Active Wound Management

Following the release of your infant or toddler’s (and even older adult or child) oral restriction one important factor that appears to contribute to the success of the release procedure is the component of stretching the release sites. . This practice is also known as Active Wound Management (AWM). There is currently no ‘best practice’ studies to show what exactly is the best post-release care after a frenectomy, however from clinical experience and an understanding of wound healing it appears that AWM is an integral part of achieving the best results.  You can read more about the puzzle surrounding post release care here.

Following a complete release of oral restrictions – there should be a diamond shape wound present (whether that is under the lip, tongue or buccal area).  It is common knowledge that the mouth is an excellent healing spot for the body and a simple bite on the cheek or ulcer usually heals within 24-48 hours – this usually means that there is little risk of infection following a release procedure. If left untreated the release sites will very quickly heal back to where they started via primary wound healing principles and the wound will ‘reattach’ creating a loss of function again.

Tongue pic 2.png

What we want to implement is for the diamond shape wound to remain open and heal vertically (along the blue line) where point C to D will eventually come together instead of point A to B.  This is where AWM kicks in – by doing the stretches frequent enough you are essentially slowing down the healing process and encouraging the release site to heal vertically and create a new unrestricted frenum.

For active wound management to be successful these stretches should be performed frequently for the following weeks post procedure.  Ideal time frames include stretching 5-6 times in a 24 hour period (essentially every 4 hours) for 21 days followed by a week or so of 3-4 times in 24 hours.  Leaving the stretches for greater than 4-6 hours will increase the risk of reattachment and loss of function.  Stretches do need to be performed around the clock and not left overnight.  The stretches should only take a short amount of time (10-15 seconds).  Some parents even report that their infants sleep through the stretches.

To perform the stretches:

Lip

  • With two fingers elevate the lip so that you can see the diamond shape completely open and hold the diamond shape open for 3 seconds
  • If your baby has had their buccal (cheek) ties releases continue the rubbing of the lip along to their buccal sites and elevate the lip above the site for 3 seconds each side.

Tongue:

There are two different methods that seem to be succcessful in preventing primary reattachment.

Method one:

Run your finger with medium pressure from the gumline (point B) down onto the release site and lift the tongue (towards point A).   This can be done once over a slow count to three or three short sweeps.

Method two:

Insert two fingers either side of the tongue and place your fingers at the edge of the side of the diamond (Point C and D) and lift the tongue upwards to open the diamond.  You should be able to visualise the diamond once this exercise is performed.

You can watch a video demonstration of stretching technique here.

When performing the stretches on your infant or toddler a couple of tips that may help include:

baby-pic
Correct positioning for performing stretches.

 

  • Swaddle the infant to stabilize his/her body
  • For an older infant/toddler you may find it easier to sit on the floor with legs out straight and place your child in between your legs.
  • For easy access – position the baby so their feet are away from  you
  • Make sure you have washed your hands and cut/filed your nails short
  • Approach the stretches in a calm and efficient manner (making it into a game can be helpful – pulling silly faces/singing a song etc).  Babies are highly attuned to their parents emotions so its essential to remain as calm as possible.
  • Use pain relief options as required
  • Try feeding your infant a little bit of milk first, then perform the stretch and continue on the feed
  • Avoid using any oils such as vit E that can promote healing

The diamond shape wound should slowly get smaller and smaller over the first three weeks post release and the fourth week of stretches is to ensure movement remains within the tissue. It can be beneficial to continue the stretches even after the wound has closed properly (2-3 times a day) to keep the tissue supple as further healing will continue underneath the surface. During this time of healing the release site may vary in colour (from pink/red, white, yellow and sometimes even green).

When the upper lip is healed you will see a new attachment to the gumline – this is normal and supposed to be there.  As long as you can continue to see improved function there is usually no need for concern. Under the tongue you may also see the presence of a new frenulum – once again unless there is loss of function this will be considered normal.

Between 2-4 weeks post release you may be able to feel some tension under the tongue frenum which is a normal part of healing.  This is as the fibers of the frenulum are knitting together and the frenum will feel tight and then release again when normal function is returned.  This is why continuing to perform the stretches is vital as if left at this point can result in a loss of function.

Please follow up with your revision provider or IBCLC if you are having concerns regarding the healing phase for your infant.

 

Tamika Newman

RN, RM, IBCLC

 

 

 

Advertisements

The puzzle of Tongue/Lip-Tie release 

After the diagnosis of a tongue and or lip tie it is really important to arm yourself with information and be prepared for the recovery journey.

Tongue/lip tie revisions are usually not a magical elixir that once the revision is performed – that’s it. Sometimes the first feed after revision does feel like magic as the baby suddenly has normal movement, however there is a recovery journey to be had and a process for both yourself and your baby.

Different factors such as the age of your baby, severity of the restriction caused by the ties and the impact of the ties on oral function will all determine how long a baby will take to recover from a release procedure.

I like to describe the recovery journey as needing a few different pieces of a puzzle to achieve optimal results from a tongue and or lip tie release.

So what are the puzzle pieces?

1. Having a complete revision 

To enable a return of normal oral function, a tie needs to be released by a practitioner who has a good understanding of tethered oral tissue and who understands there is a posterior component to all tongue ties. Just releasing the anterior portion rarely allows for full return to normal function.

2. Receiving craniosacral therapy

When a baby/toddler/child has tethered oral tissue they learn to suck/swallow/breathe in an abnormal pattern. Babies learn to suck in utero and continue their learning from birth and from their first breastfeeding.

When a baby has their ties released, they then need to re-learn how to use their tongue correctly. With this new found tongue motion – comes new muscles that have never been used before.

Think about if you suddenly ran a half-marathon tomorrow without any training. You would be ok tomorrow, however the days following you would have sore muscles as you have suddenly exerted muscles that you haven’t used before or recently.

The same process occurs after the release of tethered oral tissue. For this reason, working closely with a practitioner who is familiar with both craniosacral therapy and tongue/lip tie recovery is essential.

Having a couple of sessions of craniosacral therapy prior to revision is ideal to release any tension prior to revision as well.

3. Pain management

As discussed in point 2 – most babies do have some form of discomfort post procedure. This usually begins 24-48 hours after the release and lasts for two to three days. For most babies – days 2-5 are considered the hardest part. This is because there is discomfort associated with the new muscle function while learning normal oral function.

Understanding these discomforts and the associated recovery period and providing adequate pain relief is a vital step. There are some excellent natural remedies to aid your baby’s discomfort. Lots of skin to skin, deep baths and extra cuddles also go a long way.

4. Active wound management

To achieve optimal results of a tie revision, it is important to ensure the wound/s heal correctly. The mouth is an amazing part of the body that heals incredibly quickly – sometimes too quickly.

You can read more about active wound management here.

It is really important to follow the instructions given to you by your revision provider.

5. Working closely with an IBCLC

Working closely with an IBCLC who is familiar with ties is also another important step to complete the puzzle.

When a mother has been breastfeeding a baby with tethered oral tissue – their baby has not been feeding effectively and therefore some latch techniques and Mum’s milk production may need a little help.

Particular attention needs to be paid to helping your baby learn new latch techniques, learn sucking exercises to strengthen the underdeveloped muscles of the tongue and support for Mum’s to maintain adequate milk production.

The journey of tongue tie recovery is just like you would expect with any other procedure. Often two steps forward and one step back until your baby has gained full oral function.

It is really important to take all the necessary steps to ensure full function has been gained.

Tamika Newman IBCLC

 

Dangers of early introduction of solids

I have see this article around Facebook recently. I also hear lot of talk about parents introducing solids to their 8/9/10 week old babies.  

The fact that I hear of many parents introducing solids too early really concerns me so I wanted to share some information. 

Whilst there is still debate in regards to the timing of introduction of solid foods (4-6 months vs 6 months), there is unilateral agreement from health authorities worldwide that babies should NOT be introduced to any form of solid food before the fourth month of a babies life. 
Countless studies have shown that introducing supplementary foods before at least the fourth month of life poses significant risk and health problems to infants as before this age, – the digestive system, immune system, kidneys and ability to chew and swallow are not yet fully developed or ready for solids.
Early introduction of foods has been proven to increase the risk of asthma, allergies, coeliac disease, digestion problems, gastroenteritis, respiratory tract infections, ear infections, obesity, diabetes and SIDS death. 
For over 20 years now many health experts (The World Health Organization, Unicef, American Academy of Paediatrics, American Academy of Family Physicians, Australian National and Medical Research Council, Health Canada, SIDS and Kids association, Le Leche League and Australian Breastfeeding Association) agree that it is best to leave the introduction of solid foods until at least 6 months.

 The current recommendations from all advisory bodies mentioned include: babies should be exclusively breastfed (no cereal, juice or any other foods) for the first 6 months of life. 
Not only does introducing solid foods prior to the recommended time frame increase health risks for the infant but also impacts the breastfeeding relationship and the mothers ability to maintain her milk production. 

By replacing breastfeed with solid foods and enforcing artificial spacing of feeds (especially in the first three months when milk production regulation is establishing) the mothers milk production may decrease.

You can read more on my thoughts on when and how solids should be introduced here.

How to deal with biting

A common theme that I have seen recently is to do with babies biting while feeding. I was just reading some responses to a question about babies biting at the breast and to be honest some of the answers like “bite them back”, “just flick their cheek” and “time to wean” etc sadden me. 

The number one thing to remember is your baby is not biting you on purpose and certainly don’t need to be punished or taught a lesson.

Babies physically cannot bite if attached to the breast properly and actively feeding as their tongue needs to be over their bottom gum.
It is pointless getting mad at your baby as he/she is not intentionally hurting you and has no idea that the reaction you give is related to the bite. 

Imagine you are a baby happily suckling at your mummy’s breast and all of a sudden you are on the floor and your mumma is speaking strongly to you. Your baby will be confused and understandably upset. I totally understand that it may be instinctive to yelp as it can really hurt but try not to react angrily towards your baby.

  

Why do babies bite?

The common reason for coping a bite from your baby is due to sore gums, being distracted or possibly trying to tell you that the flow is too fast or too slow.

Frequent biting can also be an indication of a decreased milk production.  If your baby is reasonably young (less then five months) and frequently biting or chomping down on the breast – this can be a sign of a tongue tie as baby needs to work extra hard to maintain adequate latch. If this is the case – consider seeing an IBCLC to have your feeding technique assessed and baby checked for anything effecting his/her latch. 

What can you do to stop or prevent babies biting at the breast?
* Make sure your baby has a nice deep latch on the breast. Often after feeding for a couple of months we can get complacent so paying close attachment to their latch is important. Keeping some pressure between your babies shoulder blades will ensure his/her head is extended and encourages a deeper latch. 
* Watch your baby closely. As I said before babies cannot bite while actively feeding – so by watching their feeding rhythm and taking them off when they finished actively feeding can really curb the biting. Also dont let them play at the breast.
* If you know your baby gets distracted easily – try and find a nice quite place to feed them.

* If you feel your baby is biting due to sore gums/teething you can offer something to help their gums. A cold spoon, washer, breastmilk icey poles or a teether are great biting tools for your babe.  I find the homeopathic remedy chamomillia to be extremely helpful for teething babies. 

* If baby is biting due to fast flow you can try expressing and letting down into a towel before you put the baby in the breast.
* If baby is biting due to a slow let down you can also try hand expressing until you start to let down and put babe to the breast or use breast compressions during a feed. 

What can I do when baby does bite?

The best thing to do is pull bub into the breast which will cover their nose and he/she will release the nipple. This method will also stop you getting nipple damage as a swift pull off while sharp little teeth are clamped onto your nipple can result in nasty damage.
 You can then say something along the lines of “no biting it hurts mummy – how about you chew on this” but try not to yell or physically hurt them. 

If your nipples are sore and damaged from biting try having a rest and express day and offer expressed milk via a syringe or cup. 

Always remember though “this to shall pass” and continue on with your beautiful breastfeeding journey.

                          

Solids – the simple answer

Ah the conundrum of solid foods and ‘when’ to introduce them. Lately I have been asked the question of “has Imogen started solids” or “when are you starting her on solids”. This is something that is in the forefront of parents minds and usually up for a lot of debate.

There is a lot of different advice out there from starting at 4 months …. To starting at 6 months and everything in between. I once read a really scary statistic from a study done by the CDC which showed over 40% of the babies studied had started solids before four months and 9% before four weeks!

Science is starting to uncover and understand the impact on the role of gut flora/gut health and how it effects well pretty much everything. With the ever increasing amounts of childhood illnesses such as asthma, allergies, autism, diabetes, obesity etc that is seen today the thought of parents introducing solids well before any recommendations and the impact that could have is incredibly scary.

I’m sure most people have heard of the ‘virgin gut theory’. You can read a great explanation here. Whilst I agree with the concept of the gut needing to be ready and developed enough to accept solid foods – giving a ‘blanket’ rule still doesn’t sit right with me. 

Even with a blanket rule of six months … What is even considered six months? Is it six calendar months? Is it 24 weeks? Do you take gestation into account (ie. if baby was born at 38 weeks do you allow an extra two weeks or if a baby born at 42 weeks do you subtract two weeks)?

And what about the “signs” of being ready for solids??? Some of the regular ones you will hear are along the lines of:

– reaching double birth weight

– the arrival of teeth

– being ‘interested’ in food

– being able to sit independently

– waking through the night

– appearing hungry

– making chewing motions

Confused yet??

  

Imogen is rapidly approaching the six calendar months and was 24 weeks today and ticks all those boxes but is she ready for solids? Despite watching me intently as I eat from eight weeks, doubling her hefty birth weight and sitting independently from four months and having teeth from five months the answer is …. No!

How do I know this and what have I learnt from years of study into the subject for the breastfed infant? (Please note these thoughts are only for the breastfed infant as formula fed babies do in fact need to source extra nutrition from food sources around the four month mark as formula unlike breastmilk doesn’t change to the needs of the infant).

Starting solid foods is just like any other physical milestone. With a basic knowledge of human biology we know that every child is an individual and will be developmentally ready for milestones at different times so why do we have one for introducing solids?

Imagine if we approached other milestones like we do solids … Oh little Jimmy is 4 months and 15 days today so we must start him sitting. Pretty illogical right?

To give a “start date” or blanket rule just seems preposterous to me …. Yes even the six month rule. Just like ‘most’ babies walk at or very close to 12 months some walk at 10 months and others not until 14 months which are all within normal parameters for that particular milestone. Most babies will be ready for solid foods around six months but some babies will be ready earlier/later then others and we should let them guide the way rather then forcing them to eat solid food before they are ready.

So I know Imogen is ready for solid food when she can pick up a piece of food, bring that piece of food to her mouth and bite, chew and swallow …. Simple as that.

The theory behind this being that her body wouldn’t allow her to be physically ready to consume food before her gut is ready to receive food.

  
I’m not sure when that will be for her and I’m sure it’s not too far around the corner but it just makes sense that the gut will be developmentally ready when she is physically ready to do those steps and NOT before.

She is definitely in practice mode at the moment and is starting to steal food from myself or her sister and puts it to her mouth but doesn’t have the bite, chew or swallow motion going on. I haven’t stopped her if she does grab something off my plate, yet by watching what she does with said food is a great indication that her body is not ready for solids.

  

(Imogen looking very proud of herself as she stole the apple out of Daddy’s hand)

This school of thought totally negates the need for any pureeing or mashing of food and in fact if I was to feed her puréed food which I’m sure she would love … I would in fact be introducing food before her body is truly ready and possibly cause her life long issues.

When she is physically capable to consume solid foods I will simply be providing a variety of substantial whole family foods such as avocado, broccoli, carrots, slightly steamed apples, cooked meats, eggs etc cut in large (bigger the then her hand) pieces so she can negate them easily. Basically anything we are eating she will eat within reason (she won’t be having any of mummy’s chocolate!). You can read more on what foods to introduce, how to prepare them and more on baby led weaning here.

So the simple answer to when is a baby ready for solids is ….. Probably somewhere around the six month mark and when your baby can grab, bite, chew and swallow.

Tamika Newman

RN, RM, IBCLC

What can I do for you?

LC pic

Many women find that when it comes to breastfeeding it doesn’t necessarily come “instinctively”.  During pregnancy so much focus and preparation is usually directed towards the actual labour/birth and sometimes the post natal period, however lots of women are a little shocked to find breastfeeding doesn’t always just “work”.

As a International Board Certified Lactation Consultant I have undertaken many years of breastfeeding specific study on top of my nursing/midwifery degrees to learn all about human lactation and the human infant and then sit and pass an international exam.  I am very committed to working with my clients and reaching their individual goals when it comes to feeding their infants.

Some of the things I can help with include:

  • Antenatal management plans (This is particularly helpful for women who are expecting twins or more, have been diagnosed with gestational diabetes, are having a scheduled caesarean or have experienced problems previously.)
  • Correct attachment/positioning techniques.  Some times the simplest changes in positioning can be life changing in regards to comfort and continuing your breastfeeding relationship
  • Mastitis
  • Damaged/Cracked Nipples
  • Painful attachment
  • Low milk production
  • Overactive milk production/Forceful let down
  • Reflux/unsettled babies/colic
  • Tongue/lip tie diagnosis and management
  • Low weight gain
  • Insufficient glandular tissue
  • Returning to work/expressing plans

I am available for both long and short consults at the My Own Midwife GC – Ashmore clinic and can discuss and help solve many issues.

To book an appointment please contact me via phone 0409 762 960 or email tnewmanlc@live.com.au.

A little bit about me …

Hello and welcome.

My name is Tamika Newman and I am a Registered Nurse/Registered Midwife and an International Board Certified Lactation Consultant (IBCLC). As of January 2015 I have joined the team at My Own Midwives GC at the Ashmore clinic on the Gold Coast.  I am absolutely thrilled to be a part of such a dynamic team of wonderful practitioners who are providing exceptional care for women and their babies. You can find out all about their wonderful services here.

For the past ten years I have been working in a large tertiary hospital where the majority of my time was spent assisting women establish breastfeeding.

Since I gained the qualification of International Board Certified Lactation Consultant in 2010, I have been able to apply my knowledge gained from my midwifery work and focus and expand on the finer details of human -lactation.

Throughout my years of practice, I have stayed current with latest evidence based practices by attended many conferences and spending countless hours studying all things related to infant feeding, growth, sleep and development. I am also very interested in oral anomalies such as tongue/lip ties and enjoy working with families to correct and establish effective feeding strategies.

As a mother of two beautiful children I understand just how important breastfeeding support is to establishing and maintaining a good breastfeeding relationship. I am extremely passionate about assisting mothers during their transition to motherhood and particularly enjoy working with mothers to help meet their own personal goals during their unique breastfeeding journey.