Micky, I have a list of suggestions for mothers of toddlers whose teeth are
hurting the nipples. Perhaps some of these will help you.

Often as babies grow older we get lax in our attention to positioning. Baby
sits on our lap and reaches up and hangs on to feed. So the first thing is
to pay close attention to positioning as you did at newborn.

Hold the baby very close, up off the lap, tummy to tummy. Lift him higher
onto the breast.

Before latching ask him to open wide. If he begins to put his teeth into
the tissue, remove him and let him know that his teeth hurt and ask again
for him to open wider. [I have had a number of mothers of toddlers
respectfully explain to their little ones what they need from them and they
understand and cooperate. These conversations have been about sleeping
issues or behavioral issues. They understand more than we think and with
our respect they will want to be cooperative.]

Press in on his shoulders to get his chin more deeply into the breast which
will move the upper teeth away from the breast. Have him tilt his head
slightly backwards. Make sure that he isn't having to "hang on" to the
breast with his mouth but is supported.

These suggestions are for upper teeth problems but any improvement will help.

If it is, in fact, tongue tie you could still have the frenulum clipped
even though it will be more painful than if it had been done in the
beginning. Your baby would still benifit from the frenotomy.

Question #2:

I learned from a Lactnet writer that 5 drops an hour of colostrum expressed
from the breast  and given to a newborn will be enough to prevent a low
glucose reading. I have been recommending this in my breastfeeding classes
and it has worked very well in my clients. Most get more than 5 drops (hand
expression instead of pumping) and they give it to the babies in a spoon by
scooping it up with their fingers and putting it into baby's mouth.

Such hand expression and giving colostrum to an infant who doesn't feed
well at the breast after birth would likely help with jaundice too. If this
is done as often as possible with as much volume as the mother can express
the baby would stool sufficiently to lower the circulation of bilirubin.

What is the national heritage of this mother. Ethnic heritage can impact
the normal levels of bilirubin with Asian, Native American, and Latino
babies normally having a higher reading than caucasian-connected babies.
Babies of African heritage will have normal readings lower than
causcasian-connected babies. And, unfortunately, the standard measures are
based on caucasian babies.

I have had mothers whose milk seems to be late in coming in who do choose
to begin galactogogues on day 2 or 3.  So she may want to do that.

You mentioned giving recommendations for birthing practices and that is
good. Any birthing interventions that cause edema will delay the milk's
coming in. As the edema resolves the milk supply increases. So if there is
edema have her take steps to resolve it--dietary aids are watermellon,
apples, grapes and cucumbers.

Of course, early and often feeding at the breast and no separation of
mother and baby, including having baby in the plastic box, and lots of skin
to skin (bare chest to bare chest) will help baby feed better.

Patricia Gima, IBCLC
Milwaukee, Wisconsin
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