Kim Ticman-Mapua MD Pediatrician & Lactation Consultant

Kim Ticman-Mapua MD Pediatrician & Lactation Consultant Contact information, map and directions, contact form, opening hours, services, ratings, photos, videos and announcements from Kim Ticman-Mapua MD Pediatrician & Lactation Consultant, Medical and health, C. Raymundo, Pasig.

Pediatric Health and Breastfeeding Medicine
Fellow, Philippine Pediatric Society
International Board Certified Lactation Consultant
Member, International Lactation Consultant Association
Member, Human Milk Bank Association of the Philippines

Lord, make me faithful even in little things. Teach me honesty and trustworthiness when no one is watching, so I can hon...
31/05/2026

Lord, make me faithful even in little things. Teach me honesty and trustworthiness when no one is watching, so I can honor You with much. Amen.
Have a Blessed Sunday.🙏

Family connections
28/05/2026

Family connections

ROOMING-IN: More Than Just Staying in One Room 🩷I had a patient who consulted me because they wanted to shift from mixed...
27/05/2026

ROOMING-IN: More Than Just Staying in One Room 🩷

I had a patient who consulted me because they wanted to shift from mixed feeding to exclusive breastfeeding. When I took a history, I gathered that her baby was not roomed- in and remained in the nursery for the entire hospitalization. Her baby was well and she needed to go down to the nursery to feed her baby which she was able to do once a day. When we thought that ROOMING-IN should be a national policy yet there are still hospitals not complying.

In the Philippines, “rooming-in” means keeping the mother and baby together 24 hours a day after birth instead of separating them in the nursery. This is supported by the Philippine Rooming-In and Breastfeeding Act of 1992 (Republic Act No. 7600), which promotes early bonding and breastfeeding.

Why is rooming-in important?

✅ Helps mothers recognize baby’s hunger cues early
✅ Improves breastfeeding success and milk supply
✅ Promotes bonding and emotional security
✅ Helps regulate baby’s temperature, breathing, and blood sugar
✅ Reduces risk of infections from unnecessary nursery exposure
✅ Builds maternal confidence in caring for the baby

When mothers and babies are routinely separated, possible consequences may include:
⚠️ Delayed or difficult breastfeeding
⚠️ Lower milk supply
⚠️ Increased stress for both mom and baby
⚠️ Higher chance of formula supplementation
⚠️ Less opportunity for bonding and skin-to-skin care

Rooming-in is not just a hospital setup — it is evidence-based care that supports the health of both mother and baby from the very beginning. 🤱

☝️For new parents, do ask your obstetrician during prenatal check up if the facility where you will be giving birth practice rooming-in. When there is a rooming-in policy, mothers and babies have unlimited time to breastfeed.

References:
• Republic Act No. 7600 – Rooming-In and Breastfeeding Act of 1992
• World Health Organization (WHO)
• UNICEF Baby-Friendly Hospital Initiative





TWO-TONED LIPSThis is my 5 month-old patient referred by their Pediatrician due to shallow latch. I first met him when h...
25/05/2026

TWO-TONED LIPS

This is my 5 month-old patient referred by their Pediatrician due to shallow latch. I first met him when he was about. 3 weeks old and they were direct breastfeeding with 2-3 bottles of expressed breastmilk/day. Mom reported breastfeeding pain, reast preference to left and head turning preference to right. On physical examination, there was a tongue-tie type 4, just finding with examining finger during oral assessment. When breastfeeding was tried, baby was not actively latching and at the same time painful. I advised d them to do oral exercises and observe.

One month after their first check up, there's still breastfeeding pain. Reflux was observed 2-3x/day. Baby hated tummy time.On physical examination, lips were 2-5oned with blisters. There was blanching oon the upper gum when upper lip.was lifted and the tongue-tie was still there. We finally performed frenotomy.

One week post frenotomy, mom reported that they had difficulty breastfeeding during the first 24 hours but was able to latch the next day. Breastfeeding pain was only at the beginning of feeds unlike before. Reflux decreased to 1-2x/day but noted spillage of milk during bottle-feeding. He still hated tummy time. Lips were still 2-toned but less blisters. Baby was gaining enough weight. Baby had a good suck on examinibg finger and no longer biting with no reattachment. When breastfeeding was tried, he was actively sucking and more relaxed. I advised them to continue oral exercises and stretching.

One month Post frenotomy, mom reported difficulty latching on the breastband increase in reflux to 3x/day though there was less spillage in the bottle. He still hated tummy time. On physical examination there was 2-toned lips and slight reattachment and advised them to improve stretching and continue oral exercises.

Two month post frenotomy, mom reported that they were doing direct breastfeeding when mom was at home. Mom only pumped 2x a day when at work. Mom reported a 5/10 pain only at the beginning of breastfeeding. He still hated tummy time. He still had 2-toned lips with no blisters. There's no reattachment and tongue could reach the palate.

Three months postfrenotomy, they were still exclusively breastfeeding. Pain at the beginning of the feed seldom happened. He could do tummy time for 10-15 minutes and lips were no longer 2-toned. Praise God. 🙏

You have probably seen a two-toned lips -darker on the outside and lighter in the center . Some babies with oral ties (especially those with lip ties), the upper lip cannot fl**ge or move normally during feeding. Constant tension and compression of the lip may cause uneven color, blanching, or a “2-toned” appearance.

After frenotomy, the tight tissue is released, allowing better lip mobility, improved blood flow, and a more natural latch. Over time, many parents notice the lip color and shape becoming more normal as feeding function improves.

A better latch can also mean:

✔️ Less ni**le pain

✔️ Better milk transfer

✔️ Less clicking and air intake

✔️ More comfortable feeds for both baby and mother















Lord, keep me rooted in You - connected through Your Word, prayer and presence so my life bears fruits that honors You....
24/05/2026

Lord, keep me rooted in You - connected through Your Word, prayer and presence so my life bears fruits that honors You..Amen
Have a Blessed Sunday!

Advantages of having pets.
20/05/2026

Advantages of having pets.

BLOOD IN STOOLS OF A BREASTFEEDING BABY?Sorry please excuse the very gross pictures if you are eating at this moment...T...
20/05/2026

BLOOD IN STOOLS OF A BREASTFEEDING BABY?

Sorry please excuse the very gross pictures if you are eating at this moment...

The other day, a mom brought her 5 month-old exclusively breastfeeding baby due to blood in stools. Baby was healthy, feeding well with no other symptoms.

Cow's milk is the most common gastrointestinal allergen. If a formula-fed baby who was apparently well and active then all of sudden, a mom found blood in the stools, cow's milk allergy or in broader term "food protein-induced proctocolitis" is suspected. It's a broad term since other protein like soya milk or egg can also cause gastrointestinal allergy in a form of bloody stools. Shifting milk to breastmilk (which is definitely a wise choice) or if the family can afford, a very expensive extensively hydrolyzed or amino acid formula can resolve this condition.

But what if the baby is exclusively breastfeeding and still have this condition? Then you have to go back to the diet of a mom. A 24-hour food recall of the mom must be done. Majority of breastfed infants with food protein-induced proctocolitis respond to elimination of cow's milk from the mother's diet and a very few require elimination of multiple proteins. If the infant's symptoms fail to resolve, the first step is to review the mother's diet carefully to make sure that all sources of cow's milk protein have been completely eliminated. If cow's milk was completely eliminated for at least two weeks and the infant remains symptomatic, then soy, followed by egg, should also be removed from the mother's diet.

Going back to the case, I asked the mom if she had dairy on her diet. She said yes and a day before she found blood on baby's stools, she drank 3 glasses of milk.

Among my patients who had food protein-induced proctocolitis, one was given formula milk once a week, one baby had a mom who ate lots of cheese a day prior, one mom drank a rock-salt cheese milktea and the other mom drank soya milk. Fortunately, the condition resolved after a few days when the culprit was eliminated in a mom's diet.

But I remember a mom who completely eliminated everything from milk to eggs and even bread but her baby continuously pooping with streaks of blood. Her baby's condition completely resolved after 3 weeks of complete elimination of suspected proteins.

PS. There is a also one condition wherein blood in stools is a surgical emergency called "intussusception." This manifested as "currant jelly" stools (gross blood) and the baby is very irritable.
Most of the time, blood in stools are unnecessarily treated as infection like amoebiasis without considering food protein-induced protocolitis first.

Source: Uptodate


-inducedproctocolitis


TONGUE-TIE TYPE 4 -MOST COMMONLY MISSED TONGUE-TIE This is my 4-month-old patient from Quezon Province . I saw him firs...
18/05/2026

TONGUE-TIE TYPE 4 -

MOST COMMONLY MISSED TONGUE-TIE

This is my 4-month-old patient from Quezon Province . I saw him first online when he was 12-day old. Mom's concerns were low milk supply and crying while breastfeeding. Breastfeeding lasted for 1.5 hours every 1-2 hrs but with no pain. Baby had choking episodes with spillage, fussy with hiccups and back arching and breast preference to left. On physical examination, there's a tongue-tie type 4 , lifted midmouth. There was biting on examining finger but good suck. During breastfeeding, mouth was narrow with spillage and cheeks sucked in. I advised to do oral exercises and look for a release provider in their area.

Mom updated me that they gave bottle because baby would cry on the breast. They found a Pedia dentist and diagnosed baby as having a lip-tie but no tongue-tie. Baby ended up being released by an ENT who only recognized lip-tie only 4 days after our online consultation. Mom noted that there was improvement on baby's latch on the right breast (less preferred).

One month post frenotomy of lip-tie, we again had an online consultation. There's no more choking and spillage and reflux seldom happened. He was fussy on the left breast with head turning preference. Sleep didn't last long when lying on his back and he couldn't be put down. Lips were 2-toned with blister on midupper lip and a tongue-tie type 4. During breastfeeding, there were no more spillage and cheeks were already full. Mouth was initially wide but later on became narrower. I advised them that the other symptoms could be from the tongue-tie.

The parents decided to travel to Pasig all the way from Quezon to do the tongue-tie release and advised to continue oral exercises and aftercare.

During the first week post frenotomy, baby wouldn't take the breast and would only cry so they bottle-fed. He would easily awaken when put down. They also started formula that time.

More than 1 week postfrenotomy, baby was able to accept the right breast only but painful with a scale of 5/10 and had difficulty latching the left breast. He still had head turning preference and reflux. He was able to sleep for 2 straight hours for the first time which also gave the parents good sleep. Mom pumped the left breast 3x a day and they would top up 2 oz of formula per day. When breastfeeding was tried on the left breast on football hold, baby was more comfortable though not continuous.

Six week post frenotomy, mom reported that giving formula lasted only for 4 days after our last consultation. Baby was able to latch on the breast comfortably 2 weeks after the last consult. They were exclusively breastfeeding even now that mom already returned to work and was able to donate extra milk to others. Baby was breastfeeding on both breasts at any position even side lying pain-free. There's no more head turning preference. Praise God 🙏

Tongue-tie type 4 sits way under the tongue - it’s a posterior, submucosal tie. You won’t see a obvious “heart-shaped” tongue or a tight frenulum at first glance. That’s why it’s missed so often.

But even if you can’t see it, baby can feel it. A Type 4 tie restricts tongue lift and movement, so latch gets shallow, milk transfer drops, and feeding turns painful for mom.

Even if there was improvement on breastfeeding after a lip-tie release, there were other remaining symptoms brought about by tongue-tie.













Lord Jesus, there are things in my life I don’t understand right now, plans that feel confusing, delays that feel heavy...
17/05/2026

Lord Jesus, there are things in my life I don’t understand right now, plans that feel confusing, delays that feel heavy, and moments that don’t make sense. Help me trust that You know what You’re doing, even when I can’t see it yet. Give me peace to rest in Your timing and faith to believe that one day, I will understand. Teach me to walk with You now, even in the not-knowing.
Amen.

Connection not isolation from
14/05/2026

Connection not isolation from

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C. Raymundo
Pasig

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