There is a surprising lack of easy-to-digest information on tongue ties (and lip ties) readily available on the internet. I know, because I spent many middle-of-the-night hours desperately searching for answers.
My little girl was born via c-section at 37 weeks 5 days. I wasn’t able to attempt breastfeeding until she was about an hour old, and she wouldn’t latch. At first I was told it was probably because her glucose level was making her lethargic. But even when that was resolved, she would still slip off my breast in a matter of seconds. What was I doing wrong?
Turns out, nothing. My baby had a tongue and lip tie. Of course, at the time I didn’t know that. As the nurse handed me a nipple shield, I knew I needed to get to the bottom of what wasn’t working.
Please Be Advised: Breastfeeding can be a sensitive topic, especially for mamas who were not able to meet their breastfeeding goals for whatever reason, or mamas who knew they wanted to formula feed. As a breastfeeding counselor, I will always encourage a mother to breastfeed if that is her goal. Please do not mistake this for being against moms who choose formula or supplement with it! We are all caring, loving mothers doing our best. Please read the following post with caution if breastfeeding is an emotional or sensitive topic for you.
Disclaimer: The information found in this post, on this blog, and within any breastfeeding resources created by Mom Makes Joy should never be a substitute for lactation advice or in-person assessment given by an appropriately credentialed healthcare/lactation professional.
Before I figured out breastfeeding, I did a lot of research. If there was a YouTube video on latching and positioning, I watched it. I Google-searched tongue ties, of course, but found myself with more questions than any one site could answer for me. So I met with an experienced IBCLC, and I joined several tongue tie support groups on Facebook. I listened to other moms’ experiences and asked loads of questions.
Since then, I’ve learned so much about ties. I’ve even become a breastfeeding counselor with a non-profit and a Certified Lactation Educator Counselor (CLEC)! And now I’m sharing what I’ve learned with you! This is the information I wish I had from the beginning, all in one place.
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1: THE SYMPTOMS CAN MIMIC OTHER ISSUES
The symptoms of tongue ties and lip ties can vary widely. You may experience all of these symptoms or just a handful.
- Cracked, sore, or bleeding nipples that don’t improve after the initial few days/weeks of breastfeeding
- Blanched (white) nipples and/or vasospams
- Shallow latch that may or may not be painful
- Inability to latch on or stay latched on the breast and/or bottle
- A clicking (“tch tch tch”) sort of noise when baby suckles from the breast or bottle
- Inability to flip the upper lip out when latched onto a breast or bottle (upper lip should be flipped out, not tucked in)
- Inability to open mouth “wide enough” or diagnosis of “small mouth”
- Milk leaking from the sides of baby’s mouth
- Painful gas/colic
- It taking a long time (over 30 minutes per breast) for baby to soften the breast
- Baby seeming constantly hungry
- Inability for baby to soften the breast/feeling engorged
- Green, foamy, explosive stools (usually resulting from foremilk/hindmilk imbalance)
- Clogged ducts, mastitis or symptoms of oversupply
- Baby repeatedly falls asleep after only a few minutes of nursing
- A quivering tongue motion when baby nurses
- Reflux or reflux symptoms (e.g. back arching)
- Gagging, choking, sputtering on breast milk, formula, or solids
- Slow or no weight gain, or baby falls off his/her personal growth curve
- Failure to thrive
- In older children: A gap between baby’s top front teeth
As you can see, a lot of these symptoms can be caused by things other than ties. Reflux symptoms could be caused by–you guessed it–reflux, or they could be the result of a tongue tie affecting how milk is brought into the mouth and swallowed. Needing or wanting to feed all the time could be (and is usually chalked up to) a growth spurt, or it could be that baby is feeding all the time because he/she isn’t able to remove much milk from the breast at a time. Slow weight gain can look like low supply or just a small baby, or it could be that baby can’t efficiently remove the milk you are making in perfectly sufficient quantities!
2: LEFT UNTREATED, TONGUE TIES CAN CREATE PROBLEMS
Often babies diagnosed with reflux are put on a cocktail of medications to ease or alleviate their symptoms. Sometimes this is warranted, but I suspect often it’s a tongue tie and not true reflux. If baby isn’t gaining well or seems hungry all the time, a mom may fear her supply is low and decide or be instructed to supplement with formula without also being told to continue to pump to preserve her breast milk supply, which may in fact not be low at all but may become that way soon. Engorged breasts may have mom pumping to empty them (which can cause oversupply and its associated issues) or actively trying to decrease her supply too early, resulting in low or no supply when she needs it later.
Alternatively, a mother’s supply may seem fine for the first two to four months of her breastfeeding relationship. But after that point–the point at which milk production stops being regulated by hormones and starts to be regulated by supply and demand, i.e. how much a baby is able to remove from the breast–she finds herself unable to meet her baby’s increased demand for milk as her milk supply drops.
Often times this results in baby being put on formula, which may be a welcome break for mom, especially if breastfeeding has become unbearably painful. However, this can be a huge blow to mothers who wanted to breastfeed or for moms who now find themselves needing to exclusively pump. For a small percentage of babies, even being fed with a bottle is not enough. Very restrictive ties can prevent a baby from being able to eat even from a bottle. These are the babies often diagnosed with failure to thrive.
Even if baby is able to take a bottle, untreated ties can cause problems for baby down the road, including speech impediments, a gap between the top front teeth, tooth decay (from the tongue being too restricted to properly swipe the teeth and clear them of build-up and bacteria, as well as from food getting caught in an upper lip tie), difficulty chewing/swallowing solids and texture aversions. Additionally, since the muscles in the mouth, face, and jaw are all connected, some have experienced chronic headaches and jaw issues as a result of their ties.
3: NOT ALL TONGUE OR LIP TIES NEED REVISION
All that said, tongue and lip ties fall on a spectrum. Not all ties cause all symptoms and therefore not all ties warrant revision. My baby wasn’t able to latch onto my breast at all by herself, but she could latch onto a nipple shield decently well. Some mothers opt to continue to use a nipple shield throughout their breastfeeding journey without issue (Note: there is some evidence to suggest that nipple shields may have a negative effect on mom’s breast milk supply, but the research that suggests this may be outdated). Others opt to exclusively pump or formula feed and have children who grow up without major speech impediments or problems with solids, etc.
Whether or not you will have your baby’s tongue/lip tie revised is a very personal decision best made in partnership with and under the guidance of a qualified medical professional. Do not feel you MUST always revise a tongue or lip tie, or that both must be revised. Sometimes only a tongue revision is warranted if baby can feed well despite an upper lip tie. Always do what you feel is in the best interest of your baby, and do not let others scare you into or out of your decision either way.
4: MOST PEDIATRICIANS AREN’T TRAINED TO LOOK FOR OR EVALUATE TIES
If you suspect you may be dealing with a tongue or lip tie, where do you go to have it evaluated? The answer is probably NOT your pediatrician. Unless your pediatrician is a preferred provider. A preferred provider is a professional, sometimes a pediatrician or pediatric dentist, with a proven track record of correctly treating and evaluating tongue and lip ties.
With the advent of formula and the relative ease of bottle feeding, training doctors to evaluate and revise tongue and lip ties fell out of fashion. I get frustrated when a mom says her ped doesn’t think there is a tie. Most peds aren’t really qualified to say, even if they tell you they are!
We had the unfortunate experience of being told by “the tie lady” (another doctor in the practice) at our pediatrician’s office that Little Bo didn’t have a tongue tie, that we should just work harder at latching and breastfeeding. After all my research, my gut said this doctor was wrong, especially since my IBCLC was able to point out the tie. And because I’m a huge believer in getting second (and even third) opinions, I took Little Bo to a preferred provider for evaluation. Within seconds of looking at her lip and feeling under her tongue, she was diagnosed with the full gamut: a tongue tie, a lip tie, and a high palate! When in doubt, always ALWAYS get a second opinion.
5: ALWAYS ASK QUESTIONS AND FOR REFERRALS
If you don’t have a preferred provider in your area, be sure to ask around for who others recommend. You want a provider that is knowledgeable in the proper techniques used to revise as well as the proper aftercare exercises. Dr. Ghaheri, who is perhaps one of the leading experts in this area, has a great blog post offering excellent advice on how to choose a provider here, including questions to ask them.
6: NOT ALL TONGUE TIES ARE VISIBLE
Some ties, called posterior tongue ties, are submucosal and cannot be seen with the naked eye. Rather, they must be felt for by someone who knows what they’re looking for. Dr. Ghaheri has a great blog post about this here. This submucosal or “posterior” tie is the kind of tie my little girl had.
Also, lip ties almost always accompany tongue ties. In other words, if baby has a lip tie, baby probably also has a tongue tie–this is the case for more than 90% of children, according to Dr. Ghaheri. Rarely is one present without the other. Furthermore, a baby being able to stick their tongue out does not mean they do not have a restricted tongue! More important than the ability to stick the tongue OUT is the ability to lift the tongue UP, as that more closely resembles the motion necessary for a baby to successfully remove milk from the breast.
7: POST-REVISION WOUND STRETCH AND SUCK EXERCISES ARE IMPORTANT
Once your ties have been revised properly, it is critical that you do the stretches and exercises given to you by your doctor. These help the wound from reattaching. Once again, Dr. Ghaheri has an excellent post on how to do these exercises (complete with photos), which typically need to be done at least every 4-6 hours for at least two to three weeks (my doctor had us do them for five to six). It sounds like a lot of work, but the exercises are themselves quickly done and can happen around the same time you would otherwise change baby’s diaper. And if baby is young, you’ll be waking up in the middle of the night anyway!
Unfortunately, some babies are fast healers. My baby is such a baby. We did stretches religiously, closer to once every 2-5 hours, and she still had mild reattachment two weeks post revision. Even so, it wasn’t enough to warrant a second revision at the time. We had her evaluated again at 6 months after an increase in breastfeeding pain shortly after her bottom teeth popped through. Fortunately, this pain passed quickly. While the doctor did say she would be a candidate for a second revision, he did not feel the level of our symptoms warranted it at that time since the pain that originally prompted the appointment had left us.
Although baby’s latch isn’t perfect, she is able to empty the breast efficiently/in a reasonable amount of time (possibly due to my fast letdown) and the pain of her latch is very very bearable–extremely mild discomfort and sometimes no discomfort at all.
8: NEVER UNDERESTIMATE THE IMPORTANCE OF BODY WORK
One thing I should have done better once baby was revised was get more body work, including chiropractic care and cranialsacral therapy. These help loosen the tight muscles in the face, jaw and neck, as all those areas are connected and made stiff by a tongue tie. I was a skeptic at first, but after just one chiropractic adjustment, Little Bo was able to open her mouth noticeably much wider!
While some moms notice their babies take to the breast immediately after revision, other moms I’ve spoken with did not start to notice an improvement in baby’s ability to breastfeed until a few sessions of body work, so make appointments to have this done after revision if you can. Look for a chiropractor who has experience or specializes in working with babies and young children. The kind of adjustments made on young babies are extremely gentle–about the amount of pressure you would use to check to see if a tomato is ripe. In fact, it was so gentle I was almost positive it wouldn’t make a difference, but it really did.
9: IT IS POSSIBLE TO SAVE YOUR BREASTFEEDING RELATIONSHIP!
If you are exclusively pumping or bottle feeding, you may be able to revive your breastfeeding relationship with the right support from an IBCLC and the appropriate body work. Yes, even if baby is currently refusing the breast! I have heard of parents who have been able to breastfeed babies who haven’t taken the breast in months. It will take time and patience, but if it is something important to you do not lose hope that it can be done!
If breastfeeding is not possible or too painful at present, one way you can bottle feed a baby you hope to breastfeed later is paced feeding, which involves making sure baby is drinking from the slowest flow nipple you can find and ensuring that baby doesn’t guzzle the milk too quickly. This also gives baby a chance to feel full–just like you as an adult feel more full when you eat slowly compared to when you chow down.
10: SUPPORT GROUPS ARE HELPFUL: JOIN ONE!
Do a quick search on Facebook or ask your provider or IBCLC if he or she knows of any breastfeeding support groups or meet-ups in your area. Being around other moms breastfeeding and struggling is super helpful, and something I wish I did more of. I am a part of several support groups for moms of tied babies and breastfeeding moms on facebook and have been able to learn a ton and get a lot of my questions answered there–which is sometimes a sanity saver when it’s 2am and you just need a quick answer while your IBCLC’s office is closed!
The most important thing to remember is you’re not alone, and you can only do your best. You and baby can make it through this. And even if breastfeeding doesn’t work out, what matters is that baby is fed, growing, and healthy!
Lastly, should you be struggling with nipple soreness or supply issues, be sure to check out Earth Mama Angel Baby’s line of organic breastfeeding products. Their nipple butter was a LIFE SAVER when I was struggling to breast feed! It will not be the solution to a tongue/lip tie or a poor latch, so be sure to get to the root of the issue and be seen by a professional!
Have you ever breastfed a tongue-tied baby? What was the biggest challenge you faced?