Breastfeeding and Tongue Ties – FAQs

• Painful nursing for mother.
• Poor latch (popping on and off, sliding off and falling asleep at the nipple) often with frustration
  for both baby and mother.
• Sucking/biting in short bursts followed by a pause rather than a continuous suck-swallow
  rhythm.
• Colic.
• Reflux.
• Slow nursing with clicking and milk dribble during nursing.
• Mouth breathing.
• Restless sleeping with heavy breathing, snoring or grunting.
• Many infants hate being placed on their backs because they find it hard to breath.
• Many infants are fussy and unhappy all the time; others sleep way too much because they are
  not getting enough calories to even fuss and cry. Either way, they are always hungry and not
  getting enough to eat.

Remember, not every baby has to have all the signs. Infants are good at accommodating to whatever they have to cope with. If your infant is experiencing any of these symptoms, consider getting a tongue tie consult. Different types of tongue ties cause different symptoms. Some of the most innocent looking ties can be the worst.

When I do my exam, I look for the following:

• A retruded chin.
• Nursing blisters from not flanging the lips when nursing (usually from an upper-lip tie which is
  frequently seen along with a tongue tie).
• A high, narrow palate.
• An upper lip tie.
• A finger suck that is really biting.
• Mouth breathing with or without a tongue thrust. (A common mistake is to see the tongue
  sticking out and think that it means the tongue is not a tied. The truth is that the tie is
  preventing the tongue from going up to the roof of the mouth and the only way it can move is
  forward. This will cause dental and airway problems as the child grows.)

Painful nursing is a very common symptom of a tongue tie. When a baby can’t use its tongue properly to be able to suck on the breast it often does the only thing it can do which is bite. However, some mothers have such a strong let down that milk literally flows from the nipple. In those cases, the infant can “get away with” just drinking what comes out rather than having to suck. The problem with this is that when they get to be about 3-4 months old, the amount of milk that just flows out is not enough and they stop gaining weight. The infant may be suffering from other signs of a tongue tie which are ignored because nursing doesn’t hurt. Just because nursing doesn’t hurt doesn’t mean there is not a problem and that it should not be addressed as early as possible. Look for other signs such as mouth breathing, restless sleep with snoring or grunting and an unwillingness to be put down on her back.

No. There are many long-term consequences of not releasing a tongue tie in infancy. An uncorrected tongue tie can cause problems with eating solid foods, problems with tooth decay, speech, mouth breathing, lack of downward and forward growth of the jaws causing a long thin face with a narrow airway and sleep disordered breathing. The longer you wait to have it corrected, the more difficult it is for the child to re-learn how to swallow correctly and to keep the wound from healing closed after the procedure.

Post-op stretching exercises are important to be sure the wound does not heal closed. I know the baby doesn’t like them, but it is better to get it to heal properly the first time than have to have the procedure done more than once. The exercises don’t have to take a long time. Just get in there, break the fibers that are trying to heal closed, and get out. What is good to take a lot of time with is the play time exercises which consist of finger sucking and side-to-side movements of your finger along the lower gums. These help the baby build strength in muscles that were never used before because of the restriction on the tongue. The first week is the most important. After that you want to keep the healing areas soft for a couple more weeks.

As we always say, every baby is different. Some babies get so angry over the process that they then refuse to eat. If that is the case, feed first and then do the stretches. Other babies find that being fed is consoling so for them you can stretch first and then feed. Some mothers do the stretches at every diaper change if the baby is going to be upset anyway. Some do the exercises when switching from nursing from one breast to the other. You have to figure out what is best for you and your baby.

In toddlers and children, I suggest baby Advil or Tylenol as prescribed by your pediatrician. Best to keep ahead of the pain by giving it every 6 hours. It’s good to wait at least 15 minutes after giving the medication to let it take effect before doing the stretching exercises. For toddlers, children and adults, anything cold like popsicles can help numb the mouth. Infants can also be given Tylenol though we try not to. I give parents small vials of coconut oil with a hint of clove oil that is an old-fashioned pain remedy. There are also many over-the-counter herbal remedies for infant pain. You can make little breast milk popsicles for infants to suck on that can cool and help to numb the mouth. Most infants are upset only for the first two days except for when you do the stretching exercises. Remember to keep your own energy calm. If an infant senses that his parents are upset, he feels afraid which only makes things worse. And always, lots of finger sucking and skin-to-skin.

Some babies are a little fussy for the first day or so, but have no real trouble getting over the procedure. Other babies are in such shock over the pain in their mouths after the procedure that they will refuse to nurse. They may be inconsolable for many hours. In that case, try to reassure them and just let them be upset until they get hungry enough to eat. Forcing a baby to eat can cause an oral aversion. Switching back and forth between bottle and breast is confusing to an infant and can keep them from figuring out how to suck. They will never forget how to bite. But if you don’t help them learn to suck, they won’t gain all the benefits of having had the tongue tie released.

No. The laser cauterizes the area so there is little or no bleeding. The wound area will look like a diamond shape. It will form a wet scab which is a white film that can look like infection, but it is not. In fact, a diamond-shaped white scab is exactly what you want to see for healthy healing. There is virtually no risk to having the procedure done if you use a skilled and experienced provider.