Is My Baby's Tongue Or Lip Tie Affecting Breastfeeding?
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As first-time parents, we had never heard of tongue ties or lip ties when our lactation consultant first used these words with our 3-week-old son. Our baby had extra tissue under his lip and tongue? It sounded almost harmless to me until she explained that the band of tissue under the lip or the tongue, known as frenulums, can hinder your baby’s ability to form proper latch and suction when breastfeeding. If something is hindering your breastfeeding relationship, it may be worth having your baby checked for a tongue tie or lip tie (or both).
I snapped this photo of my buddy’s lip tie while trying to determine if we needed to consult our pediatrician.
Our outcome
We met with an ENT (Ear, Nose, and Throat) specialist at the local children’s hospital who advised us to allow him to do two procedures; 1) clip the frenulum under the tongue, and 2) clip the frenulum under the upper lip. The recovery was shorter than I expected, but it involved “sweeping” my baby’s gums with my finger multiple times a day for the next week.
I expected the procedures to improve his poor latching, but sadly, it did not improve as his mouth healed. The experience left me asking how much of our breastfeeding relationship was effected by a tongue tie or lip tie versus other factors and how to know if your baby truly needs the procedure.
Is this a new diagnosis, a condition likely due to epigenetic causes? Or was there more to it, perhaps a history that would educate us on how to feed a baby with lip ties and tongue ties?
If you take a historical look, this is actually not as new as it seems. Interestingly, there are stories of midwives keeping one nail long in order to snip baby’s ties as a general practice after birth! By the mid-1900s, hospital births and infant formula were on the rise. It’s almost impossible to imagine now, but it was a time when many people, including health professionals and researchers, believed in the scientific development of formula over mom’s natural milk. As a result, the familiarity with lip and tongue ties was forgotten until the emphasis on breastfeeding as the “gold standard” resurged over the last 3 decades.
Nowadays, we are more knowledgeable about many breastfeeding challenges, albeit with yet some strides to go, but we know that tongue ties and lip ties are among them. So, how do you know if a tongue tie and/or lip tie is affecting your baby’s feeding?
Tongue and lip ties defined
A tongue tie, called ankyloglossia, is when the band of tissue (the frenulum) under the tongue is too tight or too far forward on the tongue and prevents baby’s tongue from making the swaying motions necessary for effective breastfeeding. When a baby is tongue-tied, the movement of the tongue is restricted so he will often suck more intensely or grasp firmly on mom’s nipple, resulting in pain and damage to the nipple tissue. In babies who are not tongue-tied, the tongue contours to mom’s nipple and coincides with sucking in a way that sends good signals to mom’s breasts to make more milk.
A lip tie, by comparison, is when the frenulum (band of tissue) under baby’s upper lip is tight and restricts baby’s ability to “flip” her lip upwards. When they suck, the lip pulls inward and usually feels like a clamp on mom’s nipple. Babies with lip ties often have the appearance of a flat upper lip. It’s common for babies with a tongue tie to also have a lip tie.
My son had both tongue tie and lip tie, and when he latched his pursed lips formed a C-shape over my nipple. We could flange his lower lip out for him, but his upper lip would not budge during feeding. Any effort to flip his upper lip resulted in completely unlatching him from the breast. At 3 weeks old, he had a procedure to “clip” both frenulums, called a frenotomy, with an ENT (Ear, Nose, and Throat) specialist at our local children’s hospital. It was a quick and simple procedure that lasted less than 10 minutes.
how are tongue and lip ties treated?
A numbing agent is injected into the area surrounding the frenulum(s). Then, with either tiny surgical scissors or a laser, the frenulum is clipped, releasing the tightness of the band of tissue. My son’s procedure was done with surgical scissors, but I have learned since that laser is usually the better option as it is more delicate with an easier healing process.
Some babies are able to breastfeed immediately after the procedure. For the first week, my son’s tongue felt “loose” as he tried to use it for feeding. During that week, as directed, we used sterile gloves and ran one finger under his tongue and upper lip to discourage the tissue from growing back. It was sore and uncomfortable for him, but we practiced exercises to “train” his tongue to nurse properly. He seemed to get the hang of the new movement, and in many cases this anatomical change allows babies to breastfeed correctly. Sadly, for us, it did not improve our breastfeeding relationship. Maybe the tongue and upper lip were not properly released, but, most likely, it’s because we were dealing with other issues like GER (acid reflux) and chronic low milk supply.
misdiagnosed tongue and lip ties
As popular as the diagnosis of tongue ties and/or lip ties has become, not all physicians and lactation specialists believe all identified babies have an actual “tie” of the tongue or lip. Some IBCLCs (International Board Certified Lactation Consultants) believe that a percentage of babies actually have strain or damage to muscles while in utero (especially during those final weeks of pregnancy when the uterus is cramped) or during birth. The tight or strained muscles take a while - and proactive work - to repair and relax after birth. If you look at the anatomy of the tongue, it’s quite a mashup of which muscles attach where in the head and neck, and physically, muscle tightness or rigidity can cause restricted movement of the tongue, thereby adversely affecting breastfeeding.
Think about that time you woke up with a “crick in your neck.” One side of your neck down into your shoulder was tight and tender, and you compensated all day in order to avoid the pain. Remember how you drove your car, drank your coffee, or ate your lunch that day while keeping your head slightly turned to one side? It’s similar for a baby with strained muscles except it’s not as obvious. Rather than a procedure, these babies need the intervention of a pediatric chiropractor or trained lactation consultant who can teach you how to massage and release baby’s tight muscles.
Telling the difference
So how do you know if your baby has tight muscles from utero/birth or if he actually has a tongue tie and/or lip tie? It’s difficult to tell on your own (I know, frustrating). I googled hundreds of images and compared my son’s mouth to all of them (which helped), but I couldn’t be accurate because it was difficult to get a decent comparison as he cried and turned away. Moreover, a home diagnosis is near impossible because the symptoms of infant reflux, fast letdown, low milk supply, and allergies or digestive sensitivities are very similar (e.g. frequent unlatching, arching away from the breast, coughing/gagging, crying when feeding, etc.) Tongue ties can also contribute to infant reflux because digestion actually begins in the mouth!
If you suspect that your baby may have a tongue and/or lip tie, it’s best to talk with a lactation specialist and your pediatrician. If you are convinced that your baby has ties (or some physical issue hindering breastfeeding) but do not find the support you need, seek a second opinion. There may be other intraoral restrictions (swallow dysfunction, high palate, etc.) which impact your baby’s ability to feed.
This shows how your pediatrician (or other doctor) should be examining your baby for tongue/lip tie.
Summary and final thoughts
Tongues can look rounded, square, or normal and still have a tight frenulum, or tie. It’s all about how it affects the tongue’s mobility.
Lips can look “normal” but still have a tight frenulum, or tie. In this case, it’s about how the lip is able to move or to what degree it is held towards the gums.
Tongue/lip ties do not necessarily “go away” on their own. Both tongue and lip ties can affect teeth and speech as babies grow into toddlers. (That said, don’t let this scare you into an intervention if you and your trusted pediatrician do not think your baby has a tongue or lip tie!)
A good sign that your baby may have a tie is difficulty feeding from both the breast and the bottle as well as trouble with pacifiers.
There can be other intraoral restrictions such as swallow dysfunction, high palate, infant reflux, or allergies causing feeding issues. (Reflux and colic can often coincide with tongue ties because milk - and later food - is not properly moved to the back of the mouth.)
Lip ties are very often accompanied by tongue ties.
When breastfeeding doesn’t work
If you try everything and still can’t get baby to feed from the breast, I understand what you’re going through. We worked on breastfeeding for 14 weeks without success, and it caused more stress and grief than I anticipated. You are definitely not alone, and there are healthy alternatives to breastfeeding. If you decide that infant formula is the right choice for you and your baby, I wrote this article on choosing the right formula for your baby. I know some days you end up with more questions than answers, but remember that you are doing a fantastic job with the information and resources you have! Advocate for what you need and find support wherever it’s available. One day soon, your seemingly fragile, struggling-to-feed little baby is going to be a toddler shoveling green slime into his mouth!
