Finding the Best Pediatrician for Your Growing Family

Are you pregnant and planning on breastfeeding?  If the answer is yes, you should commit to finding a pediatrician that will help you meet your goal. First, start off by doing your research.  Topics to consider:

  • Ask friends, family and coworkers for recommendations for pediatricians.

  • Visit the prospective pediatricians’ websites to learn more about what is offered at the practice(s).

  • Consider the proximity of the office to your home.  Of course, you should be willing to travel a little farther to obtain the best care possible.

  • Review the practice hours.  Do they offer weekend/holiday hours if your child is ill. Know who covers them on weekends/holidays.

  • Schedule a prenatal visit (some pediatricians allow for one-to-one sessions, while others meet expectant parents in a group-like setting).

  • Bring a questionnaire to the prenatal pediatrician visit, so you can be sure you leave with all the answers.

Some questions to ask regarding their support of breastfeeding:

1.  What training do you and your office staff have to support my breastfeeding experience?  

There are certainly many continuing education programs that provide physicians with some knowledge-base regarding breastfeeding. You would also want to learn what their credentials mean to you, in regards to breastfeeding.

2.  Do you have an International Board Certified Lactation Consultant (IBCLC) in your office or is there an IBCLC you refer to regularly that takes my insurance?  

An IBCLC is the gold standard of lactation care.  Ideally, every pediatric office should have an IBCLC or, at the very least, be able to tell you that how close the nearest IBCLC is that they refer to regularly.  Also a Fellow of the Academy of Breastfeeding Medicine (FABM) is another title for a physician that will be able to assist you in your feeding goals.

3.  What percentage of newborns in your practice are breastfeeding?

National average is approaching 80 percent of newborns breastfeeding, and you would expect the pediatrician’s average to be close to national average.  Don’t fret, though, if the pediatrician does not know their statistics, just be sure they are dedicated to your plan to breastfeed.

4.  Do you observe a breastfeeding session in your office to ensure nursing is effective?

Most pediatricians with lactation training desire to observe a feeding session within the first two weeks of life, when most nursing problems are evident, ensuring proper positioning and latch along with consistent milk transfer.  

5.  How long should my baby exclusively breastfeed for? When do we introduce solid foods? How long should we continue breastfeeding after introducing solid foods.

If their answer is any less than six months, you may want to look elsewhere. The American Academy of Pediatrics (AAP) recommends babies be exclusively breastfed for the first six months of life with introduction of solid foods at six months and continued breastfeeding through one year of age.  Did you know the AAP recommends breastfeeding for at least one full year, while the World Health Organization (WHO) recommends two years of breastfeeding, along with complementary foods.  Honestly, the best answer you can get as to how long to breastfeed, is however long you and baby mutually want to continue the breastfeeding relationship.

6.  If I choose to return to work while breastfeeding, how can you help me?

Some offices now offer “returning to work” classes or individual appointments where choosing the correct pump for your needs is an important topic and discussion occurs regarding expressing the most milk during your sessions.  Your provider should be able to show you methods to best transition a baby from breast to bottle and vice versa.  The pediatrician should also be well versed in the laws regarding working mothers and breastfeeding and be willing to write a letter to your employer explaining such laws, along with the benefits of breastfeeding for mom, baby and the employer.

7.  What other resources are in the area to support breastfeeding mothers?

Your pediatrician should be able to tell you about local support groups, meetings, classes and breastfeeding coalitions that will support your goals above and beyond the support you will receive in the office.  The pediatrician should also be familiar with apps and websites that can assist mothers and providers in clinical decision making regarding the safety of medications and supplements while breastfeeding.

Tongue Tie (Ankyloglossia)

Nursing Issues Related to Tongue Tie

Despite a breastfeeding mom’s best attempt to correct latch and position and to breastfeed her baby frequently and effectively, some mothers find themselves with breastfeeding problems (including sore nipples, recurrent plugged ducts, mastitis, low milk supply). Sometimes baby displays the issue by not gaining weight well, making clicking sounds or gagging/choking at the breast.
 
Tongue tie (also known as ankyloglossia) can cause many of these nursing problems.  Unfortunately, some practitioners do not acknowledge the fact that tongue tie can cause many nursing difficulties, but there is a lot of research which shows tongue tie negatively impact the breastfeeding relationship.

What is Tongue Tie?

Tongue tie - having tongue mobility restriction, due to a short frenulum describes the situation where a baby’s tongue does not have enough range of motion to latch onto the breast, maintain the latch, suck and swallow effectively. Tongue tie is caused by a lingual frenulum (the membrane under the tongue) that is either too short or too thick. Some babies with tongue tie also have an abnormally tight membrane attaching their upper lip to their upper gums, which is known as a lip tie. Babies with lip tie often have difficulty flanging their lips properly to feed and do not make a good seal at the breast when latching. This can cause them to take in excess air during breastfeeding which often makes these babies gassy and fussy.

Between five and ten percent of babies are tongue tied and sometimes the trait runs in families; therefore, if you have one baby with the issue, you may have more. Sometimes tongue tie is obvious, yet they don’t have sore nipples and their baby continues to gain weight. These mothers have a lot of milk, so they manage. For most mother of babies with tongue tie, milk production will often decrease and then their baby may not gain weight well after three or four months. Also, many children who are tongue tied may not be identified early and this may lead to speech problems later in life.

What can be done if my baby has limited tongue mobility?

The solution for tongue tied is to release it. The procedure is referred to as a frenotomy, which is a relatively painless, in-office procedure, where the tight frenulum is released.  This release allows for improved range of motion of the tongue.  If tongue-tie is causing severe breastfeeding difficulties, the frenulum should be released as soon as possible to minimize the impact on the breastfeeding mother and baby. The earlier the problem is identified, and the frenotomy is done, the less time it will take for the baby to nurse effectively and comfortably after the procedure. If the tongue-tie is not identified and the frenulum is not clipped until the baby is several weeks or months old, it may take longer for the baby to learn to suck normally. 

The procedure, in our office, takes less than a few minutes and baby is placed immediately back into his mother’s arms, with the goal of latching the baby onto the breast instantaneously.  In most cases, the mother notices an immediate improvement in both her comfort level and the baby’s ability to nurse more efficiently.  A mother’s discomfort is considerably less and baby feeds better at the breast, and when baby empties the breast better, the mother makes more milk. 

Kenneth Toff DO FAAP, FACOP, IBCLC