By Sr Teresa Hayward (RM. RN, Lactation Consultant, Infant & Paediatric Nutritionist, Baby Sleep Consultant)
It has become very fashionable on social media lately to blame everything on a Tongue tie, and often moms are seen posting pictures of their baby’s tongues, and other moms are diagnosing babies with tongue ties. Please bear in mind that every breastfeeding problem is not because of a tongue tie. In fact, very few babies have tongue ties that will cause a problem with feeding. As Lactation consultants we are trained in checking for tongue ties and assessing why breastfeeding hurts and correcting the problem.
What is tongue-tie?
A tongue tie is the term used to describe a tongue that has restricted mobility and is unable to poke out of the mouth past the lips or move freely. One of the main reasons this happens is due to the membrane under the tongue being too short or tight.
If the tongue is too tight, it can affect breastfeeding negatively
How can tongue-tie affect breastfeeding?
Breastfeeding problems that may be caused by a tongue tie include:
· Nipple pain, deep breast pain, misshapen nipples, nipple blisters, nipple vasospasm, or very sore nipples
· A baby who struggles to latch, or to latch deeply, or opening their mouth wide enough and staying on the breast
· A baby who has short, frequent feeds because he has to work so hard and then gets tired and falls asleep on the breast before the end of feed
· A baby who seems to want to feed all the time but doesn’t gain much weight
· Sucking blisters on baby’s lips
· Clicking sound during breastfeeding
· Reflux
All of the above can however be caused by other problems, and not just tongue ties, so it is important to set up an appointment with a Lactation consultant.
Beyond breastfeeding
As the baby grows up, the tongue tie may cause difficulty with licking the lips or an ice cream, or even keeping their teeth clean. In a small number of children speech can be affected, although it is not typical.
Breastfeeding issues that are sometimes blamed on tongue ties and could be due to other causes. A Lactation consultant can help to identify if these are connected to a tongue ties and will help to correct these. She will assess the following
· Position and latch – a shallow latch or poor positioning can affect how baby breastfeeds and explain pain, sore nipples, blisters, low milk supply an clicking sounds
· Anatomy – flat or inverted nipples, large breast, small mouth
· Underweight baby – a hungry baby who is not gaining weight can have high tone, fall asleep without feeding well and also have poor tongue function
· Tension from the birth – a traumatic birth can affect how baby feeds as they often have high muscle tone
· Reflux or allergy
Is my baby tongue tied?
Identifying a tongue-tie requires assessing tongue function in the context of breastfeeding, not just looking at the appearance of the tongue or ticking off a list of symptoms. Your baby needs a face-to-face consultation with a specialist but the best placeplace to start is by seeing a Lactation consultant who will take a full breastfeeding history and assess both breastfeeding and tongue function. Your lactation consultant will then recommend seeing a tongue tie specialist/practitioner.
Assessing tongue function?
Just because there is a membrane to see, even if it is pulling on the tip of the tongue to create a heart shaped tip, it may not prevent your baby from breastfeeding, it depends how much it restricts the tongue’s movement. Equally just because there is nothing to see under the tongue, doesn’t necessarily mean there isn’t an issue with the tongue function. An experienced lactation consultant will know how to assess your baby’s tongue function alongside the appearance. They will assess whether your baby can extend his tongue past his lip or gums, whether he can lift his tongue, cup the breast, how the tongue moves during sucking and more.
Getting the right help
If your baby’s breastfeeding problems are associated with a tongue-tie you will need to find the right help with a Tongue-tie practitioners
Posterior vs anterior
Tongue-ties are often described as anterior or posterior. An anterior tongue-tie describes the tongue that is tied to the floor of the mouth by a short membrane near or at the tip of the tongue. A posterior tongue-tie is used to describe a restrictive membrane at the back of the tongue which may not always be visible (submucosal). Both types are said to have potential to cause problems with breastfeeding if very tight.
What is the treatment for tongue-tie?
A restrictive tongue-tie can be treated by a frenotomy, this is a medical procedure that involves cutting the membrane under the tongue by scissors or laser.
There are said to be very few nerve endings or blood vessels in the lingual frenulum and a frenotomy is thought to cause only momentary stinging. Some babies sleep through the procedure or go straight to the breast for soothing. However, some babies can be unsettled for a few days afterwards with difficulty feeding and with increased crying
What about lip-ties?
The membrane that connects the inside of the upper lip to the gum is known as the labial frenulum. The idea that latching problems could be caused by this membrane being too short or tight (a lip-tie) seems to be a relatively new idea. During breastfeeding the upper lip need only be in a neutral or slightly everted position at the breast not flanged out like the lower lip and there isn’t any published research supporting the idea that lip-ties are associated with feeding issues. In many cases “lip-ties” are confused with normal anatomy and the presence of an upper lip frenulum tight enough to disrupt breastfeeding is unusual. Tension in the upper lip can be associated with a shallow latch, unstable positioning at the breast, or a tongue-tie, and any of these could lead to a misdiagnosis of lip-tie
If breastfeeding still hurts
A frenotomy does not always improve breastfeeding comfort and may not be a magic wand for a baby not gaining weight. A tight frenulum may not have been the cause of the problem after all. In most cases breastfeeding problems are associated with positioning If you are still finding breastfeeding painful make an appointment with your lactation consultant for follow ups in case there is another problem yet to be solved.
For more information or assistance, please feel free to contact me to set up an appointment for a Lactation consultation. You can contact Sr Teresa at 0824009501
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