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?

Gerber to the Rescue (Or So They Want You To Think)

We’ve all been there. 

You’ve been home with your new baby for a few days/weeks.  It’s 2am and you’re tired and overwhelmed.  You’ve never felt such bone-aching exhaustion.  All you want to do is crawl in bed and sleep uninterrupted.  Just for a few hours…. even ONE hour.  But your baby is crying and won’t stop.  You’ve tried everything – a fresh diaper, breastfeeding, you’ve shushed, swaddled and swung to the point of fatigue.  And the baby won’t stop crying.  You’ve woken your partner, called your mom or sister and none of the advice is helping.  You’re worried that you’re doing something wrong or that you’re doing nothing right, that something is wrong with your little one, that you’re not making enough milk.  You’d try almost anything at this moment to soothe your baby’s distress.

It’s exactly this vulnerability that formula companies prey upon when they make commercials like the one below:

The commercial for Gerber claims that the specially-created formula is effective in calming ‘excessive crying and colic.’  Nothing is more upsetting to a mother than the sound of her baby crying – we are biologically designed to physiologically respond to our own children’s sounds of distress, to do whatever we can to stop the baby from crying.  Gerber is just PRAYING that a frustrated and exhausted mother will see this commercial and think that this new formula the answer to her struggles.  Some moms may decide to introduce the formula to an exclusively breastfed baby, initiating the slippery slope of decreased supply and increasing ‘need’ for supplementation - just what formula companies are hoping for.

What Gerber fails to mention in the commercial is that the probiotic they have included (L. reuteri) has been studied and shown to exist in breast milk.  Or that breast milk also has all the calories, protein, fat, carbohydrates and vitamins that your baby needs – AS WELL as antibacterial, antiviral, and antimicrobial factors specifically formulated to protect your baby.  That breast milk contains all the probiotics AND prebiotics your baby may need.  Or that human milk changes in composition as the baby grows, continually providing a unique superfood specific to YOUR baby. 

Gerber also doesn’t explain to the new mom why her baby may be crying.  The first three months of a baby’s life is often called the “fourth trimester” and should be treated as such.  Just days ago, your baby was safely tucked in your womb, with constant warmth and soothing sounds and movements.  Upon birth, the baby is thrust into his new environment, which is often cold and bright and always unfamiliar.  Gerber doesn’t share the statistic that babies who are worn 3 or more hours a day cry 50% less than babies who aren’t.  Gerber doesn’t remind the new mom that her 2-week old baby may be experiencing a growth spurtand the constant nursing and fussiness is a normal part of this, that the baby is doing all he needs to boost mom’s milk supply as he grows big and strong.  Gerber doesn’t educate the mom on what she can add to or remove common allergenic or inflammatory foods (such as gluten, dairy, and soy) from her own diet to help soothe a colicky baby. (Check out our Boob Group podcast episode: GERD, Reflux and the Breastfed Baby for an explanation on symptoms, causes, and remedies for GERD, reflux, and colic.)

There are many reasons for a crying and colicky baby, and a number of solutions.  One action that is never the answer is replacing any amount of breast milk with an artificial milk.  Shame on Gerber for suggesting to an unsure and overwhelmed mother that her breast milk is lacking in something that could soothe her crying baby!