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Thread: Tongue & Lip Ties / Weight gain issues

  1. #1
    Join Date
    Mar 2017
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    New England
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    Default Tongue & Lip Ties / Weight gain issues

    Hi all.

    My daughter is 3 weeks old and we are struggling severely with breastfeeding. I am hoping those more experienced with this can offer other suggestions or insight in terms of what we can or should try next. Please bear with the long post as I attempt to include all pertinent details.

    My daughter was born big at 9 lb 10 oz. She immediately had low blood sugar and was too sleepy in hte hospital to latch so I syringe fed her hand-expressed colostrum but was also instructed to supplement with formula by her pediatrician as they were concerned with her rapid weight loss. She ended up losing 12% of her weight in the first week. I saw 2 horrible LC's in the hospital who just said she was losing weight simply because my milk wasn't in yet.

    After my milk came in 4 days later I was able to eliminate the formula and bottle feed her breast milk (I use a dr browns bottle with preemie nipple). We were on a strict 2 oz every 2 hours regimen as prescribed by her pedi. In the past few weeks I've worked tirelessly at getting her to latch properly and breastfeed. With the help of a LC we've made a lot of progress and she's now able to latch and feed.

    However, I have noticed the following issues with her breastfeeding. One, she rarely feeds more than 10 minutes and I notice my breast doesn't nearly feel drained afterwards. After my initial letdown, once she actually has to start working to suck, right around that 10 min mark, she kind of just gives up. (I do breast compressions to encourage milk to keep going into her mouth but it doesnt always work). She often does a lot of gumming/nibbling my breasts during ths time without any active sucking. I experience nipple pain, and my nipples usually come out of her mouth looking creased/blanched.

    I am confused because sometimes she will latch perfectly and feed for 20-30 mins per side, as if there is nothing wrong at all. Other times she will struggle so greatly to latch or suck that she gets frustrated and just goes to sleep. At that point I'm forced to give her a bottle becuase at that point, hours have gone by without her eating and she is still struggling to gain weight appropriately.

    The LC I've been working with believes she has a posterior tongue tie as well as a lip tie. I have no problem getting this fixed but I do have some doubts about whether or not it will solve our breastfeeding issues. There are times she latches and feeds just fine, though it is not often.

    I guess I am wondering if anyone has experienced similar feeding issues. How did you correct them? Does this sound like it really could be attributed to tongue and lip ties? I am at a loss and don't know what the right next step is. I am afraid if I don't figure this out soon it will become impossible to get her exclusively on the breast. I am trying to avoid bottles as much as possible but its a struggle between that and making sure she doesnt starve.

  2. #2
    Join Date
    Jun 2009
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    Default Re: Tongue & Lip Ties / Weight gain issues

    Are you still trying to feed baby on an every 2 hour schedule? And is baby's gain back on track yet?

    Here is my personal experience and solutions with a baby who sometimes latched great but most of the time latching was very difficult.

    When my oldest was born, nursing hurt, injured me, and due to concerns he was not getting enough to eat we were also put on on a strict nursing every two hours schedule at day 3. At day 6 we started using a shield, which helped a bit (before that he was refusing one side entirely) but latching baby on still took forever. Due to using the shield, I was also pumping after every nursing session in order to protect my milk production (although we never gave baby supplements, once we started using the shield after seeing our wonderful LC at 6 days, he started to gain fine and did not need them.)

    Even with the shield, we still had the issue of some nursing sessions being fine but most being exceedingly difficult or almost impossible. I will explain what we did about that in a bit.

    At that time I do not think anyone around here treated newborns for tongue tie, so while my IBCLC may have suspected that was part of the problem, she never said anything. She probably figured why bother. Years later when I learned about tongue tie, I realized that it was very possibly part of the problem and a frenectomy may have helped solve things faster. But we were able to solve our issues without that treatment. Later my third baby certainly had an upper lip tie and it negatively impacted nursing at first. But by then I felt I was experienced enough to get through and make it work, and we did.

    This is not to say don't treat tongue tie and lip tie! Certainly such treatment can and had helped in many cases, and if it was available and I was not able to solve the problems without supplementing, I would have had my kids treated. On the other hand, it is also true that treatment of tt and lt do not always solve the problem.

    What I remember with my oldest was that two situations led to baby having a much harder time getting latched and nursing. 1) he was hungry and frantic by the time he got to the breast and it took forever to calm him enough so he could latch. 2) He was extremely sleepy because he was being awoken to nurse in order to stay on the schedule, and that made it almost impossible to latch him and once latched, he immediately fell back asleep and did not nurse. In both cases, it could take an hour just to get him latched on one side. Since we were not supplementing, I could not give a bottle. I just kept trying to latch him! It was exhausting.

    Finally at about two weeks, we saw that he was pooping normally and gaining weight normally, and made two changes that made a world of difference. First, we learned to stop delaying getting baby to the breast when he cued. Previously we had changed baby's diaper as well as doing other things before settling in to nurse. Even in the middle of the night. Wow what a dumb idea! We stopped doing that. Also I learned to hold baby most of the time either topless or with easy access so he could get to the breast very easily with no delay as much as possible.

    The other change was (after getting permission from pediatrician) we let baby sleep beyond 2 hours without waking him to feed him. We were supposed to wake him after 5 hours, but in fact he woke up on his own at 4 and a half hours. After that, it was like we had hit a his "reset" button. Baby started cueing a normal amount of times (10-12 times per day, maybe a little more) but no longer on some imposed, unnatural schedule. He might nurse three times in an hour than sleep 3-4 hours, for example. This is the normal nursing pattern (Cluster feeds followed by longer sleep) and once baby was doing that, he was no longer so sleepy or so hungry that latch was a nightmare.

    As baby got older, with the many latch ideas my LC gave us, he and I learned to latch better and better and by 6 to 8 weeks we weaned off the shield entirely. Nursing no longer hurt, and baby was gaining fine. I could then stop all pumping and just nurse. It was great.

    I am not suggesting a nipple shield is the answer, there are drawbacks and your LC can talk to you about that. My main point is about how scheduled feeds and/or delayed feeds can cause issues and fixing that can help.
    Last edited by @llli*maddieb; March 12th, 2017 at 01:57 PM.

  3. #3
    Join Date
    Mar 2017
    Location
    New England
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    2

    Default Re: Tongue & Lip Ties / Weight gain issues

    Thanks so mcuh for your input. Your situation sounds eerily similar to mine.

    Getting the hang of getting her to breast when she is showing hunger cues but before she gets frantically hungry has been tough but I think I'm getting hte hang of it. It took me a while to figure out that delaying by changing her diaper first wasn't working out.

    We were on an every 2-3 hour feed schedule which was, as you said, making feeding her next to impossible because how is a baby whose dead asleep going to latch properly every 2 hours when she's not even hungry. I try and let her go longer now without waking her to feed so that she gets a chance to show me she's hungry and root, but I get worried because if she's gone 4 hours without eating, she doesn't seem to make up for it once she breastfeeds. She will only feed for like 10 minutes. Am I wrong in assuming there's no way she's getting enough to eat in 10 minutes time?

    We tried a nipple shield but for some reason it just made her clamp down on my nipples even harder than normal, and she also seemed to hate it.

    I am finding now in the past 2 days her newest thing is that she will latch on, drink a bit, then shake her head side to side and push away from my breast. I wonder if possibly my letdown is too fast/strong for her? ONce she starts eating I can hear noisy gulping, and it makes a lot of sound as it travels down her belly - almost like a gurgling gassy sound. Sometimes milk will spill out of her mouth and she'll choke. I've been assuming a strong letdown is the issue so i try and recline a bit once she gets going to ease the flow a bit, but since she has trouble hanging onto my nipple to begni with, that usually just makes her slip right off. It's such a frustrating combination of issues.

    I have an appointment for her to get her TT/lip tie evaluated and fixed this week. I am realy hoping and praying it helps fix some of these issuse.

  4. #4
    Join Date
    Jun 2009
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    10,028

    Default Re: Tongue & Lip Ties / Weight gain issues

    She will only feed for like 10 minutes. Am I wrong in assuming there's no way she's getting enough to eat in 10 minutes time?
    yes it is wrong to assume that. Some babies can easily get a normal feeding in 10 minutes, especially if mom has fast letdown. But also, a "normal" feed varies a great deal in size over the course of the day. This is why it is not only the length of feedings, but the overall amount of feedings per day that matters when it comes to making sure baby gets enough to eat. Time between sessions is less indicative of anything, as long as overall baby is nursing 8-12 times per day or more and gaining normally. That is of course key. Baby having a normal amount of poops is also a good indicator baby is getting enough overall.

    I try and let her go longer now without waking her to feed so that she gets a chance to show me she's hungry and root, but I get worried because if she's gone 4 hours without eating, she doesn't seem to make up for it once she breastfeeds. She will only feed for like 10 minutes.
    If it was always a continuous pattern of sleeping 4 hours and then nursing 10 minutes, that would probably indicate a problem. But does she ever sleep shorter other times? Might she wake, nurse 10 minutes and then nurse again 30 minutes later? Etc.

    Also ironically, here is something that can happen: Baby nurses but not well (in your estimation) or just does not latch. So you are understandably worried, so baby gets a bottle. The bottle may be more than baby would normally take, or maybe baby got more at the breast than you thought. After bottle, Baby conks out from being overfull, and sleeps longish. Then when awakens, baby is super hungry AND your milk has been sitting in the breast a little longer, increasing milk flow, making it harder for baby to handle the flow, so baby nurses a short time again, worrying you again, baby gets a bottle again...

    This is not to say do not supplement! If baby needs supplements to gain normally of course they are needed. But just be aware of the snowball effect I described above. One way to lessen that is to make sure bottles are given using paced bottle feeding technique, or use a little cup or syringe instead, as those methods are less likely to result in overfeeding.

    Also it is possible that tongue/lip ties are contributing to your baby not being able to easily handle your milk flow.

    so i try and recline a bit once she gets going to ease the flow a bit, but since she has trouble hanging onto my nipple to begni with, that usually just makes her slip right off.
    Actually laid back nursing should help baby NOT slip off, because with laid back, gravity is pushing baby into you rather than pulling baby away from you as with mom-sitting-up positions. BUT, laid back can be tricky to figure out because no one does it exactly the same. (Nor should they-every mom and baby fit together their own unique way.) Try leaning back your body more or less, and reposition baby any way you can, baby can be in any position at all. Also if you can see the LC again or go to a LLL meeting or see a Leader in person they may be able to help you with positioning adjustments.

    I remember my LC tried to convince me it would get better, and I did not believe her. In fact I thought she was very nice but nuts to tell me it would every feel natural and normal to breastfeed. But eventually, it did. You do not have to believe me either, just keep working on it, keep getting good help, and see for yourself what happens.
    Last edited by @llli*maddieb; March 13th, 2017 at 07:48 PM.

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