General

No. A really short tonguetie does need to be treated. And even a not-so-short but really restrictive tie may need to be released. It does however make breastfeeding easier while the tonguetie is not yet cut. And it teaches baby to use the tongue properly after cutting.

With a liptie there are doubts about the need to treat; this way of feeding does appear to give a better seal around the mouth and stretches the lip up and out.

No, of course it won’t. Wish it were that simple. This hold is an additional option to explore for breastfeeding mothers and babies.

When there is doubt about the need for treatment of tongu- or liptie, for example because the tie is not very pronounced or the baby is very tense so the restriction might not be in the tie itself.

• If the tonguetie is caused by general tension you often see baby relax within a few days of feeding this way. And quite often after those first day baby will start to extend the tongue more freely. If this does not happen then that is an indication that treatment may be needed.

The hold also seems to work well when every millimetre counts: when baby has a small mouth and/or mom has a large nipple. The open bodyposition allows optimal reach by the baby.

With reflux, because baby is fed in an extended, well supported upright position.

When baby has had a trauma during birth (vacuum birth for example) or has been pushed to the breast too much. In this hold there is no stress around head and neck and baby can hold the head at an angle if preferred.

With older babies who need to re-learn how to drink at breast because there was an oversupply the first weeks of life. These babies often have not needed to latch properly and run into trouble around 5 kg or 3 months of life (whichever milestone is reached earliest).

It often helps babies who drink passively (See ‘why do you think baby learns to drink well this way?’).

And small or vulnerable babies can often drink more effectively this way. This is likely because they do not have to carry the weight of the breast themselves while drinking. And the open bodyposition facilitates breathing.

Yes that is correct. Especially so if baby has a tonguetie, both before or shortly after treatment. By holding the breast so close to the mouth the tongue and lower jaw will inevitably slide under the areola. This leads to an improved milkflow, and gives the baby the experience of more milk with less effort.

As soon as baby gets the idea the support is only needed at first latch.

If this hold is used for reflux such close support of the breast is usually not needed. The support of the body with extended midriff needs more attention in that case.

That is indeed a risk.

Actually most often the support is needed only temporarily so the risk is not as high as it might seem. And usually due to better latching the milkflow is improved to such an extend that the breast is drained well.

If support is needed during the whole feed for longer that a few days it is needed to prevent blocked ducts in the lower area of the breast:

• As soon as baby is drinking well support breast with a flat hand rather than fingertips.
• Express after feeding 1 or 2 times per 24 hrs and use a warm compress and/ors soft! massage around the lower area of the breast.
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• Allow the breast to move without a bra as often as needed: lean forward and shake shoulders and breasts, do soft yoga like cat/cow and gentle twists.

If after a week precise and extreme support of the breast is needed during the whole feed to allow for painless and effective feeding, then that is an indication this hold is not the (full) solution for the issue at hand. Another way to latch or suppelementary treatment are then indicated.

In order to drink effectively at breast a baby needs to use the lower jaw and tongue. Without adequate grip on the areola an range of motion a baby drinks on mom’s letdown. As soon as the milkflow lessens baby can’t drink well anymore and has 2 options: let go and latch again, or wait until milk flows again. A baby in this position is often a ‘lazy drinker’. In my opinion baby is clever: with insufficient breasttissue in the mouth and no range of motion waiting is the best way to get milk: passive drinking is rewarded.

With a better latch baby will notice that with each jawmovement and suck milk is flowing. So active drinking is rewarded.

Compare this to pressure on a fingertip: place stress on the tip and flow is inhibited unless you ease the pressure. Place fingers beyond the actual tip and flow is increased with action.

That depends on the issue. With a severe tonguetie continuous support may be needed, both before and the first days or weeks after treatment. And with vulnerable babies who lack power to keep hold of the breast. Usually support is only needed for a few feeds or only during the first moments:

1. Mostly the support is no longer needed once baby gets it and is stronger.
2. Often the real support is needed at first latch and towards the end of the feed. In between mom can take her hand away for more ease and to facilitate milkflow in the lower area of the breast.
3. Most mothers release the support automatically because they want to use their hand to drink some water or scratch their nose. If baby then does not let go or slips off all is fine.

Quite often you can indeed correct latch during feeding. Exception is when the first moment is really painfull: take baby off and try again. But if latch is acceptable but could be better, or if baby slipped off a bit then you can indeed correct him or her while drinking. The reason seems to be that baby drinks with lots of space for the mouth, and a relaxed head and neck.

Correction during feeding only works if and when done very gently and discreetly. At any sudden movement the baby will tense and increase pressure on the breast.

If the baby rests in the soft part of the elbow with the head tilted mildy back there is ample room for a wide mouth and a relaxed hold on the breast. You can then gently ‘lift’ the breast back into the mouth if needed, and encourage baby to come closer by nudging the back towards you.

After a c-section your baby needs to be held more horizontal. Use a comfortable cushion and apply the same general principles as for normal Concorde:

• Head in soft part of elbow or (in cross cradle) on mom’s hand, mildy tilted back with no stress behind head and neck.
• Moms arm parallel to babies spine.
• Support the breast close and parallel to babies lower jaw.
• Offer breast to upper lip
• Gently guide baby towards the breast from the back (not head and shoulders)