Tongue and Lip Tie

breastfeedingcafecarnivalWelcome to The Breastfeeding Cafe Carnival!

This post was written as part of the Breastfeeding Cafe’s Carnival. For more info on the Breastfeeding Cafe, go to www.breastfeedingcafe.wordpress.com. For more info on the Carnival or if you want to participate, contact Claire at clindstrom2 {at} gmail {dot} com. Today’s post is about breastfeeding in special circumstances. Please read the other blogs in today’s carnival listed below and check back for more posts July 22nd through August 4th!
 


 

OLYMPUS DIGITAL CAMERABoth my children were born tongue-tied.

A tongue-tie is a restriction in the tongue’s ability to function properly caused by a frenulum that is too short or tight. Sounds pretty straightforward, right?

Some tongue-ties are very obvious. The tie may be so far forward on the child’s tongue that it dramatically changes the shape of the tongue so that it is heart-shaped. A breastfeeding mother may experience a lot of pain or even nipple damage. The baby may be so ineffective at sucking that there is a delay in the milk “coming in,” or the baby may not gain enough weight.

Or the tie could be harder to see, the mother may not be in pain, and she may have an abundant supply that allows the baby to coast by, gaining enough without actually being able to move his or her tongue properly.

Each of my children had very different experiences with being tongue-tied. My daughter spit up all the time. She had a very difficult time handling letdowns, and my abundant supply was very overwhelming for her, yet it helped her to gain weight despite having a rather shallow latch and having a difficult time maintaining suction on the breast. As my supply regulated, she got by through nursing every 45 minutes around the clock. I lost track of how many times she would nurse in the middle of the night when it got to be more than ten times a night, and I could practically set a timer for 45 minutes after getting up in the morning or sneaking away from her during her naps to know when she would wake up and need to nurse more.

She refused to comfort nurse when she was hurt or upset and refused to nurse to sleep at night for months. Instead, I spent hours walking her, bouncing her, singing to her until she fell asleep, fast asleep enough that she would not wake up when I moved her to bed because if she woke up too soon, she still would not nurse back to sleep.

OLYMPUS DIGITAL CAMERAAround 7 months old, before she was eating any solid foods, she started to get tooth decay on one of her front teeth. Certainly, there were likely many factors involved, but there is evidence that it could be related to her lip tie, a frenulum connecting her top lip to her gums. When she did start eating solid foods, she gagged a lot. She did eventually figure out how to eat, though she is still a slow eater.

My son hardly ever spit up. He was always willing to latch on for a few seconds to calm down. He handled my letdowns fine, and he didn’t gag much when trying to eat solid foods. Instead, he drooled all over the place because he couldn’t swallow his own saliva, he lached on frequently without really sucking, he had a difficult time triggering letdowns on his own, especially when I wasn’t overly full or he wasn’t in an optimal position, and he could barely get any solid foods back far enough to gag on them, much less swallow them.

Both my children gained well at first, and while my daughter is skinny, she never really stopped gaining well. When my son was born, with both children nursing, my milk came in quite quickly. My son barely lost any weight after birth and then gained quickly. He was a very sleepy baby, common with tongue-ties, but I held him all the time and shoved a breast in his mouth every time he stirred in his sleep. He also nursed quite frequently with his sister, who was great a triggering letdowns and would trigger one for both of them, and he was able to keep up on the weight charts for a few months.

Photo3bySarahJones-PopielThere were signs along the way that there might be an issue, but I didn’t realize. He had a high palate and recessed chin. He refused to suck on a finger or anything when he was screaming in the car as a newborn. Whenever we were out and about or on the road for much of the day, and he spent too much time nursing in a carrier or in the car, he got orange spots in his diaper, often a sign of dehydration. He still had plenty of wet diapers, though less than usual on those days, and we assumed he was fine. He would get frustrated with nursing to sleep, not because he was overwhelmed like his sister, but because he had a hard time getting let-downs all by himself when my milk supply was lowest in the evening. He would cluster nurse, back and forth, back and forth, nursing for half an hour or more without a letdown. Finally, one would come, and he would fall right to sleep. As he got older and my milk supply was lower, he began to wake up at night, crying and not able to get a letdown.

He was showing signs of a foremilk-hindmilk imbalance. I figured that it was due to my oversupply and I used block nursing to have him nurse on an emptier breast to get the fattier milk that comes when the breast is emptier. I sincerely regret doing this. The trouble was that he couldn’t get the milk out as well when the breast was emptier. Block nursing reduced my supply, and then I watched my son’s weight slowly fall down the growth chart. He was 9 months old, though, before I realized that his weight was so much of a problem that I had to do something.

Photo4byMeghanJohnstonI became a La Leche League Leader shortly after my son was born. I had worked hard to get accredited, and I still had a lot to learn. As soon as I became a Leader, I remember hearing a lot about something called a “lip-tie.” When my son was 4 months old, I finally got around to figuring out exactly what that was and pulled up my son’s lip to check. Woowza! He had a class IV lip tie that was going to put a space between his upper teeth when they came in. Maybe that explained why he still frequently lost suction while nursing. Maybe that explained why he had dipped some on the growth charts. I read about laser revision, and it sounded like the way to go, especially for such a serious tie, but I wasn’t aware of anybody who revised lip ties in the area using lasers, and we were nursing ‘fine’, so we decided to wait to see how things went and what options became available to us. My biggest concern at the time was tooth decay, but thankfully, he did not get his upper teeth until much later, so that was less of a concern… yet.

As I continued to learn more as a La Leche League Leader, one of my coleaders showed me a video on Alison Hazlebaker’s assessment tool for determining tongue-tie. I loved that it looked mostly at tongue function. Most people have a frenulum, and it is difficult to tell how much of a problem a frenulum is by looking just at it. Looking at what the tongue can do gives a much clearer picture.

OLYMPUS DIGITAL CAMERAI remember hearing someone tell me over and over again when my daughter was an infant that if a baby can stick his or her tongue out past their lip, they are not tongue-tied. My daughter could stick her tongue out, and my son could stick his out even farther, so they couldn’t be tongue-tied, right?

OLYMPUS DIGITAL CAMERAWhat I didn’t realize is that there is a lot more that a tongue needs to be able to do than stick out. It should lift when a baby cries, most of the way to the palate, not on the floor of the mouth like my kids’ tongues. That smacking noise my kids made with every suck when they nursed is a sign that the tongue is not functioning properly enough to maintain suction. The tongue should be forward in a baby’s mouth, cupping the breast tightly, not back and flat like my son’s. A baby should be able to open wide and flange his or her lips deeply around the breast, not just suck on the mother’s nipple as if it were a bottle nipple as my children do. The tongue should make a smooth wave-like motion to remove milk effectively, which does not require the jaw to ‘chew’ on the mother.

Most of all, as Dr. Lawrence Kotlow puts it, “Breastfeeding should be fun and enjoyable.” A baby should love to nurse and be comforted by nursing. Letdowns should come easily and not overwhelm the baby. The mother should be comfortable from the moment her baby first laches on and should stay comfortable no matter how long or frequently the baby nurses. She should not be constantly battling plugged ducts, mastitis, and thrush. The baby’s teeth should not constantly dig into her nipple while nursing. Nursing should not be a fight. If your nursing relationship is not what you wish it would be, don’t be afraid to get help to find out if it could be tongue-tie or something else that is affecting your nursing relationship.

Discovering that my children were tongue-tied was the beginning of a journey, not the end, and the story is still unfolding. An amazing network of support is forming here in Utah and in many other places around the world. If you suspect that you may be nursing a child with a tongue-tie, you don’t have to walk this path alone. Call La Leche League. Make an appointment with an IBCLC. There is support here for you!

http://www.kiddsteeth.com/nursingbookaugfc2011.pdf

http://lllutah.org/home/

http://www.ilca.org/i4a/pages/index.cfm?pageid=3337

https://www.facebook.com/pages/IATP-International-Affiliation-of-Tongue-tie-Professionals/154327071396819

Photo7bySusanJohnsonJeana Jones is the mother of two beautiful children. She is a La Leche League Leader with La Leche League of Salt Lake City and the Library Liaison for this year’s Breastfeeding Cafe. She enjoys spending time with her husband and children, cooking delicious and nourishing foods, and constantly learning.

 


 
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6 Comments

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6 responses to “Tongue and Lip Tie

  1. mctimbra

    Thanks for sharing your journey, Jeana. As you know we share some similarities in our stories and I always enjoy learning from you (three years my “LLL Leader younger” 🙂 ) You are such an asset to nursing moms in this area!

  2. Great information! I hope that moms who are having similar issues see this post and know that they can get it corrected. Thanks for sharing!

  3. Jeana Jones

    Thanks, Ladies! Your mother-to-mother support makes a huge difference!

  4. Thanks for sharing your story and for the great info — my children will also both tongue-tied and I wrote about it for the Success Stories next Sunday!

  5. I hope this information gets out to more struggling mothers out there. It is amazing how something so simple as releasing a tongue tie can make such a huge difference. The fact that it is something so simple often (erroneously) makes people believe it can’t possibly be a problem. Thanks for sharing.

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