Expert Advice on breast pain and baby tongue tie written by Sioned Hilton, our in-house Lactation Consultant
Most new breastfeeding mothers will experience nipple pain. This can be for a number of reasons such as baby learning to latch on, baby suckling and creating a vacuum to remove colostrum and nipple teat confusion. Occasionally, there can be physiological reasons as to why some mothers experience nipple pain too, such as baby creating a high vacuum, tongue tie, early signs of infection, thrush and blisters.
So what can mums do in preparation for breastfeeding?
During pregnancy, mums will have the opportunity to chat with their midwife about breastfeeding to discuss how it should feel, what to expect especially when milk comes to volume and any difficulties baby may have latching on. There are also several workshops on breastfeeding where mums can seek help and practice different feeding positions.
Tips for the First Week
In the first two weeks, the most common reason for nipple pain and tenderness is attachment and positioning. Here are a few tips:
- Ensure that your baby is positioned comfortably. If it feels wrong take baby off and try again. If you are worried or feel uncomfortable, ask your midwife to assess your feeding and latch.
- Supporting baby’s shoulders with the palm of your hand (cross cradle or underarm hold) allows your baby’s head to tip back slightly
- Make sure that your baby is in straight alignment i.e. His nose is in a straight line with his umbilicus or his ear is in line with his shoulder and hip
- Don’t hold your baby’s head as this pushes the chin and jaw into his chest, place baby’s nose to nipple and chin to breast.
- Stroke his lips with your nipple to encourage him to open wide. Bring baby’s chin in snuggly to the breast, nipple to nose. The nipple will fall into baby’s mouth and the tip of the nipple will be at the junction of his soft and hard palate
- His tongue will be over his gums and his upper lip may be flat or slightly flared out – you are unlikely to see what his bottom lip is doing
- When you want to bring baby off before he self-detaches you can break the seal. Place a clean finger in the side of his mouth and this will break the vacuum.
Gentle hand expression, breast massage, and cool flannels can help to relieve the fullness of breasts when milk comes in.
A baby with a tongue tie will not be able to elevate his tongue fully to the hard palate, he may be restricted in moving his tongue within the mouth, may not be able to protrude the tip of the tongue past the gum line and not be able to ‘pull tongues.’
Tongue Tie can affect milk intake, milk supply and baby’s development so it is important to identify this as soon as possible. Keep an eye on the nappies too, if stools are slow to change and nappies dry then milk is slow coming in or baby isn’t feeding well and it is usually a latch issue to effectively remove milk.
- It is important that a full breastfeed is observed and that mum is asked how her baby feeds in relation to sucking and swallowing bursts, tongue movement, excessive swallowing of air etc.
- If nipple pain is persistent, ask your midwife to look into baby’s mouth and check for any tongue restrictions. Any restriction of the tongue can result in nipple pain, nipple distortion and ineffective milk transfer.
- If there is a tongue restriction, you will be referred to a specialist Lactation Consultant or Tongue Tie Clinic for a feeding assessment and also treatment.
- During this time, mums will be supported to express and maintain milk production until the tongue tie can be released. A Double Electric Breast Pump may compliment this to ensure that the breasts are effectively emptied.
- If baby requires supplementation for supporting growth and development, mum can use the supplementary nursing system, cup feed or the Calma Feeding Device to support and encourage the sucking and tongue action associated with breastfeeding
- It can take time for an infant to relearn how to feed effectively after a tongue tie release, some mums adapt their feeding technique and position to optimise a more comfortable latch.
- Continued breastfeeding and lactation support is required to ensure that the frenulum doesn’t reconnect and reassure mum that all is well with breastfeeding, baby is growing and developing as expected.