Tongue tie – is it causing feeding problems?

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Sarah was desperate. Her three week old baby Tom was unsettled, squirming at the breast and because he wasn’t sucking well, she had been topping him up with formula so her milk supply was rapidly diminishing. She had seen a paediatrician who told her Tom had ‘behavioural problems’ and she was feeding him too often. Her baby health nurse had told Sarah she needed to learn ‘tired signs’ because her baby was ‘over-stimulated’. It turned out nobody had watched Sarah actually feed her baby. Tom had a very disorganized suck, he kept sliding off the nipple, he was making clicking noises and gulping in air because he couldn’t get a good seal. Milk dribbled out of the corners of his mouth whether Sarah was breastfeeding or topping him up with a bottle.

I checked Tom’s mouth and assessed the mobility of his tongue –when I touched Tom’s bottom gum, he couldn’t poke his tongue beyond his gum and when I rubbed his gums at the side of his mouth, instead of his tongue following my finger, his tongue tipped sideways. When he cried, Tom’s tongue formed a ‘trough’ anchored in the middle and curled up at the sides – he couldn’t raise his tongue up to the roof of his mouth. It turned out Tom had a posterior tongue tie that was restricting the movement of his tongue, making it almost impossible to latch and feed effectively.

In some babies, like Tom, the little membrane called the frenulum, which joins the middle of the tongue to the floor of the mouth, is too tight and ‘ties’ the tongue so that the baby has difficulty moving his tongue effectively. This means that the baby will be unable to bring his tongue forward far enough to latch onto the breast and draw the nipple far enough back into his mouth to feed well. If the baby’s tongue is restricted it won’t create an effective peristaltic action, rippling from the front of the tongue to the back, efficiently drawing out milk and maintaining milk flow. If a baby has a lip tie – the frenulum beneath his upper lip will restrict movement so he won’t be able to flange his top lip as he feeds.

Tongue and lip ties make feeding very tiring for babies, they can’t form a tight seal on either a breast or bottle so milk will often dribble from the side of the baby’s mouth as he feeds, sucking may be noisy with clicking or ‘snapping’ back on the nipple as he slides off and grasps at the nipple again while feeding, Babies, whether breast or bottle fed can be hungry and have poor weight gains because feeding is so exhausting that they may fall asleep while feeding. These babies often suck in air as they feed so they can be very unsettled and may be diagnosed with reflux that doesn’t respond to medication because the underlying cause is air swallowing due to a poor latch. They are also often referred for sleep training, when the pain and crying is a symptom of the tongue tie that has not been addressed, not a baby with a ‘behavioural problem’ or a mother who is doing something ‘wrong’

Although Sarah didn’t experience painful feeds, most likely because Tom wasn’t actually attaching, babies with tongue and lip ties can cause severe pain for their mothers as they breastfeed: the baby may latch onto the nipple, and ‘gum’ or chew it, causing severe pain and eventually, nipple damage such as blanching (white nipples), cracks and grazing that can sometimes be followed by infection or mastitis. Elle, mother of two week old Mia, had severely damaged nipples but had been dismissed by health professionals because to them, her baby’s latch ‘looked fine’ . She was told that her nipples would ‘toughen up’. Luckily Mia was persistent in seeking help. Even if the latch ‘looks fine,’ if your nipples hurt or look ‘squashed’ after a feed – Elle’s nipples were cracked and bleeding, as well as squashed like the point of a lipstick after Mia fed – please seek help. This is not how breastfeeding is meant to feel. Thankfully, after revision by a dentist who specializes in treating babies with tongue ties, Mia latched deeply for the first time and Elle was able to breastfeed pain free within a few days.

Not all babies with tongue tie have immediate or obvious feeding problems, although there are often ‘clues’ that something isn’t right. According to Mel, mother of fourteen month old Poppy, “she fed like a trooper from the start.” Mel had no pain while breastfeeding – until Poppy cut her first two top teeth. As Poppy fed, Mel felt as though she was pinching and her nipples were left with deep dents where Poppy’s teeth rested. She started having recurrent bouts of mastitis – always in the same area, probably because Poppy couldn’t drain that part of the breast. As Poppy started eating family foods, she gagged on meat, she couldn’t suck out of a straw or sippy cup when Mel offered her water. Then, when the next two top teeth came through, feeds became even more painful. One day Mel thought perhaps Poppy had some food in her mouth and tried to check under her top lip but she couldn’t flange Poppy’s lip and noticed the frenulum between Poppy’s top teeth. This is when she called me to see whether Poppy had a lip tie. It turned out that Poppy had an upper lip tie and a posterior tongue tie. Since having these revised by a dentist who uses laser, Poppy can proudly drink from a straw, she eats well, is starting to talk and, best of all, she started sleeping much better. Looking back, Mel now sees signposts that all wasn’t well – although Poppy was thriving, she fed frequently day and night, she was prescribed reflux medication which didn’t really help and when offered a dummy, it always slipped out of her mouth.

Tongue-tie is often hereditary – if either you or your partner have or had (you may have had your frenulum snipped as a baby) a tongue tie, there is a higher chance that your child will also have this condition. Often I will find a baby with tongue tie and then discover that one of the parents’ own mothers had difficulty breastfeeding and, on checking, it turns out the parent also has a tongue tie. Often too, there will be stories about speech therapy or intensive dental work when this parent was a child. It’s not just breastfeeding that can be affected by tongue or lip ties. Difficulties can happen when the child starts eating solid foods and speech can be affected (think Jamie Oliver). Tongue and lip ties can also affect dental development, from misaligned teeth due to improper palate and jaw development, to tooth decay due to not being able to use the tongue to remove food stuck on the teeth. Children and adults with unrevised tongue ties can also develop sleep apnoea and some of the delightful pleasures of life can be affected like licking an ice cream and kissing, and social interactions can include problems such as spitting or dribbling excessive saliva when talking.

A tongue tie can be easily fixed by seeing a doctor or dentist who will either snip the frenulum or use a laser to revise it (the younger the baby, the easier it is). You will be able to feed your baby straight away and you may be surprised how much more easily your baby feeds – and sleeps – after this procedure.

 

For further reading about tongue tie, check these links:

Is my Baby Tongue -tied – (includes clear photos) By Catherine Watson Jenna, Lactation (US Lactation Consultant IBCLC, author of ‘Supporting Sucking Skills in Breastfeeding Infants’)

Top Ten Tongue Tie Myths by the Analytical Armadillo (a UK Lactation consultant IBCLC)

Tongue Tie , more than ‘just’ a breastfeeding problem by Renee Beebe, (US Lactation Consultant IBCLC)

Tell Me About Tongue Ties! By Norma Ritter, IBCLC, RLC

 

Pinky McKay is an internationally certified lactation consultant and best selling baby care author of Sleeping Like a Baby and Parenting by Heart. She is also the creator of Boobie Bikkies, all natural and organic cookies to boost breastfeeding mothers energy and support a healthy milk supply. Download Pinky’s free ebook ‘Making More Mummy Milk, Naturally’ at www.boobiebikkies.com.au

12 COMMENTS

  1. We had the same problem with my son and having successfully fed my daughter for a year, I knew something wasn’t right. He was always gnawing and slipping off and very agitated all the time – probably from frequent hunger pains!
    We paid for a private lactation consultation – the NHS basically refuse to acknowledge the existence of tongue ties anymore! Guess what, a very tight posterior tie! Unfortunately it tool 3 attempts to correct 3rd time big by laser! But we continued happily breastfeeding until he was 10 months! And it’s a sheer joy to see the previously hidden tongue sticking out at all the World to see! In fact now we can’t get him to keep it in his mouth haha!
    Such a stigma associated with something so easily corrected :(.

    • That’s great that you and your son have no ill effects. However, too many women who are experiencing serious issues with infant feeds are not getting help when they do need it

  2. My baby had difficulties with breastfeeding from the first latch. I was told the pain was discomfort and will go away as my nipples toughen up. I had (and still have) oversupply so even though baby wasn’t suckling he was getting more than his full and the latch didn’t look too bad from the outside. It could take up to 35 mins to latch him and he was terribly windy and colicky. Finally this was diagnosed at 4 weeks and we paid privately to see an ENT surgeon who released a tongue and lip tie. His latch did improve but all that tongue thrusting and clamping (also to slow the flow) Meant I now have blanching and vasospasms which I treat with meds and after 3 cases of mastitis and nipple infections, milk blisters and blood blister and cracks we seem to be doing better. Baby feeds well and is over 10kgs at 4.5 months and sleeps well. We hope to breastfeed for months to come and are hoping teeth won’t stop that. He still has a shallow latch and its mostly painful feeding but I’ve been told no further release is needed and baby just latches that way. I think mums and midwives need to know more about tongue ties and check for these if mums complain at all about pain, before the damage is done.

  3. My first born had tongue tie and it was the longest three weeks of my life. I was in agony feeding him, it really was horrendous. I kept getting told it was normal and that his latch was fine. No one actually looked in his mouth. Was so relieved when a feeding specialist suggested tongue tie. 24hrs later he had it snipped. Took a good month to sort breastfeeding as I had an infection he then got oral thrush but we did it and the pain went. Needless to say I made sure they double checked on the hospital with my second baby!!

  4. I wish they checked for this routinely at birth.
    I discovered this on my own at 3 weeks with my second bub.
    I fed immediately and it was amazing. With one snip I could feed pain free.

  5. Great article – my son was born with a tounge tie and I was told straight away however they said it was no problem and he was feeding fine – I knew nothing about tounge ties, by 4 weeks old I had a very unhappy baby I was losing all my supply he was going on feeding strikes and it was a horrible nightmare that still upsets me, finaly upon leaving Australia and seeing a Lactation consultant in New Zealand it was decided very quickly that the tounge tie needed to be cut, he was 10 weeks old, and had been through so much it took bottles and formula and hours upon hours of expressing and damn hard work but after the procedure there was instant improvement and it was a matter of correcting bad habits due to the nightmare we had been through, we battled on and breastfed for 13 months but it was by no means an enjoyable experience- it all could have been avoided if the tounge tie had been cut straight away after it was discovered – the post natal care received in hospital was poor at best.

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