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Thread: Nipple confusion, tongue tie, forceful letdown, or normal?

  1. #1

    Default Nipple confusion, tongue tie, forceful letdown, or normal?

    Let me give a bit of background info first. My baby is 1 month old tomorrow. When he was 5 days old, we had to admit him to the hospital due to jaundice and dehydration. I was nursing around the clock and thought he was getting milk. He lost something like 1 pound in 2 days. They gave him IV for 24 hours and briefly put him in phototherapy (the jaundice was above normal range, but nothing too bad). Anyway, he was very slow to gain weight these last 4 weeks. Starting when he was 5 days old, from time to time I pumped and my husband gave him a bottle. It didn't seem to make a difference with my nursing.

    The pediatrician has wanted us to supplement with formula at night to help him gain weight, so every 3 hours at night I nurse him for 15 minutes, my husband gives him about 2 ounces of formula through bottle, and I pump after nursing. I've been noticing him getting frustrated sometimes after about 15-20 mins of nursing when my milk is probably coming in slower. Our home care nurse (who's a lactation specialist, but not certified or anything) said not to worry; that it's normal now that he's older and he's just losing focus. He's pretty hyper when it happens, and latches on kinda haphazardly, doesn't get milk out, unlatches, and cries. I also want to mention there are times when he chokes during my first let down.

    I spoke with a LLL leader who's a IBLCE, and gave her my son's history since birth. She said he has a lot of signs of posterior tongue tie. Tomorrow I'm going to see a pediatric ENT doctor to find out for sure. But since he doesn't know about forceful let down and nipple confusion, I figured I'd ask opinions here.

    I don't know if I should mention that at 2 weeks, he didn't have a dirty diaper for 6 days. The pediatrician (who's old and very old school, by the way) said I needed to nurse more. I don't know how that's even possible since I nurse on demand nearly every hour. But since then, he goes about every 2-3 days, which he says isn't a problem for BF babies.

    Since supplementing with formula at night, he gained 6 oz in a week. The pediatrician is satisfied and I don't need to see him for a month. But I really don't want to supplement with formula if I don't need to, or at least less (we give about 4 oz at night now). I have trouble pumping during the day since he nurses so often.

    I hope I've given all the info you need. So much has happened since he was born. If you need anymore info, just ask. thanks.

  2. #2
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    Default Re: Nipple confusion, tongue tie, forceful letdown, or norma

    Have them not only look for anterior but also posterior tongue tie as well as upper lip tie since they often go together and getting them corrected might as well be done all at once.
    After getting them clipped or corrected you need to make sure to do the stretching with him to make sure they don't re-attach.
    AND get assistance from an IBCLC if they have experience with suck re-training otherwise see if you can get to see a physical therapist with experience with infant oral motor dysfunction to help re-train so babe will be able to nurse effectively.
    Once corrected it is possible that his suck will suddenly become much more effective but if not you need to get help so that you can help bring your supply up as baby starts sucking more effectively.

    I'm struggling with this myself!!!! My LO didn't have his corrected till 8 weeks and it has taken another 5 weeks to finally get a referral to see a speech therapist with experience of infant tongue tie and breast feeding issues. My appointment with the therapist is tomorrow.

    You may need to continue supplementing a bit for a little while. If you can make sure DH uses paced bottle feeding techniques and the slowest flow nipples that baby will accept it will help him to be less frustrated with you for not flowing instantly without work the way the bottle does.

  3. #3
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    Default Re: Nipple confusion, tongue tie, forceful letdown, or norma

    Good advice from the PP. I just want to add that there's nothing magical about formula- it doesn't clear out jaundice better than breastmilk and it doesn't have more calories than breastmilk. Since you're pumping, you could supplement with breastmilk rather than formula.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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    Default Re: Nipple confusion, tongue tie, forceful letdown, or norma

    I agree. I think it is very important you see an IBCLC for a one on one consult. If this is not possible or you don't know how, please let us know.

    It sounds to me as if baby is unable to get enough milk even when baby nurses very frequently, based on you saying baby nurses hourly and yet has poor gain and infrequent poops (a breastfed baby under 6 weeks typically poops several times a day, less poops is only ok if baby is gaining normally.) Some older babies go to a less frequent poop pattern but again this is only ok if baby is gaining. On the other hand, formula might change a poop patterns as well.

    Anyway, the question then is, Why can't baby get enough? Is it low production, or a problem with transfer, or both?

    I spoke with a LLL leader who's a IBLCE, and gave her my son's history since birth. She said he has a lot of signs of posterior tongue tie.
    do you mean she is a lactation educator, or a board certified lactation consultant? ( IBCLC) also, did you see her for a consult, or only speak to her? I know it is confusing. lll leaders are here to give mother to mother support to mothers, we are basically peer counselors. Lactation educators (sometimes called CLEs) are trained to give breastfeeding classes and/or offer basic breastfeeding support, typically, in an institutional setting (for example, many nurses train to be Lactation Educators). IBCLCs (typically) have deeper training & more complete education in all aspects of breastfeeding, in particular, they are trained (or should be) in out of the ordinary or more serious breastfeeding issues and are trained to be able to have one on one consults with mothers and babies when there is a clear breastfeeding issue. When there is an issue like this, it is really important to have that one on one consult if possible.

    As far as what the ENT will do or not do, it depends not only on what he or she sees when baby is examined, but also on what his or her perspective is on breastfeeding. Sadly, even when tt or lt is apparent, many doctors will not treat if the 'only' issue is that breastfeeding is being harmed. So I suggest bring info from professionals with you to the appt. if you can. Check out the Lawrence Kotlaw website and there is a tt group on facebook I have heard good things about.

  5. #5
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    Default Re: Nipple confusion, tongue tie, forceful letdown, or norma

    Quote Originally Posted by @llli*mommal View Post
    Good advice from the PP. I just want to add that there's nothing magical about formula- it doesn't clear out jaundice better than breastmilk and it doesn't have more calories than breastmilk. Since you're pumping, you could supplement with breastmilk rather than formula.
    Oh yes agreed, When I say supplement, that means anything that is not coming directly from the breast into baby. That pumped milk is very useful for feeding a baby not getting enough milk directly from the breast. Of course if you are not getting enough from pumping yet, use formula as you have to. And if you can get a few days with some extra help through the day as well as at night to give you a chance to pump during the day, it will likely help you bring up your supply. (Seeing as a baby that isn't able to transfer milk well doesn't do moms milk supply much good till the problem is fixed.)

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    Default Re: Nipple confusion, tongue tie, forceful letdown, or norma

    Quote Originally Posted by @llli*lllmeg View Post
    As far as what the ENT will do or not do, it depends not only on what he or she sees when baby is examined, but also on what his or her perspective is on breastfeeding. Sadly, even when tt or lt is apparent, many doctors will not treat if the 'only' issue is that breastfeeding is being harmed. So I suggest bring info from professionals with you to the appt. if you can. Check out the Lawrence Kotlaw website and there is a tt group on facebook I have heard good things about.
    The Low milk supply web site also has listings that can be of help for tongue tie issues
    http://www.lowmilksupply.org/frenotomy.shtml

  7. #7

    Default Re: Nipple confusion, tongue tie, forceful letdown, or norma

    We saw the ENT today, and he said he doesn't see any tongue tie. I just spoke with a IBCLC who was recommended through LLL. There's another one who I can go through with insurance, but not sure if she's board certified. If she isn't, I'll pay out of pocket to see the recommended one.

    The problem with supplementing with my milk is that he nurses so often, so the rare times I do pump during the day, I don't get much (like anywhere from 1/2 oz to an ounce if I had nursed an hour prior). I end up saving that for 1 bottle feeding at night from my husband, so at least we're down to 2 formula bottles instead of 3. I'm hoping to build more of a supply so I can purely supplement with BM.

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    Default Re: Nipple confusion, tongue tie, forceful letdown, or norma

    I just saw a speech therapist today for my LO. Tongue tie is not the ONLY thing that can cause a disorganized sucking pattern. And as I learned from the Therapist today, it doesn't actually require a forceful letdown to cause coughing if the baby is having some issues with proper suckling/sucking and swallowing. The coughing is a reflex response to the feeling of milk almost going down the wrong pipe since reflexes are first trying to protect the airway before they worry about eating, since you can survive a while without food/drink but only moments without breathing.
    Might be worth searching/calling around to see if there are any oral motor therapists/speech therapists or others of the sort that deal with infants and breast feeding. They might not boldly advertize that part of their work but you may be able to find some one who does deal with those issues and if you can get a referral from the pediatrician, insurance may cover it!!!

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