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November 17, 2015

Breastfeeding Milk Supply vs Demand in Tongue Tied Infants

There are some breastfeeding moms who have a TERRIFIC milk supply... I'm talking newborns who at times seem to be drowning in milk the supply is so great, accidental spraying of the infant's face with milk, numerous soaked nursing pads throughout the day, etc. BUT... they also have an infant with a significant tongue tie.

What if anything should be done from a breastfeeding perspective? After all, milk supply is definitely not a problem... or is it???

The breastfeeding concern even with an initial terrific milk supply arises from two facts... the milk supply WILL go down to meet demand... and once the milk supply is gone, it will not come back.

When it comes to a tongue-tied infant, there is legitimate concern that the infant demand for milk is not there because of the tongue-tie... rather the mom is just dumping the milk into the infant mouth and all the baby needs to do is swallow.

As such, at some future point in time if the infant demand for milk does not happen, the mom's milk supply may decrease to a point where the nutritional needs of the growing baby may not be met.


Take a look at the two graphs below.

In "normal" infant, the infant demand and mom's milk supply meet at a high supply level.

Looking at the above graph, the "normal" infant milk demand and mom's milk supply meet at an earlier point in time while the milk supply is very good. However, in the tongue-tied infant graph below, the infant milk demand and milk supply meet at a much later point in time when the milk supply has been reduced to a much lower level that may not be enough to provide adequate nutrition.
In tongue-tied infant, the infant demand and milk supply meet a a much lower level.

Even when the transition is made to a bottle for the tongue-tied infant, because they historically had to put so little effort into obtaining milk, the tongue-tied baby may take much longer to "learn" that with a bottle, they do have to put effort into feeding.  Of course, the parents can manually and continuously inject the milk from a bottle/syringe into the infant mouth, but that would be a less than ideal situation.

So that's why even if the milk supply is very good, treatment for a tongue-tied infant may still be necessary.

On a more positive note, this concern for future feeding difficulty may NOT happen. The potential for feeding problems is a "risk" and not a foregone conclusion... the infant may compensate and provide adequate demand such that milk supply does not become a problem or the tongue tie albeit present, may not be significant enough to be of concern and treatment may not be recommended.

For moms who do not have as robust a milk supply and suffer from breastfeeding difficulties, releasing a tongue tie may significantly improve the breastfeeding experience.

Generally speaking, the earlier the release is performed, the better the outcomes.


References:
Tongue-tie in the newborn: early diagnosis and division prevents poor breastfeeding outcomes. Breastfeed Rev. 2015 Mar;23(1):11-6.

Infant demand and milk supply: Part 1 and Part 2. J Hum Lact 1995; 11(1):21-37.

Effect of frequent breastfeeding on early milk production and infant weight gain. Pediatrics 1983: 72:307-11.

The frequency of suckling. A neglected but essential ingredient of breast-feeding. Obstet Gynecol Clin North Am. 1987 Sep;14(3):623-33.

Infant appetite-control and the regulation of breast milk supply. Children’s Hospital Quarterly. 1991;3:113–119.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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