The Lip Tie/Tongue Tie Challenge

To help parents understand a bit more about how tongue and lip ties can affect breastfeeding, over the next few weeks we will be featuring stories from moms whose babies experienced these challenges.  We would like to extend a HUGE thank you to the brave mamas who submitted their stories for our blog!  We know you went through a ton of challenges and we are so appreciative that you were willing to share your stories!  If you have a story you would like to share on our blog, please send it to robinkaplan@sdbfc.com.

For more information about tongue and lip ties and how they can affect breastfeeding, please see our article: Does Your Baby Have a Tongue or Lip Tie?

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Written by Julie Sanders

My issues with breastfeeding my daughter started pretty much as soon as we left the hospital. I started experiencing a lot of pain in my nipples. Not just while she was nursing, but all the time. I was told it was normal for her to nurse 8-10 times a day, but my daughter was nursing 20+ times a day. Essentially, she was constantly nursing, with maybe a 10-20 minute break between sessions. I found that since any side-lying, cradled position was extremely painful, only the football hold position worked for me. I went to a breastfeeding support group her second week, and I learned that my daughter was chomping my nipples while she nursed, and that’s why they were in constant pain. Nipples are supposed to come out of a baby’s mouth just as round as when they went in, but mine were shaped like a football after a nursing session. No wonder! Someone suggested I try nursing her lying down because she was perhaps trying to stem a strong flow of milk into her mouth, but that didn’t help. On top of it all, I also got a clogged duct, which was painful and scary. I was in such excruciating pain I would cry when my daughter wanted to nurse because I just wanted a break for my poor nipples to heal. I didn’t know why it was so hard or what was wrong. The only thing that got me through this period were gel pads. The moist, cold combination was wonderfully soothing.

When my doula came over for our postpartum visit, she checked my daughter’s latch and suggested that we have her evaluated for a tongue tie. She said it didn’t look like her tongue reached far enough forward in her mouth (past the gums). We had never heard of a tongue tie before. She explained it is a very common, simple procedure our pediatrician could perform to snip the underside of her tongue to allow for greater mobility. I rejected the idea at first. The idea that my daughter wasn’t born with her mouth properly equipped to handle breastfeeding seemed ridiculous to me. My daughter was perfect in every way! But later that week when she had a wellness checkup, we asked about the tongue tie. Our pediatrician said it looked like there was indeed a tongue tie, and he would revise it if we wanted him to.  So he clipped the frenulum under her tongue. It was done with scissors while the nurse and my husband held her down. He gave her just a topical gel to numb the area, then had to do about 3-4 snips to cut what he deemed enough. She wailed like I had never heard before and cried real tears. I cried real tears too. It was scarring. I nursed her immediately afterwards to help stop the bleeding and she slowly calmed down. The bleeding stopped very soon and she seemed on the road to recovery. She had a little discomfort for the next day or two. I thought the nightmare was finally over. But it wasn’t. At first I noticed a relief in how she nursed, but it was very short lived. I found out at the breastfeeding support group the next week that there were exercises we were supposed to be doing to help my daughter learn to use the full range of motion of her tongue. The lactation consultant who runs the group emailed me a video with instructions. I did them several times a day, as suggested, but nothing changed.

At around three weeks we finally saw a lactation consultant. I wish I had seen her during week one! Within minutes of telling her our history and examining my daughter, she told us my daughter also had a lip tie, and explained that my daughter nursed constantly because she was only able to get enough milk to satiate her for a short time before she would get hungry again. I hated the idea that my daughter had another tie. My perfect baby was still perfect!  But we followed the advice of the lactation consultant and went to a pediatric dentist in the San Bernadino area who uses a laser instead of scissors, a tool that was supposedly less traumatic on both patient and parent. The thought of driving 80 miles with a baby so young almost deterred us, but we decided to go for it.

The dentist had my husband lie down in the chair and hold my daughter face up on his tummy. Being held by dad was far less traumatic than being pinned to a table by strangers. She also got to wear adorable little sunglasses to protect her eyes from the laser. The dentist checked her out and said she did indeed have a lip tie, and he wanted to do another revision on her tongue to cut more of the frenulum. It literally a minute per tie, if even. He lasered, she cried, and before I could even get upset he was done. I nursed her immediately, just like before, and she calmed very quickly. They gave me exercises to do with her several times a day to help the range of motion for her mouth. Once again I left with the feeling of “It’s over. It’s finally over.” But it wasn’t.

The discomfort again only lasted a day or two, and seemed a little worse for her lip than her tongue. I did the exercises but she just kept chomping. Though with the new mobility of her tongue, her bottom gums were padded a bit, and the pain, while still painful, was much more bearable by comparison. By this point I had gone through so much, I was determined to make this work. My lactation consultant had told us “body work” might be required. After all, my daughter had used her mouth to nurse a certain way her whole life thus far and she was used to it. So we went to a craniosacral therapist. The therapist observed my daughter while she nursed and felt all around her head to examine how her muscles were moving. She massaged around her head and jaw for a bit, and then she told us my daughter’s jaw was very tight, and that’s why she wasn’t latching correctly, but that there wasn’t anything she could do to loosen it.

Next we tried a chiropractor. Chiropractic was another kind of body work my lactation consultant had suggested we may need. She recommended a few people who worked with babies in my area. Over the next two weeks I saw the chiropractor three times. She adjusted areas in my daughter’s upper spine and around her jaw to try and loosen it. Between the three appointments and our periodic massaging of her jaw, gradually at around six to seven weeks old, my daughter’s jaw loosened, she stopped chomping my nipples, and started sucking the way Mother Nature intended. It felt like an eternity, but she is now three months old and our time breastfeeding is easy, a lovely bonding experience and no longer something I dread. It’s easy and wonderful, and it was worth every minute we spent at appointments and every dollar we spent on doctors and specialists and consultants.

I learned a great deal during this trial. A good lactation consultant is invaluable. Ours not only identified our issue right away, but she had all the references to specialists we needed. We were not in a place where we could have researched and found someone to go to on our own. We trusted our lactation consultant, we went where she sent us, and we were never disappointed. Surrounding myself with people who supported my determination to exclusively breastfeed was also pivotal. Being a new mom is an emotional time with many ups and downs even when breastfeeding is going well. My mental state really ran the gambit, and having people to tell me it would get better and that I could do it helped me through my lowest moments. The friend who introduced me to gel pads is an absolute saint! And I learned how strong a person I am.  Compared to this experience, labor was easy. I always referred to what we were going through as “a breastfeeding challenge” because a challenge is something you overcome, and usually leaves you stronger and better off than when you started. 

Does Your Baby Have a Tongue or Lip Tie?

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?