Does My Baby Have a Tongue Tie?
By Melanie J Yanke, MSN, CNM, CPNP-PC, IBCLC
So, you have spent 9 months preparing for an amazing birth, breastfeeding, and becoming parents. Maybe you have already met your little bundle of joy or are still waiting. Did your birth experience go like you were hoping? However it played out, maybe now you are looking forward to a beautiful breastfeeding experience.
The first week or two postpartum can be exhausting for everyone but having prenatal education about breastfeeding, pumping, newborn care, and what to expect can make it easier. Having a team of family, postpartum doulas, and lactation support can make all the difference in the world. Some of you may have had a lactation consultant visit you before you go home or even once you were home. Even if this is your first or fourth baby, they are all different and the breastfeeding experience can be widely different too.
Have you found breastfeeding to be more of a challenge than you expected? Were you hoping that at least this would be easy? Does it seem like everyone who helps you tells you something different? Maybe things started off really good and then after a couple of weeks breastfeeding was harder and you worried about your milk supply. Does your mommy intuition tell you that something is just not right even though the pediatrician tells you the baby is growing and they have no concerns? Maybe your provider tells you that your baby could have a tongue or lip-tie, but they will grow out of it. Maybe you've seen a lactation consultant who thinks the baby could have a tongue and/or lip-tie and you are looking for someone to evaluate your baby.
I have heard all these scenarios and can empathize with you. YOU ARE NOT CRAZY! I would like to offer you some information that may help you sort things out.
Here are some of the symptoms of tongue-tie and lip-tie that babies can experience:
Poor latch, shallow latch
Noisy sucking or clicking
Coughing, gagging
Gumming, chewing the breast
Popping on and off the breast, frustrated
Sleepy, tired baby on the breast
Long feedings, lasting up to an hour, frequent feedings
Baby always hungry
Lip blisters
Milk leaking on the sides of the mouth
Fussy baby, colic, gassy
Reflux, frequent spitting up
Poor weight gain
Unable to hold a pacifier
Poor bottle feeding
Noisy breathing, snoring while sleeping
Thrush in the mouth
Lactating people may experience some of these symptoms:
Poor milk supply
Oversupply
Severe pain when breastfeeding
Bleeding, cracked, or blanched nipples
Nipple vasospasms
Clogged ducts
Mastitis
Nipple thrush
Frustration and anxiety associated with breastfeeding
Problems bonding with the baby
We all have a band of tissue under our upper lip and tongue that is present at birth – it is a remnant from the development of the embryo in utero. It does not go away and you do not grow out of it. The appearance can look very different from one baby to the next – from thin to thick, stretchy or not, from the tip of the tongue to hardly visible under the tongue. Lips can flange easily or be so tight that it is hard to latch the baby.
What makes that band of tissue a tongue-tie or lip-tie? It has to cause a functional problem, otherwise, it is not a tie and does not need to be corrected. So, to thoroughly evaluate for a tie, you need to have an assessment of the function and appearance of the tongue and lip done by a specially trained professional that works with babies who have tongue and lip-ties. This would include:
a medical history of the mother and baby
symptoms that the mother and baby are experiencing
an exam for function and appearance of the tongue and lip
observe a feeding at the breast or bottle
baseline weight measurements and transfer of milk at a feeding
a discussion about the findings and the risks, benefits, and alternatives for treatment
What if your baby does have a tongue-tie?
You may think about it and decide that breastfeeding is not that bad. Sure, it hurts some and your nipples are pinched, but you can endure this so your baby doesn’t need a procedure to correct it. After all, you are just hoping to breastfeed for 6-12 months and you can last that long! Maybe breastfeeding doesn’t even hurt. You have heard that tongue-ties mostly affect breastfeeding so why would you want to correct it?
Untreated or undiagnosed tongue-ties can present different symptoms in toddlers and older children. Symptoms include:
Difficulty when introducing solid foods, picky about textures
Food aversions due to not being able to properly manipulate food in the mouth.
Speech issues, specifically pronouncing the ‘r’, ‘k’, and ‘l’ sounds. This is because the tongue cannot properly elevate to the roof of the mouth.
Sleep apnea because the restriction of the tongue does not allow for the airway to be blocked off while sleeping, resulting in the tongue slipping down the throat and occluding the airway.
Malocclusion of the teeth and improper jaw development. When a tongue is restricted, proper pressure is not placed on the upper or lower jaw to allow for expansion, resulting in small jaws and necessity for orthodontic care that may involve removal of adult teeth and braces to properly align teeth.
Emerging research suggests that adults with untreated tongue-ties often experience: TMJ symptoms, tension headaches, neck and shoulder pain, and sleep apnea. The reason for these symptoms is that the jaw has improperly formed over time resulting from the tongue not being able to elevate to the roof of the mouth to create a seal.
Now, what do you do?
Whether you have decided that it is in the best interest of your baby to correct the tongue-tie, or you have decided to wait and try more lactation help, chiropractor or bodywork to see if that makes a difference. It’s your decision! Who do you go to and how do they do the procedure?
Tongue-tie releases (called frenectomies) remove the tissue or tight frenulum under the tongue or upper lip to allow better mobility of the tongue and lip. Releases can be performed with scissors, diode lasers, erbium lasers, CO2 lasers, and electrocautery. Trained providers that can do frenectomies include doctors (ENTs or Pediatricians), dentists (adult or pediatric), midwives and nurse practitioners.
In the Albuquerque area, there are several pediatric dentists that use lasers, and some pediatricians, ENTs, and midwives that use scissors. I have observed and performed releases using both of these methods and in my experience, I see more precise and complete releases with better healing using the laser.
So, the laser procedure takes only 10-15 seconds under the lip and under the tongue – it’s quick. But then the real work begins. This procedure is not the magic pill and quick fix you are hoping for. It is going to take some time to correct the compensating habits that your baby has had since before birth and to strengthen the tongue to improve the suck. As with everything, some babies see the benefits quickly and others take longer -- even up to a couple of months to retrain. The best results are seen when we take a team approach to help mom and baby together. This may include lactation support, chiropractic, cranial sacral therapy, bodywork, feeding therapy, and a supportive family village.
Just remember, the benefits of a complete release for the baby last a lifetime and can include:
Improved breastfeeding
Better weight gain
Less reflux
Deeper sleep
Easier transition to solid feeding
All the benefits of breastfeeding – less obesity and diabetes
Improved speech
Better dental alignment
Better attention due to better sleep
Less risk for sleep apnea and all the risks associated with it (cardiovascular disease)
Less TMJ and headaches
Improved posture
If you have answered the question – Does my baby have a tongue-tie? – with a definite “yes” or “I sure think so”, then I encourage you to find a professional to evaluate your baby to find out for sure. Then you can make an informed decision about your baby’s health.
Hope you have learned something from this post and looking forward to you and your baby THRIVING!!!
Melanie
Melanie J Yanke is a Certified Nurse Midwife (CNM), Certified Pediatric Nurse Practitioner (CPNP-PC) and International Board Certified Lactation Consultant (IBCLC). She is the owner of Beyond Birth ABQ – a private practice specializing in breastfeeding medicine, lactation, tongue-tie evaluation with laser release, pediatrics and women’s health. You can learn more about her services and tongue-tie at https://beyondbirthabq.com/tongue-tie