Thursday 11 December 2014

Let's talk tongue and lip tie

Fair warning. This post is about breastfeeding. I talk about my nipples. There are pictures of my crying child because that's how I could best photograph his tongue. If that's not your thing, feel free not to read this post and maybe read about my kitchen instead :)

I've mentioned that with parenting the second time around, you just know when things aren't right. So I just knew that feeding little Jimmy wasn't going right. Sure, he was gaining weight. In fact, one month post birth he was over a kilogram heavier than birth weight. That's great! Not so great however, was convincing people that something wasn't right, because they all pointed out he was putting on weight and having the appropriate number of nappy changes.

Still... feeding took forever. He slept poorly, waking on a 1.5-2 hour cycle, around the clock. He was constantly gassy, and dribbling milk. My poor nipples were sore and bruised and little Jimmy's mouth was one big blister from gripping onto me for dear life. I'd had his mouth checked at the hospital before discharge and was told he looked fine and his latch seemed good if a little shallow. I never seemed to be able to get him to flange his lips or open as wide as I thought he should to latch on. When he cried, his little tongue would cup up and not poke out much at all.

At two weeks, I reached out to our community health feeding clinic, who watched a feed and told me I was doing everything right from a mechanical perspective. Of all the people I'd seen and asked about feeding, this lactation consultant was the only person who felt around in Jimmy's mouth and diagnosed him with a posterior tongue tie, which was also confirmed at my home midwife visit when I asked her. However I was advised that since he was gaining well, it likely didn't need treatment, and my sore nipples were normal newborn feeding side effects.

I'd never heard of tongue tie before to be honest. I googled the heck out of it, and joined support groups online. It made me feel better to know there were other people going through what I was going through - the sleepless nights, the painful nursing, all while hearing there was no problem "because baby is gaining weight"!

Captured! A sleeping moment
For me though, the pain was awful. My nipples would come out misshapen and I'd dread the next feed. I found a local dentist who was passionate about tongue tie and specialised in laser tongue-tie surgery. I scheduled a consultation and treatment as soon as possible - Jimmy would be five weeks old before we could be seen. Knowing I had that appointment kept me sane... ticking off the days until I could get help meant I was able to get through all those feeds.

The day of the appointment arrived and I have never felt such relief. Someone listened to me and sympathised with all my symptoms. Jimmy was diagnosed with a class IV tongue tie and a class III lip tie, which commonly occur together. Releasing the ties would help our nursing relationship, and further, would decrease the likelihood of future issues such as speech and eating problems, cavities and orthodontic work which are common disorders associated with tongue tie.

Jimmy was taken away and we were asked to step outside so that we didn't hear his reaction to the treatment and I could nurse him calmly afterwards (infants who are breastfeeding are typically revised without anaesthesia). I'm told he was swaddled and held tightly while the dentist used the laser, and that my Jimmy didn't cry at all. All up it took maybe five minutes maximum, and then I was taken to a quiet room, Jimmy was placed in my arms and we breastfed under the direction of the dentist (herself a mum and strong breastfeeding advocate) and a lactation consultant.

Before and after - look how high that tongue goes and how far the mouth opens now!
That first feed... what can I say. I'd always been told that breastfeeding was painless and pleasant. Although I fed Ellie for nine months, I can honestly say it was never completely pain free, but I grew to enjoy it. With Jimmy, I finally got what everyone meant. He latched beautifully, he drained my breast and I fed him without pain. And then... miracle... he slept, for three hours. And that night, he slept in three hour cycles, which meant, for the first time in FIVE weeks... so did I. Do you hear that? I slept longer than an hour. I felt like a new woman.

One week post procedure, it's still rough I'll be honest. We do some manual therapy to complement the release, because Jimmy needs to relearn how to use his mouth and nurse 'correctly' as opposed to coasting along off my let down and gripping me with his gums. We've been given exercises to do to improve his suck and help him develop muscles that he hadn't been using before. Essentially he is re-wiring his brain and learning new ways to control this extra movement he suddenly has, which is pretty amazing really.

Doing the stretches to make sure his ties don't reattach is heartbreaking. Constantly correcting his latch is frustrating, and knowing he is in pain is awful. We are getting there though. We still have bad feeds, but we also have good feeds as well. Just like we have good sleeps and bad ones where he is back to his 1.5 hour cycle. He is gradually starting to sleep longer though (hallelujah!) and he is much less windy because he is latching better and therefore swallowing less air. My nipples still get sore and he still has nursing blisters, but I'm confident that will improve as his muscle tone and mouth strength improve, especially as we continue with the physiotherapy and work with a lactation consultant.

It's hard having a growth-spurt, post surgery cranky baby and a highly energetic and attention hungry toddler, but this is where baby wearing comes in handy. I do adore snuggles and the little snores that happen when he falls asleep against my chest.

Snuggles for the win!
Tongue tie is a contentious issue I've found. Some medical providers don't believe they affect feeding. Some believe if you came poke out your tongue (Jimmy could) there is no issue, failing to consider a posterior, sub mucosal tie might be present. These sorts of ties can only be felt with a manual examination and often cause many feeding problems initially as the tongue doesn't reach the roof of the mouth for efficient drainage. They can be hard to diagnose as some babies continue to gain weight coasting along off initial good supply and strong let downs. Apparently, with the increase in formula feeding, lots of medical people stopped learning about tongue ties, but now that breastfeeding is increasing, a lot more ties are needing attention - after all, a bottle doesn't complain of pain.

I don't blame the medical people I saw at all, but what I did learn from this experience is to trust your instincts... if you don't get the answers you need, continue to seek help because no one knows your baby like you do.


  1. You know one day he's going to be a world famous opera singer or something and thank you for getting it done 😄

    1. Oh... think of the hours of practice I'd have to listen to first though... :-)

      Thanks for the kind words



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