The Vanderhorst Family

The Vanderhorst Family

Tuesday, August 19, 2014

Tongue-tie/lip-tie/high-pallet/short tongue issues

If you are pregnant or nursing right now and still having difficulties, this is something you'll definitely want to read.

Tongue-tie/Lip-tie/High-pallet/Short tongue is a pretty common problem for many breastfeeding moms, and yet for some reason, the majority if the medical field (or even those in the lactation field) do not know about this issue, or often shrug it off as something that you and your baby will "grow out of." After dealing with my own frustrations with both of my kids, and hearing friends and close family members deal with the same thing, I wanted to write a blog post about this to raise awareness of these issues and to give support to those struggling with this, because chances are they aren't finding much support anywhere else.

What is it?

If you hear any of those phrases, it can mean a few different things. Either your kid has a tongue-tie, or their upper or lower lips are tied. This means there is a tendon that is connecting the lips to the gums, or that there is a tendon right below the tongue that attaches the tongue to the bottom of the mouth. See pictures below:

This is a tongue-tie

This is an upper-lip tie. Notice how if that is not cut back that it can cause a gap between the upper two teeth once they come in.


How to tell if your child is lip or tongue tied?

Make sure your baby is lying on their back. To check a lip-tie, see if the center of either lip resists moving out (or flanging out). You can also move your finger along both the top and the bottom gums to see if you can feel the frenum attached.

For a tongue-tie, you can lift the baby's tongue up to see if there is a frenum attached, or move you finger below the tongue to see of the frenum is attached. You can also put your finger in their mouth to see what their sucking motions are like. If they are able to consistently have a good, deep "suck suck suck suck suck" motion, then you're probably ok. If you notice that they do a "suck suck chomp, suck suck chomp" motion, then they are having a hard time always moving their tongue completely out of their mouth because it is tied back.

What are the effects of tongue or lip-tie?

There are a few--if left untreated, a severe enough case of tongue or lip-tie can effect the way the teeth come in once your baby gets teeth, and it can also cause some speech impediment issues.

The biggest effect though is on nursing. Here are some ways that it can effect both mother and baby:

~cracked, blistered, bleeding nipples
~clogged ducts
~discomfort while nursing (there will be some discomfort for the first 2 weeks of nursing. After that you should not be feeling pain while nursing except for maybe the first 30 seconds if that).
~decrease in milk supply

~reflux or colic
~difficulty latching
~chomping on nipples
~poor weight gain
~makes clicking noise while sucking
~excessive drooling
~choking on milk or popping off the breast to gasp for air

You and your baby may not have every single symptom, and a few of these symptoms (especially in baby) are just symptoms of being a baby.

What can be done?

There is a procedure that can be done called a frenectomy. Most offices use a laser to cut the tie, but some offices use scissors. It is important to note that after the procedure is done you need to massage the area where the procedure was done for about a week after to make sure the frenum does not reconnect.

Until you can have the procedure done, these are some things that helped:

~Whenever I nursed, I used a football hold. I read somewhere that this position was easier for kids with a tongue or lip tie, and although it was still painful, at least the pain was manageable.
~I recommend pumping once a day. This helps make sure that your milk supply stays up, it can give your nipples a break from being chomped on, and the chances of mastitis decrease because you are draining your breasts at least once a day. This is not a professional recommendation (since I'm not a lactation consultant and they tell you to not pump the first 6 weeks), but I'm telling you, I would have died if I didn't pump once a day. I KNOW my milk supply would have decreased and I know that I was reducing the chances of an infection by making sure my breasts were drained at least once a day. And don't worry about nipple confusion. If your baby is full-term, they are usually able to go between bottles and breast pretty easily.

Most people that do this are either oral surgeons or pediatric dentists. Here are just a few tips from my own experience:

If the office says they need to sedate your infant, they obviously have no idea what they are doing. This procedure does NOT require sedation for such a young person, and to be honest there aren't a lot of nerves on the frenum at that age, so it does not hurt your child in any way.

There is a scale for how severe a lip or tongue tie is. The scale is from 1-4, where 4 is the most severe. In the eyes of the academic community, a 4 is no question--they would do the procedure. A 3 would be a recommendation. A 2 or a 1 they usually leave alone. Usually if your child has a severity of a 1 or 2, it shouldn't have a huge effect on your ability to nurse.

I'm usually not an advocate for "patient is always right" mentality, but in this case, I most definitely am. The reason?

For whatever their reasons, the medical community gives very little support to mothers who deal with this issue. Many brush it off by saying that "your baby will grow out of it." This is a half truth: your baby will grow out if it AS LONG AS THE PROBLEM IS FIXED! A high pallet will be fixed by breastfeeding, but only after a frenectomy is performed.

Also, the medical community seems to really only care about how your baby is doing. This past week I took my daughter in to be examined, and the oral surgeon said that she didn't seem to be struggling because she was gaining weight just fine. It's true, she has been gaining weight just fine, but she still has a shallow latch which makes it incredibly difficult and painful for me to nurse.

I don't understand why they are such butt-heads about this procedure, but they totally are. It takes them 2 seconds, they are making money off of it, and it will make your life easier to nurse. I really don't see what the big deal is.

Hailey was both tongue and lip-tied, but her tongue-tie wasn't as severe (even I thought it didn't need to be snipped. Andrew on the other hand had a really severe tongue-tie, and once it snipped it made feeding for him so much easier).

Hailey's lip tie was more severe though. The thing that kills me is I really had to convince them to cut it. They didn't want to because she was gaining weight just fine and they weren't convinced that it would help. It was 2 male oral surgeons, so they brought in a female oral surgeon for another opinion. She said the same thing. I asked her if she was a mom, to which she replied yes. I then asked her if she breastfed, and if so if it hurt her. She said it did for the first week or so, but that it was normal. Finally I told her that it is NOT normal for me to still be in pain when my daughter is a month old. She shrugged it off and said that she would grow out of it. I just thought to myself "oh really?! Tell that to my sore and cracked nipples!" I finally determined the only way to convince her was to show her my nipples. I did, and she said "Oh! Ya that definitely is not normal! I can't promise the us cutting the lip will help, but we'll go ahead and do it just to see." Guys, I had to show this woman my nipples to convince her how bad it was! And guess what--it totally worked. Hailey is doing great! Her latch is much deeper now because she can flange her lips out like she should, and I've noticed that she's more relaxed when she eats and not swallowing as much air.

If you are still in pain after the first few weeks of nursing, you may want to look at the tongue and upper lip. If you see something (it's pretty obvious to tell if it's tied), then for heaven's sake get it snipped! You may have to do some convincing, but this is one case where I believe the patient is right. No one knows how painful nursing is but you. Stick your ground, get the frenectomy done, and I promise it will help!