Tongue and lip ties are present in about 10% of the population and are slightly more common in males. In the 1950's or more years ago in both the US and UK or more it was semi routine to snip a baby's frenulum as part of the post birth care. With the rise in bottle feeding in the 1970's the practice fell out of favor and professionals lost the ability to detect tongue ties.
Maternal presentation is commonly characterized by:
- Nipple pain and/or erosions that do not improved after the first few minutes of nursing and improve greatly over time
- A clamped or pinched look to the nipple
- Painful breasts
- Persistent Thrush
- Low milk supply
- Plugged ducts
- Mastitis
- Frustration, disappointment, and ddiscouragement with breastfeeding
- Untimely weaning
Infant symptoms and signs include:
- Poor latch and suck
- Inability to latch to a bare breast
- Inability to stick tongue out past the baby's gums or lips
- Clicking sound while nursing (poor suction)
- Ineffective milk transfer
- Inadequate weight gain or weight loss
- Irritability or colic
- Fussiness and frequent arching away from the breast
- Acid reflux or excessive gas
- Fatigue within one to two minutes of beginning to nurse
- Difficulty establishing suction to maintain a deep grasp on the breast
- Gradual sliding off the breast
- “Chewing” of the nipple
- Falling asleep at the breast having taken less than an optimal feed, as proven by “test weight” on a digital scale
- Weight loss of greater than 10% in a newborn
- Milk running out of the sides of the mouth when bottle feeding
- A heart shaped, forked or little butt shaped tongue
What does it look like?
This is my fourth baby, Oliver getting his newborn exam performed and you can really see the lower tongue tie on him.
Here are some other examples
Experience Number One
My third child, Everett, was born with a tongue tie. This was not something that was pointed out during the newborn exam by my midwife. He nursed decently but I attributed that more to me being a third time mom and breastfeeding champ then to him. He made a terrible clicking noise when ever he swallowed and I still had nipple pain and bleeding when he was three weeks old. I started doing some research and a midwife apprentice friend of mine stopped by to visit and picked out the short frenulum right away. She shared that it was much more common in baby boys and tended to be genetic. I called my fraternal grandmother and sure enough my father had been tongue tied, had never nursed successfully and had it clipped when he was about five years old for speech problems. I called around several places and no one seemed to know what to do with me or willing to help me. The hospital IBCLC recommended using nipple shields, which based on my doula experience and problems I had seen them cause I was not willing to do. Because he was a happy baby and gaining weight well I decided to wait it out. I would rub his frenulum between my fingers and have him mirror me often sticking my tongue out as far as it could go. Over the course of the next few months his frenulum eventually stretched and the nipple pain ceased. He is almost six now and has a little bit of trouble saying certain words and definitely has a "butt shaped" tongue, but for our situation I felt like I made the right choice.
Experience Number Two
My fourth child,Oliver, was also born with a tongue tie. We picked it out right away. Having been down that road before it was a problem I wanted to identify early on. He nursed but not very well. He was a very fussy baby and would cry often. He did not gain weight well and seemed generally unhappy all the time. He would only nurse for a minute or two and then would fuss and nurse again twenty minutes later. I assumed that his frenulum would stretch just like his older brother. We did the same massage, tongue exercises, and nursing like before but no change. At about six weeks postpartum with bleeding nipples and a unhappy and underweight baby I took him to see my family doctor. After a short consultation he agreed that the tongue tie was severe enough that it needed to be clipped. As a mother I was very stressed about the surgery but I knew that what we had been doing was not working for either of us. The doctor took a piece of gauze and grasped his tongue and pulled it out and up. Then he took a blunt ended pair of scissors and clipped the tiny piece of tissue that was ruling out lives. There was one spot of blood. Oliver cried when this tongue was held by the gauze but not with the cut. He latched on and nursed perfectly from then on out. What a different experience.
My Role as a Midwife
As a midwife establishing a good breastfeeding experience is imperative to not only mothers emotionally, prolactin hormones make you happy, but also physically as breastfeeding reduces your chances of post partum hemorrhage because it keeps the uterus clamped down. Although my experience's regarding tongue tie were far from fun, I am thankful to have the different experiences to help my clients in assessing and improving their nursing relationship.
What Can Be Done?
Nothing- if you and baby are doing fine nothing needs to be done.
Massage- as I wrote about massage to help the tissue stretch can help some
Breastfeed- the nature of nursing helps to stretch the frenulum and eventually things can improve
Clip the Frenulum- as in the story above this is a simple procedure can can be performed by multiple care providers including a doctor or dentist
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