to be a higher chance of a baby having a tongue tie if there is a family history of tongue tie though, and often if one child in the family has a tongue tie, it’s not uncommon that their siblings do too.

What does a tongue tie have to do with breastfeeding?
When a baby breastfeeds he needs to be able to keep his tongue forward over the bottom gum, use the tongue to cup and grasp the breast, bringing the breast tissue far enough back in the his mouth to ensure that the nipple is not squashed between the tongue and hard palate, and create the vacuum in his mouth that results in the milk flow from the breast.  If the movement of the tongue is compromised in any way then some or all of these activities can be more difficult.  The baby’s tongue should be able to work in a rippling type of movement that carries the milk from the front of the baby’s mouth to the back for swallowing.

If a baby is tongue tied some mothers experience pain that cannot be managed by improved positioning and latching, the nipple may be squashed or grazed by the tongue causing bruising and/or bleeding, cracked nipples; the baby may not gain weight well as he is unable to remove milk efficiently from the breast, leading to low weight gain, or a sleepy baby due to insufficient calorie intake.  Sometimes the baby may not gain weight well, but the mother may not experience any pain.  In some cases all seems well for the first few weeks.  The mother naturally has an abundant milk supply and the baby is gaining weight well.  However, as supply becomes dependent on the baby removing milk from the breast well (rather than hormonally driven as in the first few weeks), the baby’s weight gain starts to drop and the mother notices a decrease in milk supply.  All of these things MAY be an indication that the baby has a tongue tie.

How do you know if there is a tongue tie?
If a mother is having problems with painful breastfeeding, or the baby is not gaining weight sufficiently, then the first thing to do is check that the baby is positioned well at the breast and is latching well.  Many painful breastfeeds can be rectified by improved position and/or latch.  However, if things cannot be resolved this way, then the possibility of tongue tie should be investigated.   Tongue ties are generally deemed to fall into one of four classifications:  I, II, III and IV.  The first two tend to be easier to see and involve the tip of the babies tongue being restricted.  These are often called anterior tongue ties. However, tongue ties are diagnosed by both appearance and function – some tongue ties just don’t cause problems for feeding and may be left alone if the parents prefer.  Many practitioners use a combination of assessment tools such as the Hazelbaker, BTAT or TABBY assessments – all include looking at both appearance and functionality of the tongue in the breastfeeding baby.

Why are tongue ties more common these days?
It’s not clear why tongue ties seem to be occurring more often, or even if they really are more common – it could be that we are just hearing more about them than we used to. You may have heard stories about midwives in the past keeping a finger nail long to cut them as soon as the baby was born. As formula became more of the “norm” for babies, and for a while was believed to be scientifically superior, it was easier to switch babies to bottle feeding and the tongue tie was less of an issue. It is likely that due to more mothers wanting to breastfeed, and generally having access to better and more easily available breastfeeding help, tongue ties are again being recognised and dealt with.

How do you fix a tongue tie?
The procedure of dividing a tongue tie is called “frenotomy”.  There are a number of ways of carrying out a frenotomy – laser, scalpel, diathermy.  Laser is more expensive than scalpel or scissors.  Some midwives and lactation consultants perform frenotomies, in other areas GPs or paediatric dentists will carry out the procedure. With scissors or a scalpel the tight frenulum is usually cut in one or two places to relieve the tongue and allow normal movement.  There is usually very little bleeding – the risk of excessive bleeding and infection is deemed to be very low.  Usually a small piece of gauze will be placed against the cut area for a few seconds and then the mother encourage to feed the baby.  With laser, the tight frenulum is removed and there is usually very little bleeding. The baby is often not upset by the procedure itself, but often doesn’t enjoy adult sized fingers being poked in the mouth and under the tongue during the process.  Some mothers report immediate improvement, however most babies take more time to get used to the new mobility of their tongue. Tongue exercises are reported to help many babies learn to use their tongue more efficiently and effectively:

There is more and more evidence to support taking tongue tied babies to an osteopath or craniosacral therapist. Ties can result in tightness in the baby’s jaw, neck, and shoulder areas, which can exacerbate feeding problems. It is becoming more common for mothers to be advised to see bodywork for their baby before and after a tie has been revised.

There are times when what looked and behaved like a tongue tie, is actually resolved by body work. This was reported by  Alison Hazelbaker a few years ago, and has led to more practitioners advising bodywork prior to tongue tie treatment.

Once the tongue tie has been divided, it’s always worth going back to your breastfeeding support person to ensure positioning and latching is optimal.

References/further reading:

Is my baby getting enough milk?

This is a question that many mothers ask themselves at some point during the time they are breastfeeding their baby.

Often the frequency of a baby’s feeding habits can be a surprise for new parents and without the right support and information it’s easy for a mother to feel she hasn’t got enough milk for her young baby’s growing needs.  Many women I speak to worry about not having enough milk, and I often hear that well-meaning friends and relatives have commented on how the baby should be made to wait for 3 hours, or sometimes longer, or to top up with a bottle of milk after a breastfeed.  Unfortunately this advice, if followed, actually has the opposite effect on the mother’s milk supply, and therefore the baby’s growth too.

On average, a baby born at around 40 weeks of pregnancy can only fit around 5mls (a teaspoon) of milk into his or her tummy in the first 24 hours of life.  This increases to around 25/30ml by about day 3, and 60/80ml by about day 10.  Even though a baby only drinks small quantities of milk, it can still take them 20 minutes or more to finish feeding.  Just like adults, each baby is unique and some eat more quickly than others, so it’s important to let the baby decide when he or she has finished; that way babies will drink until they are full, ensuring they get enough calories to grow well, and stimulate the mother’s milk supply adequately.

Every time milk is removed from the breast, more is made.  However, if milk is left in the breast then a protein called FIL (Feedback Inhibitor of Lactation) increases, which slows milk production.  Therefore, the more often a baby feeds at the breast, the more milk a mother is able to make.  Most people are not symmetrical and this applies to breasts too.  A lot of women have breasts that vary slightly in size, this is quite normal.  The size of a woman’s breasts bears no relation to the quantity of milk she will make.  Large breasts may contain a small amount of glandular tissue and vice versa.  It is not possible to tell!  By allowing a baby to feed as often, and for as long, as he or she needs to, most women’s breasts will make enough milk for their baby.  If you think of the breast as a glass, it doesn’t matter how big the glass is – you can still drink lots of water in a day from a small glass, you just need to drink more often.

So even if you feed your baby for as long and as often as he or she wants, how do you know it’s all working?  Weight gain and growth is something that can be measured, and certainly in the first couple of weeks your baby will be checked to ensure that by around day 10 your baby is at least still at birth weight.  Many babies lose a little weight in the first few days and this is completely normal.  If the mother has had IV fluids during labour then the baby’s weight can be slightly inflated at birth and this can mean the baby loses a little more weight than otherwise as they lose the excess fluids taken on during birth.  On average, a baby will gain anything between around 110g-220g a week in the first four months.  As you can see there is a wide range of “average” and at different times babies put on different amounts of weight.  It can be important not to weigh a baby too often as some weeks babies won’t put on much weight which can cause unnecessary worry.  It’s better to look at the overall pattern of growth, taking into account growth in head circumference and body length as well as weight gain, and to ensure that the overall trend is upwards on the growth chart, and that the baby is staying more or less on their percentile line on the chart.

However, in between your baby being weighed you’ll want to feel confident that things are going well.  One of the easiest ways to do this is to check what’s coming out the other end 🙂  If milk is going in at the top, then something will be coming out the other end.  It’s amazing how important the contents of your baby’s nappy becomes!  When your baby is born his bowel contains meconium.  This is the first poo you baby will pass and breastmilk helps your baby’s digestive system start to work; the colostrum works a little like a laxative helping your baby pass meconium – a sticky, black/dark green bowel motion.  In the first 2 days your baby should produce one or more poos a day, and two or more wees a day.  On days 3 and 4, your baby will produce three or more poos a day, which will become more green coloured and possibly a little softer, and three or more wees a day.  On days 5 and 6, your baby will produce three or more soft yellow poos.  The poos change to yellow as all the meconium has been passed and your baby starts to drink and digest more milk.  By now you will notice that you are producing more milk.  From day 7 onwards, your baby will produce at least two soft yellow poos, possibly a lot more, which is quite normal.  They may also look a little “seedy”, which is fine.  Your baby should also be producing six or more heavy wet nappies a day.

It can be hard to feel confident of something that we haven’t done before, and having a baby that seems unsettled or unhappy is enough to make any mother concerned.  If you are worried about your baby’s behaviour, development, or health then you should always seek advice.  A mother’s instincts are often right and sometimes it can take a while to get to the root of the issue, so keep asking and talking to people who have been well trained and have good experience until you are satisfied.

You can find some great information here about how milk production works, and on this page for what to expect in the early days of breastfeeding.  If you are worried about how often your baby is feeding, you might feel reassured after reading the information on this page.

Please feel free to comment on this post, or ask questions.  You can also contact me directly vie email: