Painful, cracked, compressed-after-breastfeeding nipples. Baby not gaining weight well. Constant breastfeeding sessions that seem to take over an hour. Excessive baby fussiness and gas. These are some of the many signs that your child may have a tongue and/or lip tie. So, what is a tongue and lip tie and how do they affect breastfeeding? What are ways to fix them and improve breastfeeding?
With several fantastic articles already written on this subject, we are going to give brief answers to these questions and link to our favorite comprehensive resources. Also, over the next month, we will be sharing stories from breastfeeding mothers whose babies had tongue and/or lip ties.
What is a tongue tie and lip tie?
There are pieces of connective membranes under the tongue and behind the upper lip called frenula. Everyone has a lingual (tongue) frenulum and a labial (lip) frenulum, which means that if your baby has one, it doesn’t automatically mean that you are going to have breastfeeding challenges. It’s how the tongue and upper lip function that determine if the frenula are causing a problem.
Tongue tie
Upper lip tie
How do tongue and lip ties cause breastfeeding challenges?
When the frenula are tight, they act like rubber bands, tethering down the tongue to the base of the mouth or the upper lip close to the upper gumline. This makes it difficult to move the tongue in an effective manner or flange the upper lip out. When the tongue doesn’t have full range of motion, it can cause all sorts of issues. Some moms’ nipples will be compressed, causing pain and ineffective milk extraction. Some babies will become very tired and fatigued while breastfeeding, having to work extra hard to compensate for the lack of range of motion in their tongues. This can turn into ineffective, long feedings and slow weight gain for babies. Other babies gain weight perfectly fine, but have tons of gas and excessive fussy periods because they are taking in so much air while breastfeeding due to the inability to push the milk back in a wavelike motion. Babies with tongue ties or significant lip ties often continually fall off the breast, as they are unable to form a good seal and suction. Other babies have such difficulty latching on to the breast that they refuse to breastfeed altogether.
Here are two articles that describe how tongue and lip ties can affect breastfeeding:
A Breastfeeding Mom’s Symptoms are as Important as Baby’s
Baby’s Weight Gain is Not the Only Marker of Successful Breastfeeding
Why didn’t my healthcare provider mention this to me?
Most health care providers have not been trained to assess and diagnose tongue or lip ties. Again, it is how the tongue and lip function (or not function) that cause the breastfeeding challenges. Most health care providers have not been trained to complete suck assessments on infants, therefore they cannot accurately assess what the tongue is doing while feeding. The best person to assess for a tongue or lip tie is a trained IBCLC (International Board Certified Lactation Consultant).
Who can treat my child’s tongue and/or lip tie and what are my options?
The best person to diagnose and treat a tongue or lip tie is a trained dentist, ENT (Ear, Nose, and Throat surgeon), oral surgeon, naturopath, pediatrician, or other medical professional trained to do minor surgery. Make sure to do your research, as not all professionals that revise tongue and lip ties know how to release them effectively. If the professional doesn’t do the revision procedure effectively and completely, then it will not fix the breastfeeding challenges completely and your baby may have to have the procedure again.
In most cases, the tongue or lip tie revision is done at an office visit. Some practitioners will numb the area before the procedure, although it isn’t necessary. Some practitioners, such as ENTs and pediatricians, may use blunt-edged scissors to snip the tight frenulum. Others, such as dentists, may use laser for the revision procedure.
Are there any negatives to having the tongue or lip tie revised?
There is very little risk for having your baby’s tongue or lip tie revised. Most parents comment after the procedure that their only regret is that they didn’t do it sooner, as it improved their breastfeeding challenges tremendously. Some babies may be a little fussy after the procedure, but most will settle with some extra cuddles. Some parents find that a little infant tylenol or homeopathy can help relieve pain (but always check with your healthcare provider for appropriate dosing.)
How can I keep the frenulum from scarring down after the procedure?
It is very important that parents do suck and stretching exercises after the procedure to prevent scarring down. My colleague, Melissa Cole, IBCLC, created this quick and easy video for suck exercises after tongue tie revisions: http://vimeo.com/55658345. She recommends doing these a few times a day, during baby’s quiet alert time, to retrain baby’s tongue to suck effectively and to prevent scarring down. A local dentist recommends bending baby’s upper lip up to his/her nose after an upper lip tie release to prevent scarring down.
Will my breastfeeding challenges resolve immediately after the procedure?
Most moms report some immediate improvement after the procedure, but it can sometimes take up to a few weeks or months to resolve all of your breastfeeding challenges, depending on other confounding issues, such as mom’s milk supply or baby’s progress. Remember, your baby has been using his/her tongue and upper lip in this way since he/she was in utero, so it may take some time to ‘relearn’ how to use his/her tongue and upper lip effectively. Body work, such as craniosacral therapy and chiropractic, can help speed up this process as it can reset your baby’s nervous system, as well as relax the muscle tension that your baby may have developed while using compensating mechanisms.
Here are some additional online resources that have excellent information about tongue and lip ties. Stay tuned for our featured stories from moms whose breastfeeding challenges improved after having their babies’ tongue and lip ties revised. Better yet, sign up for our newsletter and have these articles delivered directly to your email inbox!
Websites that offer ways to see if your baby might be tongue tied:
Catherine Watson Genna: Is My Baby Tongue Tied?
Dr. James Ochi: Tongue Tie Survey
More researched-based articles about tongue and lip ties:
American Academy of Pediatrics Tongue Tie article
Dr. Kotlow: Tongue Tie Fact Sheet
The Leaky Boob: The Basics of Tongue and Lip Tie: Related Issues, Assessment, and Treatment
Boob Group episode: Tougue Ties and Lip Ties: Symptoms, Treatment, and Aftercare
If you would like to submit your personal story about breastfeeding a baby with a tongue or lip tie, please email it to robinkaplan@sdbfc.com
Did your baby have a tongue or lip tie?
How did this affect breastfeeding?