Earlier this week I talked about my personal breastfeeding story, including the surprising physical and emotional challenges that I did not expect. Most of our difficulties stemmed from my baby’s tongue tie, which I later discovered is fairly common. Unfortunately, it can be common for physicians and other healthcare practitioners to misdiagnose or even ignore tongue tie breastfeeding challenges. At best they often underestimate the severity of the issue.
Tongue Tie Breastfeeding Impact
What is a Tongue Tie?
We all have tissue under our tongue, called a frenulum. However, some babies are born with a tight frenulum that restricts the movement of their tongue. This can impact the baby’s ability to breastfeed or even take a bottle or pacifier.
What is a Lip Tie?
Similar to a tongue tie, a lip tie is extra tissue under the lip which makes it difficult for the baby to get a good grasp on the breast. Babies who have lip ties are almost always tongue-tied as well. Baby R had both a lip and tongue tie. And, in fact, it was the lip tie that led me to have him examined further. I took him to a lactation consultant initially because I noticed that the tissue under his lip seemed thicker and tighter than it ought to be.
Tongue Tie Symptoms
I had no idea there were other signs of a tongue tie besides poor weight gain and latching difficulties. As I related in my personal breastfeeding story, Baby R was 2 months old and gaining weight like a champ before we realized he had a tongue tie. However, he had tons of other symptoms which were all quickly brushed off by many. After all, he was gaining weight well, and he latched easily after the first week. It turns out there are symptoms BOTH baby AND even Mom can have if baby has a tongue tie.
Keep in mind, not all symptoms have to be present. In fact, Baby R and I did not experience many symptoms collectively. My body compensated early on with an oversupply of milk. The healthcare professionals explained to me this is likely how he continued to gain weight in the early days. But, the main symptoms we were experiencing (reflux, gas, and difficulty sleeping on his back) were enough to set us on the right path. Eventually, we got him diagnosed by a pediatric dentist. (Read more about my personal story here.)
Below are some of the signs and symptoms either mom or baby may experience.
- Nipple pain or damage
- Incomplete milk removal – This can lead to mastitis, undersupply, etc.
- Discomfort while nursing
- Sleep deprivation (This was my biggest one! I was getting NO sleep as Baby R had difficulty sleeping due to constant need to burp, reflux-like issues, and needing to nurse frequently.)
Dr. Ghaheri goes into more detail about some of the main symptoms mom’s experience in this article.
- Difficulty latching
- Falls asleep at the breast and waking soon after to nurse again
- Reflux and colic symptoms – As Dr. Ghaheri describes, baby seems to constantly have air in stomach that burping does not get out (This is exactly what we continued to experience with Baby R.)
- Upper lip blister – It is common for babies to have them in their first weeks of life. If they persist it can be a sign of an upper lip tie as they may be unable to properly flange out the upper lip.
- Poor Weight Gain – Remember not all babies will have trouble with weight gain, but many will.
- Does not or is unable to take a pacifier
- Clicking noises while sucking
- Popping on and off the breast often
Tongue Tie Diagnosis
Not all pediatricians are trained in diagnosing a tongue tie. Given the impact this can have on breastfeeding, it is important to get a second opinion from someone who deals with tongue ties on a regular basis. There are several ways you can go about this.
- An IBCLC (International Board Certified Lactation Consultant) with Tongue Tie Experience – I first took Baby R to a lactation clinic with 2 IBCLC’s who had excellent reputations in our community for their work with tongue and lip ties. While all IBCLCs may have experience or knowledge about tongue ties, some certainly have more experience in advanced breastfeeding issues like this. It never hurts to get a second opinion when you have breastfeeding issues. As in all professions, different lactation consultants have varying degrees of experience and different strengths and specialties. Lactation consultants do not officially diagnose, but they can tell if there is tightness and recommend follow-up.
- A Preferred Provider (Often a Pediatric Dentist trained to correct Tongue Ties with laser) – Most states have local tongue tie organization. Check the Facebook group for your state to help you find preferred providers in your local area. If you have trouble finding your state’s organization, you can seek support in the big Tongue Tie Facebook group.
- Community Support – Support groups in your community, such as your local La Leche League, may be able to connect you with the right professionals. Most hospitals and towns have a variety of free breastfeeding clinics. These clinics can be really useful in getting free support and pointing you in the right direction to seek help. A simple Google search can help you find free clinics in your area.
Tongue Tie Treatment
Tongue ties can either be clipped with scissors or scalpel, or released by a laser. Most IBCLCs I’ve talked to recommend laser revisions, as they feel it is often a more complete and thorough revision. Unfortunately, it is not uncommon to hear of babies being revised by providers who aren’t fully trained to do a full release. Sometimes they even end up needing a second procedure. This is why (as with any health professional) it is imperative that you do your research before deciding who will perform the release.
Dr. Ghaheri details some really good things to consider when choosing your provider and method. As he sums up, many argue that a laser will offer a more thorough and complete revision. One of my lactation consultants informed me that those using the laser method are generally doing very frequent revisions (also described by Dr. Ghaheri) and are trained in a complete release. Plus, there is typically no bleeding with a laser. This allows the doctor or dentist to better see and get a full release.
Breastfeeding After Tongue Tie Release
The dentist encouraged me to breastfeed right after the procedure, and I could tell a difference immediately. Baby R’s latched was improved immediately. However, he did refuse to nurse by that evening. He had both a lip and tongue tie revision and his lip seemed especially sore when flanging it out to nurse. I pumped and we bottle fed that night. Thankfully, by the next day he was able to nurse again.
For many, however, latch and breastfeeding does not immediately improve. It can take several weeks and plenty of bodywork and therapy to help release tightness from the tongue tie. Some babies may also need oral exercises and suck training to develop better nursing habits.
Recommended Aftercare After Tongue Tie Release
Most reputable providers will provide information on aftercare exercises to do following the release. We were instructed to do them every 4-6 hours. This video shows some of the aftercare stretches. We had to do stretches on both the tongue and lip. Apparently, they keep it from growing back too quickly and reattaching. If you read our personal tongue tie and breastfeeding story then you know Baby R hated them at first, but adjusted by the end of the 3 weeks.
Recommended Therapy After Tongue Tie Release
Bodywork was recommended to us following the tongue tie revision. As always, talk to your healthcare providers for specific recommendations for you and your baby. Here are some possible therapies your provider may recommend:
- CranioSacral Therapy
- Myofascial Release Therapy
- Chiropractic Care
- Physical, Occupational, or Speech Therapy
Your provider will also likely recommend follow-up with your lactation consultant following a revision to ensure baby relearns proper oral skills.
Helpful Resources on Tongue Tie
Dr. Kotlow’s website – May helpful educational resources including videos on tongue tie aftercare exercises.
Breastfeeding a Baby with a Tongue Tie Helpful Resources by Kellymom – May helpful articles and information on tongue tie and breastfeeding issues.
Dr. Ghaheri’s website – More resources and blog posts, articles on tongue tie.
Disclaimer: I am not a lactation consultant, physician, therapist, or expert in tongue ties. This post is simply the information I gathered for my informational purposes as a mother. You should not rely on my experiences or results and should always consult with a professional before relying on information on this blog/website.