As a general rule milk can be stored at room temperature for 4-6 hours, in a refrigerator for up to 8 days, in a refrigerator freezer for up to 3 months and in a deep chest freezer for up to 6 mon or 12 months in a deep freezer. If you are using breast milkstorage bags, be sure to get all the air out of the bag before sealing it to prevent freezer burn. Thawed breast milk must be used within 24 hours and must be refrigerated until use. Never refreeze breast milk. CLICK & SEE
It’s very important to remember to chill your breastmilk before freezing it. Do NOT stick it directly into the freezer before it’s spent a few hours in the refrigerator.
The kind of storage you use for your milk comes down to how you plan to use it. If it’s stored for occasional use, meaning your baby is almost always getting nourishment straight from the breast, then using the plastic storage bags designed for breastmilk storage is fine. If your baby is generally being nursed from a bottle of expressed milk, as in a daycare situation, you may want to use glass bottles, as the live antibodies in breastmilk tend to stick less to the sides of glass then they do to plastic.
If you pump more in a single day you can add to your supply. If you already have milk from the same day in the freezer you can chill freshly expressed milk and add it directly to the bag that you’ve already frozen – this can only be done for same day expressions.
When warming frozen milk there is one major rule – NEVER put in on the stove or in the microwave! Microwaving destroys the antibodies in human milk and that’s one of the major reasons for breastfeeding in the first place. First thing is to remember to defrost the oldest milk first. Milk in glass bottles is best thawed in a bottle warmer. For milk stored in storage bags take it out of the second storage bag with the written information on it and either run it under warm tap water or place it in a bottle warmer.
Once your milk is warmed to the proper temperature you can pour it into the feeding bottle. Human milk is not homogenized so the fat does separate. NEVER shake human milk – always gently swirl it to mix it.
Milk thawed from the freezer can be stored in the refrigerator for up to 24 hours but remember to NEVERreuse milk that has already been in a bottle your baby has sipped off of. If you thaw 6 ounces of milk and pour 4 ounces into a bottle for baby, you can save the other 2 ounces in the refrigerator. But once the bottle has touched your baby’s lips you can only keep that milk for about an hour, due to the bacteria.
Freezing breastmilk kills some of the beneficial antibodies but is still better then formula feeding. Fresh breastmilk, either milk directly from the breast, freshly expressed or refrigerated is best, but frozen breastmmilk is still a safe and better choice for baby.
Definition:
By definition, complete ankyloglossia is the total adherence of the tongue to the floor of the mouth. Partial ankyloglossia is incomplete separation of the tongue from the bottom of the mouth due to a short frenulum, which is a fibrous membrane extending from the bottom of the tongue to an area below the bottom front teeth. Tongue-tie can be evident when the baby is crying or by careful inspection.
List of images in Gray’s Anatomy: XII. Surface anatomy and Surface Markings (Photo credit: Wikipedia)
Symptoms:
There are certain facial features that have been found to be associated with a short frenulum.
*High-arched palate: characterized by a higher than normal arch of the roof of the mouth.
*Retrognathia: very small chin.
*Micrognathia: a recessed or undefined chin.
*Prognathism: a protruding lower jaw.
*Can’t stick the tongue forward
*Difficulty feeding
*Excessive attachment of tongue to bottom of the mouth
*V-shaped notch in tip of tongue
Causes: Tongue-tie causes a significant portion of of the problems encountered with breastfeeding. It also is thought to pose other short term and long term complications, such as speech impediments, problems with swallowing, and the formation of teeth arrangement. There is some controversy over the defining characteristics of tongue-tie as well as the treatments.
When we hear the term “tongue-tied”, most of us have a mental image of someone who is struggling to speak in public, but is stammering nervously and is at a loss for words. In reality, tongue-tie is a medical condition that affects many people, and has special implications for the breastfed baby.
The medical term for the condition known as tongue-tie is “ankyloglossia”. It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and tight, causing the movement of the tongue to be restricted.
Tongue-tie is congenital (present at birth) and hereditary (often more that one family member has the condition). It occurs relatively often: between 0.2% and 2% of babies are born with tight frenulums.
To tell if your baby is tongue-tied, look at him and stick out your tongue. Even tiny babies will imitate you. If he is unable to extend his tongue fully, or if it has a heart shaped appearance on the tip, then you should have him evaluated by his doctor. You can also try putting your finger in his mouth (pad side up) until he starts sucking. See if his tongue extends over his gum line to cup the bottom of your finger. If not, you may want to have him checked.
In most cases, the frenulum recedes on its own during the first year, and causes no problems with feeding or speech development. A lot depends on the degree of the tongue-tie: if the points of attachment are on the very tip of the tongue and the top ridge of the bottom gum, feeding and speech are more likely to be affected than if the frenulum is attached further back.
Severe tongue-tie can cause problems with speech. Certain sounds are difficult to make if the tongue can’t move freely (especially ‘th’, ‘s’, ‘d’, ‘l’, and ‘t’). In addition to forming specific sounds, tongue-tie may also make it hard for a child to lick an ice cream cone, stick out his tongue, play a wind instrument, or French kiss. While these may not seem like important skills to you as a new mother, someday they may be very important to your child! Dental development may also be affected, with severe tongue- tie sometimes causing a gap between the two lower front teeth.
Of more immediate importance is the negative impact that a tight frenulum can have on a baby’s ability to breastfeed effectively. In order to extract milk from the breast, the baby needs to move his tongue forward to cup the nipple and areola, drawing it back in his mouth and pressing the tissue against the roof of his mouth. This compresses the lactiferous sinuses (the pockets behind the areola where the milk is stored) and allows the milk to move into the baby’s mouth. The tongue plays an important role in breastfeeding, and if the baby’s frenulum is so short that his tongue can’t extend over the lower gum, he may end up compressing the breast tissue between his gums while he nurses, which can cause severe damage to the nipples.
Tongue-tie can cause feeding difficulties such as low weight gain and constant fussiness in the baby. Nursing mothers may experience nipple trauma (the pain doesn’t go away no matter what position is used), plugged ducts, and mastitis.
Some tongue-tied babies are able to nurse effectively, depending on the way the frenulum is attached, as well as the individual variations in the mother’s breast. If the mother has small or medium nipples, the baby may be able to manage to extract the milk quite well in spite of being tongue-tied. On the other hand, if the nipples are large and/or flat, then even a slight degree of tongue-tie may cause problems for a nursing baby.
In addition to problems with nipple soreness and weight gain, some other signs that the baby may be having problems nursing effectively include breaking suction often during feedings, and making a clicking sound while nursing. Since these symptoms can also be caused by other problems, it’s a good idea to be evaluated by a knowledgeable health care provider (a lactation consultant if possible) to rule out causes other than tongue-tie. Tongue-tie should definitely be considered a possibility if breastfeeding doesn’t improve even after other measures such as adjustments in positioning have been tried.
If it is determined that tongue-tie is causing breastfeeding difficulties, there is a simple procedure called a “frenetomy” that can quickly correct the problem. In a relatively painless in-office procedure, the doctor simply clips the frenulum to loosen it and allow the tongue full range of motion. It takes less than a second, and because the frenulum contains almost no blood, there is usually only a drop or two of blood. The baby is put on the breast immediately following the procedure, and the bleeding stops almost instantly. Anesthesia and stitches are not necessary. The baby cries more because he is being restrained for a few seconds that he does because of pain. Comparing the procedure to ear piercing is a good analogy. Both involve a second or two of discomfort and a very small risk of infection, but are overall very safe and simple procedures.
Diagnosis
According to Horton et al., diagnosis of ankyloglossia may be difficult; it is not always apparent by looking at the underside of the tongue but is often dependent on the range of movement permitted by the genioglossus muscles. For infants, passively elevating the tongue tip with a tongue depressor may reveal the problem. For older children, making the tongue move to its maximum range will demonstrate the tongue tip restriction. In addition, palpation of genioglossus on the underside of the tongue will aid in confirming the diagnosis.
In most cases, the mother notices an immediate improvement in both her comfort level and the baby’s ability to nurse more efficiently. If the tongue-tie isn’t identified and the frenulum isn’t clipped until the baby is several weeks or months old, then it may take longer for him to learn to suck normally. Sometimes suck training is necessary in order for him to adapt to the new range of motion of his tongue. If tongue-tie is causing severe breastfeeding difficulties, then the sooner the frenulum is clipped, the better. Sometimes children end up having the procedure done when they are much older, because the problem isn’t identified until after they begin developing significant speech problems.
Even though clipping the frenulum is a simple, safe, and uncomplicated procedure, it may be difficult to find a doctor who is willing to perform it. The history of treating tongue-tie is somewhat controversial. Up until the nineteenth century, baby’s frenulums were clipped almost routinely. Because of the potential for feeding and speech problems, midwives were reported to keep one fingernail sharpened so that they could sweep under the tongue and snip the frenulum of just about all newborn babies. Any procedure that involves cutting tissue in the mouth can potentially involve infection or damage to the tongue, especially back in the days before sterile conditions and antibiotics. Because the procedure was overdone and in most cases, wasn’t really necessary, doctors became very reluctant to clip frenulums at all and the procedure was rarely performed.
Part of the reason frenotomies fell out of favor for many years was the fact that doctors discovered that in all but the most severe cases, speech was not affected by tongue-tie. They preferred to take a “wait and see” approach and let nature take it’s course. Most of the time, the frenulum would stretch out on its own with no intervention.
During the same time period that frenotomies were becoming less common, the rate of breastfeeding also declined dramatically. Bottle-feeding doesn’t present the same feeding difficulties for tongue-tied babies that breastfeeding does, because the mechanics are very different and extension of the tongue doesn’t play as big a role in feeding from the bottle. Since the majority of babies were bottle fed, it was easy for doctors to say that they weren’t going to perform an unnecessary procedure that didn’t interfere with feeding, and rarely caused speech problems.
Even today, with most infants in this country starting out breastfeeding, it may be difficult to find a doctor who recognizes the problem that tongue-tie can present for a nursing baby and is willing to perform a frenotomy. The procedure is seldom mentioned in the pediatric literature, and is no longer routinely taught in medical school.
If you feel that your baby’s breastfeeding difficulties may be due to tongue-tie, you may need to work at finding a health care provider who can diagnose the problem and clip the frenulum. Although any pediatrician or general family practitioner can theoretically perform a frenotomy, many prefer to make a referral to an oral surgeon, dentist, or ENT specialist.
Diagnosis of Clinically Significant Tongue-Tie
Based on a combination of anatomical appearance and functional disturbance:
Anatomical Type I: Frenulum attaches to tip of tongue in front of alveolar ridge in low lip sulcus….
Type II: Attaches 2-4mm behind tongue tip and attaches on alveolar ridge…..click for picture.
Type III: Attaches to mid-tongue and middle of floor of the mouth, usually tighter and less elastic. The tip of the tongue may appear “heart-shaped”
Type IV: Attaches against base of tongue, is shiny, and is very inelastic
Effects:-
Ankyloglossia can affect feeding, speech, and oral hygiene as well as have mechanical/social effects. Ankyloglossia can also prevent the tongue from contacting the anterior palate. This can then promote an infantile swallow and hamper the progression to an adult-like swallow which can result in an open bite deformity. It can also result in mandibular prognathism; this happens when the tongue contacts the anterior portion of the mandible with exaggerated anterior thrusts. The authors sent a survey to a total of 1598 otolaryngologists, pediatricians, speech-language pathologists and lactation consultants with questions to ascertain their beliefs on ankyloglossia; 797 of the surveys were fully completed and used in the study. It was found that 69 percent of lactation consultants but only a minority of pediatricians answered that ankyloglossia is frequently associated with feeding difficulties; 60 percent of otolaryngologists and 50 percent of speech pathologists answered that ankyloglossia is sometimes associated with speech difficulties compared to only 23 percent of pediatricians; 67 percent of otolaryngologists compared to 21 percent of pediatricians answered that ankyloglossia is sometimes associated with social and mechanical difficulties. Limitations of this study include a reduced sample size due to unreturned or incomplete surveys.
Feeding
Messner et al. studied ankyloglossia and infant feeding. Thirty-six infants with ankyloglossia were compared to a control group without ankyloglossia. The two groups were followed for six months to assess possible breastfeeding difficulties, defined as nipple pain lasting more than six weeks, or infant difficulty latching onto or staying onto the mother’s breast. Twenty-five percent of mothers of infants with ankyloglossia reported breast feeding difficulty compared with only 3 percent of the mothers in the control group. The study concluded that ankyloglossia can adversely affect breastfeeding in certain infants. Infants with ankyologlossia do not, however, have such big difficulties when feeding from a bottle. Limitations of this study include the small sample size and the fact that the quality of the mother’s breast feeding was not assessed.
Wallace and Clark also studied breastfeeding difficulties in infants with ankyloglossia.[8] They followed 10 infants with ankyloglossia who underwent surgical tongue tie division. Eight of the ten mothers experienced poor infant latching onto the breast, 6/10 experienced sore nipples and 5/10 experienced continual feeding cycles; 3/10 mothers were exclusively breastfeeding. Following a tongue tie division, 4/10 mothers noted immediate improvements in breastfeedings, 3/10 mothers did not notice any improvements and 6/10 mothers continued breastfeeding for at least four months after the surgery. The study concluded that tongue tie division may be a possible benefit for infants experiencing breastfeeding difficulties due to ankyloglossia and further investigation is warranted. The limitations of this study include that the sample size was small and that there was not a control group. In addition, the conclusions were based on subjective parent report as opposed to objective measures.
Speech
Messner and Lalakea studied speech in children with ankyloglossia. They noted that the phones likely to be affected due to ankyloglossia include sibilants and lingual sounds such as [t d z s ? ð n l]. In addition, the authors also state that it is uncertain as to which patients will have a speech disorder that can be linked to ankyloglossia and that there is no way to predict at a young age which patients will need treatment. The authors studied 30 children from one to 12 years of age with ankyloglossia, all of whom underwent frenuloplasty. Fifteen children underwent speech evaluation before and after surgery. Eleven patients were found to have abnormal articulation before surgery and nine of these patients were found to have improved articulation after surgery. Based on the findings, the authors concluded that it is possible for children with ankyloglossia to have normal speech in spite of decreased tongue mobility. However, according to their study, a large percent of children with ankyloglossia will have articulation deficits that can be linked to tongue tie and these deficits may be improved with surgery. The authors also note that ankyloglossia does not cause a delay in speech or language but, at the most, problems with enunciation. Limitations of the study include a small sample size as well as a lack of blinding of the speech-language pathologists who evaluated the subjects’ speech.
Messner and Lalakea also examined speech and ankyloglossia in another study. They studied 15 patients and speech was grossly normal in all of the subjects. However, half of the subjects reported that they thought that their speech was more effortful than other peoples’ speech.
Horton et al. discussed the relationship between ankyloglossia and speech. The authors believe that tongue tie contributes to difficulty in range and rate of articulation and that compensation is needed. Compensation at its worst, the article states, may involve a Cupid’s bow of the tongue.
While the tongue tie exists, and even years after removal, common speech abnormalities include mispronunciation of words. The most common is pronouncing Ls as Ws; for example the word “lemonade” would come out as “wemonade.”
Mechanical/Social
Ankyloglossia can result in mechanical and social effects. Lalakea and Messner studied 15 people, aged 14 to 68 years. The subjects were given questionnaires in order to assess functional complaints associated with ankyloglossia. Eight subjects noted one or more mechanical limitations which included cuts or discomfort underneath the tongue and difficulties with kissing, licking one’s lips, eating an ice cream cone, keeping one’s tongue clean and performing tongue tricks. In addition, seven subjects noted social effects such as embarrassment and teasing. The authors concluded that this study confirmed anecdotal evidence of mechanical problems associated with ankyloglossia and that it suggests that the kinds of mechanical and social problems noted may be more prevalent than previously thought. Furthermore, the authors note that some patients may be unaware of the extent of the limitations they have due to ankyloglossia since they have never experienced normal tongue range. A limitation of this study is the small sample size that also represented a large age range.
Lalakea and Messner note that mechanical and social effects may occur even without other problems related to ankyloglossia such as speech and feeding difficulties. Also, mechanical and social effects may not arise until later in childhood as younger children may be unable to recognize or report the effects. In addition, some problems may not come about until later in life, such as kissing.
Complications
The complications are rare, but recurrence of tongue tie, tongue swelling, bleeding, infection, and damage to the ducts of the salivary glands may occur.
Treatment:
Surgery is seldom necessary but if it is needed, it involves cutting the abnormally placed tissue. If the child has a mild case of tongue tie, the surgery may be done in the doctor’s office. More severe cases are done in a hospital operating room. A surgical reconstruction procedure called a z-plasty closure may be required to prevent scar tissue formation.
Prognosis:
Surgery, if performed, is usually successful.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
We know that breast feeding is best, but what is the bottom line for nursing mothers? What length of time provides maximum health benefits for infants? The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least twelve months. But not all women are able or willing to reach the twelve-month goal. According to the International Lactation Consultant Association (ILCA), approximately 70% of women in the United States breastfeed alone or in combination with formula at the time of hospital discharge. The rate drops to about 33% at six months, with even lower rates for low-income and African-American families. Parenting guides and books suggest that breastfeeding longer is better. Doctors tell mothers that breastfeeding for a few weeks is better than not breastfeeding at all.
But how long is long enough? In 2001, the World Health Organization (WHO) changed its recommendation from exclusive breastfeeding for four to six months of age to exclusive breast feeding for at least six months. The term “exclusive breast feeding†means exactly that: the infant receives only breastmilk. No supplemental formula, water, other liquids or solid foods are provided.
Of course, vitamins, minerals or necessary medicines are included in this guideline.
Even after the WHO released its recommendation, there was still some lingering debate and confusion regarding the optimal length of breastfeeding. This confusion arose in part from the lack of information about the comparative health gains of different breastfeeding time frames. Most research studies were not specifically designed to clarify whether breastfeeding for three versus four or even six months really mattered. Breastfeeding Duration Is Important
New findings support growing evidence that the length of time is important. The WHO recommendation is correct six months seems to be the magic number.
Researchers from the University of Califonia-Davis Children’s Hospital, the University of Rochester and the American Academy of Pediatrics Center for Child Health Research studied a nationally representative sample of 2,277 babies.
These scientists compared five groups of infants. The first group included formula-only babies. The other groups of infants were fully breastfed (using formula on a less-than-daily basis) for different lengths of time: less than one month, one to four months, four to less than six months and six months or more. Infants fully breastfed for six months or more were less likely to suffer from pneumonia, ear infections, and colds than infants breastfed for four months. These health gains continued throughout the infants’ second year.
Researchers in 2003 reached similar conclusions regarding breastfeeding duration effects. They compared the benefits of three and six months of exclusive breastfeeding in a sample of 3,483 infants. Babies exclusively breastfed for six months had a lower risk of developing gastrointestinal infections. In addition, exclusive breastfeeding did not cause any negative side effects such as iron deficiency during the first year of life.
Additional Benefits
These two recent studies complement the large body of evidence indicating that breastfeeding has important benefits for children, mothers, and society. Besides protection from upper respiratory and gastrointestinal effects, the benefits of breastfeeding for infants include:
* Fewer infectious and non-infectious diseases
* Reduced risk for chronic diseases such as diabetes, cancer, allergies and asthma
*Reduced likelihood of becoming overweight and obese children
*Lower incidence of skin disorders
Mothers who breastfeed also experience positive health effects such as less postpartum bleeding, an earlier return to pre-pregnancy weight, and a reduced risk of ovarian and pre-menopausal breast cancers. Families with breastfed infants save thousands of dollars on formula and medical care. Society benefits, too. Fewer trips to physicians and hospitals reduce overall healthcare expenditures. Reduced rates of absenteeism and increased morale can translate into huge savings for large corporations as well as small businesses.
Breastfeeding Barriers
Given the overwhelming amount of research pointing to the benefits of breastfeeding, why do only one-third of American women continue to nurse their infants for six months? Certain characteristics are associated with breastfeeding. Women who fully breastfeed tend to be older and more educated. Mothers who smoke, are single and do not participate in childbirth education classes are less likely to exclusively breastfeed.
The most commonly reported reasons for bottlefeeding are:
* Father’s negative attitude toward breastfeeding
*Uncertainty regarding how much breastmilk is consumed by the nursing infant
* Return to work
Other factors influencing rates of breastfeeding include:
*Negative attitudes of healthcare professionals
* Ready availability of formula
*Nipple pain and irritation
* Time constraints
* Embarrassment
* Lack of confidence
* Concerns about dietary or health practices
Mothers indicate that receiving more information from prenatal classes, TV, magazines, and books would increase the likelihood of initiating and maintaining breastfeeding. According to lactation specialist Charlotte Burnett, BSN IBCLC from Truman Medical Center Lakewood (Kansas City, MO), much of the educational process targets dispelling common myths about breastfeeding.
For example, many women believe that they are completely unable to eat beans, spicy foods, chocolate, junk food or drink soda while breastfeeding. Other women seem to think they should not even start to breastfeed if they are planning on returning to work or school in six weeks, says Burnett.
Obtaining more family support would also help increase rates of breastfeeding. If a mother or sister didn’t or couldn”t breastfeed, a new mother may have less confidence and desire to breastfeed, reports Burnett. Even if a mother chooses to nurse, detrimental family comments an undermine this decision. Burnett”s clients have heard comments such as, Just give him a little real milk or She wants to breastfeed so much. Are you sure you shouldn”t just give her a bottle?
To complement education and family support, the International Lactation Consultant Association states that supportive, breastfeeding-friendly communities are imperative to increase national rates of breastfeeding.
This may be one of the most difficult hurdles to overcome. A huge barrier is the free formula that companies give away. We are trying to change a culture, reports Patricia Lindsey-Salvo, a lactation specialist who runs the Breastfeeding Center at Beth Israel Medical Center in Manhattan.
In 2001, the Department of Health and Human Services released a Blueprint for Action on Breastfeeding as part of the Healthy People 2010 initiative. This document detailed a comprehensive national breastfeeding policy with a goal of increasing the number of new mothers who breastfeed to 75%. The document also calls for expanding the proportion of women breastfeeding at six months to fifty percent, and twenty-five percent at twelve months.
So What Should a Mother Do?
So what does all of this research and information mean for a mother? Get as much information as you can before deciding to breast or bottle-feed. Discuss problems or concerns that are likely to affect your breastfeeding goals with a lactation consultant or sympathetic pediatrician. Share information with your family and friends, and surround yourself with encouraging and supportive voices. Nurse your infant as long as possible, aiming for at least six months. “The evidence is rolling in every day about the benefits of breastfeeding,†reports Lindsey-Salvo.
As part of the study, researchers developed a novel mouse breast cancer model to mimic human breast cancer disease. Estrogen receptor-positive breast adenocarcinoma cells were subcutaneously injected near the pad of the fourth mammary gland of female immunocompetant mice (C57BL/6).
The mice were fed with moderate EtOH (alcohol) for four weeks, the equivalent of two drinks per day in humans. In the second week, mouse breast cancer cells were injected at cite referenced above.
Researchers found that moderate alcohol consumption significantly increased the tumour size of breast cancer and micro-vessel density in mice. This study presents the first animal model to confirm that alcohol consumption stimulates tumour growth and malignancy of breast cancer.
