Breast or chest feeding challenges may relate to positioning and attachment, milk supply, breast anatomy For bottle-fed babies, factors such as feeding pace, teat flow, positioning, coordination and comfort Breastfeeding, chest feeding, bottle feeding, expressing and combination feeding all deserve respectful Changes to feeding support, positioning, pacing or expressing plans can be meaningful for some families It should never be presented as a guaranteed solution for pain, milk transfer, bottle feeding or unsettled

is going, milk flow, positioning, the family’s concerns and any symptoms that need medical review. Yet bottle-feeding challenges can also relate to teat flow, pacing, feeding position, volume, the baby Positioning, attachment, breast fullness, milk ejection reflex, previous breast surgery, infant prematurity Positioning and feeding strategies may help some babies manage the flow more comfortably. References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine Position Statement

Continuing pain, clicking, lengthy feeds, milk transfer concerns or bottle-feeding difficulties may warrant Feeding can be influenced by positioning and attachment, milk supply, breast and nipple anatomy, infant prematurity, jaundice, neurological or muscular differences, reflux-like symptoms, flow preferences, bottle-feeding For bottle-fed babies, it may include seal, coordination, endurance, coughing or spluttering, and whether References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine position statement

breast or teat shape, positioning, parental comfort and the practical realities of family life. For bottle-fed and combination-fed infants, support should be equally thorough. and the caregiver’s experience. https://www.tongue-tie.info/post/bottle-feeding-with-a-tongue-tie-baby-safely A bottle-fed infant may have challenges linked to flow preference, feeding pace, coordination, reflux-like References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine position statement

When a baby is unsettled at the breast or bottle, when feeding is painful, or when parents are worried They may relate to positioning and attachment, the infant’s gestational age and health, breast or chest anatomy, milk supply, flow preference, bottle-feeding dynamics, neurodevelopmental factors, maternal It should also address the realities of both breastfeeding and bottle feeding. Bottle-fed infants can experience feeding challenges, and they deserve the same careful, non-judgemental

dribble with bottles, or seem unsettled around feeds. Equally, a feeding parent may need practical, individualised support to find positions or approaches teat flow, positioning, or challenges with expressing and maintaining milk supply. Where bottle feeding is used, observing a typical feed can be equally informative. Further information can be found in the ATP Position Statements (www.tongue-tie.org.uk/position-statements

Not every visible frenulum causes feeding difficulty, and not every feeding difficulty is caused by tongue-tie Breastfeeding, chestfeeding, bottle feeding and combination feeding can be affected by positioning, attachment It brings together the history, the infant’s feeding behaviour, observed milk transfer or bottle feeding It may include skilled support with positioning and attachment, paced and responsive bottle feeding, References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine position statement

These signs are not specific to tongue-tie and can have many other causes, including positioning and Teat flow, feeding pace, bottle angle, positioning and other medical or developmental factors should In bottle feeding, it may involve observing coordination, seal, pacing, stress cues and the baby’s comfort Sometimes a change in positioning, attachment, feeding pace, pump flange fit, milk supply support or For professionals, it can be helpful to document both positive and negative findings.

When someone else feeds the baby Having another caregiver give a bottle of expressed milk can be a really This is not because bottles are inherently a problem. to stay close to their baby while having their hands available for other tasks, provided the baby is positioned Looking at positioning, attachment, comfort, swallowing, pauses, milk flow, breast softening and the Positioning and attachment, milk flow, oral function, prematurity, illness, fatigue, neurological or

Feeding is a relationship involving infant oral function, positioning, attachment, milk transfer, breast or bottle dynamics, parental comfort and a baby's wider health. For bottle-feeding families, it may include assessing feeding pace, teat flow, positioning, coordination The Association of Tongue-tie Practitioners (ATP) position statements on wound management and post-procedure care can be found here: https://www.tongue-tie.org.uk/position-statements.

With bottle feeding, the assessment may consider the baby’s seal around the teat, tongue and jaw movements Bottle feeding with a restriction Does my baby need a tongue-tie release? a conventional bottle. These bottles may have soft, squeezable reservoirs or other features designed for particular feeding These specialist bottles are used for particular feeding needs associated with cleft palate or palatal

Did it include infant feeding? Did it include both breast and bottle feeding? Look for someone who understands breastfeeding and bottle feeding where relevant, and who can recognise issues such as positioning, attachment, milk transfer, milk supply, bottle-flow mismatch, feeding endurance For a breastfed baby this may include observing positioning, attachment, milk transfer and feeding behaviour Do you observe a breastfeed or bottle feed where appropriate?

An infant's oral posture is variable and changes with feeding, breathing, sleep, alertness, positioning An infant may temporarily adopt a lower tongue position depending on their state, breathing, positioning During bottle feeding, teat flow, teat fit, bottle angle and pacing can influence the coordination of For some infants, appropriate support may involve feeding positioning, pacing, addressing bottle flow An IBCLC can assess feeding function whether a baby is breastfed, bottle-fed or combination-fed, and

skills, muscle strength, coordination, milk supply, positioning or the many other things that influence For bottle-fed babies, smaller amounts taken more frequently may sometimes feel easier than trying to Follow your baby's usual feeding pattern as far as possible and avoid pressuring them to finish a bottle Others may prefer the breast, a bottle or another familiar method of soothing. References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine Position Statement

Others may experience feeding concerns, but those concerns may also relate to positioning, attachment Learners need to understand that breastfeeding, chestfeeding, bottle feeding, combination feeding and For bottle-fed infants, it may include feeding pace, seal, milk loss, coughing, fatigue, comfort and A course should encourage practitioners to consider factors such as suboptimal positioning and attachment That principle is equally relevant when supporting bottle-feeding families.

feed at the breast, combination fed, or because this is the feeding relationship that works best for Their fit can be more sensitive to positioning, capacity may be limited, and some parents find that a A setting may be too strong, the flange may not be suitable, the pump position may need adjusting, or Latch, positioning, breast and nipple health, infant development, prematurity, bottle-feeding technique often they expect to use it, whether expression is comfortable, and what is happening at the breast or bottle

Feeding concerns may involve positioning, attachment, milk supply, infant maturity, neurological or medical A baby who slips off the breast, feeds for long periods, coughs during bottle feeding, causes nipple The Cochrane review found a short-term reduction in maternal nipple pain but no consistent positive effect (Association of Tongue-tie Practitioners, Tongue-tie Training FAQs) The regulatory position therefore Breastfeeding, chest/body feeding, expressing, bottle feeding, combination feeding and changing feeding

Positioning, attachment, milk transfer, feeding frequency, infant factors and maternal factors can all When the flow slows, move your fingers around the breast to a different position and repeat. Gentle breast preparation, changing the position of the pump flange, returning to stimulation mode on If your hand becomes tired or the pump is uncomfortable, it may be worth changing your position, taking Sometimes a change in flange position, pump settings, stimulation, comfort or simply taking a short break

Bottle feeding Tongue-tie is less extensively studied in bottle-fed and combination-fed infants than Teat flow, feeding position, pacing, respiratory health, neurological or developmental factors, oral-motor coordination and normal individual variation can all influence bottle feeding. The evidence for treating ankyloglossia specifically to improve bottle feeding remains limited. This may include skilled feeding assessment, positioning and attachment support, consideration of milk

Breastfeeding, chest/body feeding and bottle feeding can be influenced by positioning, attachment, milk bottle-feeding pace and family circumstances. For practitioners supporting bottle-feeding families, this breadth is equally relevant. Bottle-feeding challenges can involve feeding rhythm, teat flow, positioning, infant coordination, discomfort www.tongue-tie.info/school References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine position

It allows a practitioner to consider how the baby approaches the breast, their position and stability Positioning and attachment may contribute, but so may breast fullness, nipple shape, engorgement, skin Where changes in position or attachment are appropriate, they should be individualised and gentle. Often, helping a parent find a supported, comfortable position and allowing the baby to come close with , expressing, combination feeding or bottle feeding.

Feeding can also be affected by positioning, milk flow, breast or chest comfort, bottle teat choice and For bottle-feeding families, it may include dribbling, prolonged feeds, coughing, distress, fatigue, Feeding patterns, oral function, positioning, milk flow, infant regulation, muscle tone, coordination may mean supporting a caregiver who wants to continue breastfeeding or chestfeeding, a family using bottles Thomas, J., Brodsky, D., et al. (2021) ‘Academy of Breastfeeding Medicine position statement on ankyloglossia

If you are moving from breastfeeding to bottles, paced bottle feeding can help keep the feeding experience If you are choosing another way of offering milk, there are also alternatives to bottles. You can read more in my blogs [Alternative Feeding Methods for Babies] and [How to Pace Bottle Feeds] It may involve expressed milk, formula, cups, bottles, solid foods or a combination of different ways of feeding.

Or, if bottle fed; either down a bottle too quickly (so you think they're ravenous but its more that they are not in control of the flow and you over feed them) or feeds are so long they end up taking in We did progress with medical advances in hygiene and in some cases formula/bottle companies would pay it can later on in life but more so dentally. please refer to ATP position statement on Lip-ties and https://www.tongue-tie.org.uk/position-statements https://www.tongue-tie.info/post/what-is-a-lip-tie-does-it-need-treatment

A baby is not simply a tongue, a frenulum, a feeding position or a weight. You may be experiencing difficulties with bottle feeding. Whether you choose breastfeeding, bottle feeding, combination feeding, expressed milk, conservative management A baby may need time to adapt. A caregiver may need support with positioning or attachment. Bottle-feeding families may need help understanding changes in feeding behaviour, pace, comfort or coordination

The position of the thumb or finger varies according to the feeding position. The position of the thumb or finger may need to change according to the feeding position, breast shape Find a comfortable feeding position Choose a position in which you are well supported and your baby The position of your hand depends on the feeding position. Available at: https://www.nhs.uk/baby/breastfeeding-and-bottle-feeding/breastfeeding/positioning-and-attachment

Similarly, I have seen very short, and thick posterior ties that cause every feeding problem known to A tool combined with a feeding assessment, tongue motility assessment and noting of adverse symptoms Symptoms for any restrictive tie may include: (*Feeding symptoms may not associated with a restrictive Dribbling milk Tiring during an active feed Not maintaining a seal/latch (teat or breast) Noisy feeding Crushing teat with gums Piston action on a dummy/bottle (like Maggie Simpson!)

Breast and bottle feeding also place slightly different demands on the feeding system, so the assessment The jaw, lips, cheeks, palate, head, neck and wider body all contribute to how a baby positions themselves Assisted births, prolonged or difficult labours, different birth positions and caesarean birth can all References Association of Tongue-tie Practitioners (ATP) (2022) ‘Position statement: Infant frenulotomy Available at: https://www.tongue-tie.org.uk/position-statements Beake, S., Bick, D., Narracott, C. and

Positioning and attachment can also affect how comfortably and effectively milk is removed. My articles Breastfeeding latch and positioning and How to Improve Infant Latch: Practical Breastfeeding For some feeding dyads, positioning and attachment may be relevant. Are positioning, attachment or expressing practices contributing? Available at: https://www.nhs.uk/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/enough-milk

confuse Kotlow’s original length-based classification with modified grading systems that classify the position For breastfeeding, relevant observations may include attachment, positioning, milk transfer, sucking For bottle feeding, the assessment may also consider the infant’s oral seal, sucking pattern, coordination These can include positioning, feeding technique, milk flow, oral-motor function, infant state, discomfort References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine position statement

Step 1: Get comfortable Wash your hands and find a comfortable position. of your nipple, positioning them in the area where your baby’s chin will rest against your breast in the feeding position you are about to use. Support your baby in the feeding position you have chosen and allow them to open their mouth widely before You can read more about breastfeeding latch and positioning and recognising infant swallowing during

This needs to be considered alongside a full feeding history and direct observation of a feed where possible Positioning and attachment may need adjustment. Parents are the experts in what feeding feels like at 2 am, how long feeds are taking, and whether pain Small adjustments to positioning, attachment and breast support can improve comfort and milk transfer Livingstone, V., Douglas, P., Dahlquist, N., Donnelly, B. et al. (2021) ‘Academy of Breastfeeding Medicine position

Feeding assessment Feeding assessment considers how the infant functions during feeding, rather than Depending on whether the infant is breastfed, bottle-fed, combination-fed or receiving expressed milk , relevant observations may include positioning, attachment where applicable, sucking patterns, oral Gentle, guided interaction can support positive connection and bonding, while allowing the caregiver References Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine Position Statement

Improving positioning and attachment may resolve compression-related nipple vasospasm, whereas Raynaud Suboptimal positioning or attachment, or a baby repeatedly compressing the nipple during feeding, can If the latch feels pinchy or painful, changing position or attachment may help. Your baby’s body position, the way they approach the breast and the depth of attachment can all influence An IBCLC or other appropriately trained breastfeeding professional can assess feeding position, attachment

Excessive vacuum, a pumping session that is too long, friction from dry skin, swelling, engorgement, pump position This allows the practitioner to consider the flange’s position, whether the nipple appears to move freely Oxytocin is particularly important for the milk-ejection reflex, and positive touch, relaxation and skin-to-skin the pump, the flanges currently in use and any parts that affect fit, such as inserts or collection bottles This may include trying an alternative size or shape, adjusting positioning or settings, checking pump

Vitamin K is not a treatment for feeding difficulties or tongue-tie. Vitamin K and feeding Vitamin K is not a treatment for breastfeeding difficulties, bottle-feeding difficulties Feeding difficulties should therefore be assessed on their own merits. A baby who is struggling with breastfeeding, bottle feeding, expressing or combination feeding may have Decisions about tongue-tie should consider function, feeding history, observed feeding where appropriate

pumping, combination feeding or building a milk supply alongside direct feeding. A correctly fitted flange may support comfort, milk removal, and a more positive expressing experience If you are pumping after direct feeding difficulties, the pump is not necessarily the whole story. a replacement for a feed. For others, discomfort is a sign that a wider feeding or health issue needs attention.

, including its ability to maintain position, elevate, protrude, retract and coordinate with the jaw , and its resting position is influenced by the surrounding oral and craniofacial structures as well Resting position alone, however, does not establish whether tongue tone is reduced because the position meaningful picture than treating a particular resting position as diagnostic in itself. If movement is restricted, the way in which the tongue is positioned and recruited during sucking and

One of the most common causes is ineffective positioning or attachment, which can result in the nipple being compressed during feeding (NHS, 2026). When the nipple changes shape after a feed The appearance of your nipple immediately after a feed can provide useful information about what is happening during feeding. A small adjustment to positioning or attachment can sometimes make a significant difference.

Thickening of the wound causing further restriction, bleeding, infection or pain causing a feeding aversion ATP Position Statements - Disruptive Wound Management (2022) (The above link is from the Association tongue-tie are just a few examples) all of which can all interfere with efficient, effective infant feeding Please also see this link: Manual Therapy and Infant Feeding - Association of Tongue-tie Practitioners These are optional of course but will give your little one a 'head-start' to effective feeding.

from day of division where I will send you a weekly message to check-in with yourself and see how your feeding At the 6 week mark feeding should be well and truly on the road to being efficient and effective if it for a face-to-face follow up review where I may review feeding techniques and reassess tongue function care-planning working towards your individual goals-I am a Lactation Consultant (IBCLC) and infant feeding specialist so rest assured together we can set goals to get your little one feeding effectively (this

This includes how effectively the baby feeds, milk transfer, feeding frequency, milk production and the Feeding patterns need to be considered in the context of the individual infant, including feeding effectiveness Understanding a baby's feeding cues can help families respond to their individual needs without trying to manage feeding according to perceived changes in milk fat. of lactation to feed their baby.

additional support with feeding a baby who may need care on a neonatal unit some situations where a Keeping your fingers in position, gently compress and release them rhythmically. If your baby is feeding effectively and does not need additional milk, you may not need to use the colostrum Having colostrum stored does not replace skin-to-skin contact, responsive feeding or support with positioning You can read more about breastfeeding latch and positioning and increasing breast milk production in

Others may be exclusively expressing, combination feeding, returning to work, expressing during separation Someone trying to maintain milk production while their baby temporarily feeds elsewhere has different During pumping, the nipple should be positioned centrally and should be able to glide comfortably within If breastfeeding is also part of the feeding plan, it may be important to consider breast and nipple comfort, infant positioning and attachment, milk transfer and infant feeding function.

To know this, there would be adverse feeding symptoms, which would indicate the need for further assessment Infant feeding is one of the hardest things the tongue will need to do in a lifetime, so please ensure that your chosen provider is a registered infant feeding specialist, who also provides some form of The good news though is that in time most scars do soften over time, but we are not in a position to This is usually resolved with time, changes in feeding positions and bodytherapies (such as @Baby-Myo

WHAT IS A LIP-TIE AND DOES IT NEED TREATMENT? Sometimes a lip tie can affect the ‘vacuum draw’ of getting breast into a correct breast feeding position but this does not prevent a successful pain-free breastfeed, can be addressed with correct positioning https://abm.me.uk/wp-content/uploads/2017/03/Spring-2017-feature-article.pdf www.tongue-tie.org.uk/position-statements

It would be wise to source a reputable Infant Feeding Specialist. This may be a member of your local NHS infant feeding team, or a Lactation Consultant (IBCLC) who, even if you are no longer/did not choose to breast/chest feed or provide human milk, still possess the gold standard qualification in infant feeding. Yes-they can support you however you choose to feed your babies including the use of formula milks.

Assessment needs to consider the infant’s oral function, feeding difficulties, clinical history and whether It requires consideration of the infant’s feeding function, the expected benefit of intervention, the literature on complications following infant tongue-tie release describes concerns including bleeding, feeding A functional assessment helps establish whether tongue movement is affecting feeding and whether division A Guide to Understanding Your Baby’s Oral Function and Infant Oral Anatomy: Structure, Function and Feeding

For example, infant feeding support, lactation support or professional education may not themselves be Does every tongue-tie practitioner need their own CQC registration? Not necessarily. The precise legal position depends on the individual arrangement and who is legally carrying on the regulated Responsive CQC considers whether services respond appropriately to people's needs and whether care is Families do not need to become regulatory experts before arranging tongue-tie care.

The question is therefore not simply "What size flange do I need?" What does a correctly fitted flange look and feel like? A flange that is technically the correct diameter can still be unsuitable if the shape, positioning, Equally, a flange that feels comfortable but results in poor milk removal may not be meeting the needs Material therefore needs to be considered alongside size, shape and pump function rather than treated