Tongue ties and breastfeeding: Danielle's story

One of my pet breastfeeding issues is "tongue tie."  Tongue tie is the common term for a tongue which is anchored tightly to the floor of the mouth by a membrane called the sub-lingual frenulum.

How is this a breastfeeding issue?  Well, roughly 2 to 5% of newborns are "tongue tied," and in some cases the frenulum is tight enough to cause significant breastfeeding problems.  When a baby nurses, the tongue has to extend, and stay extended, past the lower gum line through sucking and swallowing.  When the tongue is restricted by a tight frenulum, a baby may not be able to hold this position.  This often results in excruciating pain for the mother as the tongue abrades the face of the nipple or compresses it against the upper palate.  Sometimes this tongue restriction interferes with a baby's ability to latch at all, and tongue ties can also cause speech difficulties later in life.

Doctors used to clip babies' frenula as a standard newborn procedure, but this practice died out when bottle feeding became the norm (tongue tie usually doesn't impact bottle feeding).  Today, for a mother who wants to get a frenulum clipped, it can be hard to find a doctor who will do it. 

To illustrate how a tongue tie can impact breastfeeding, I'm going to share several stories about tongue ties and breastfeeding, starting with the one below.  I'm pleased to be able to share a story written by Danielle from California.  Her baby girl, showing off her beautiful tongue, is above!

"When my daughter was born I noticed her heart-shaped tongue immediately.  The pediatrician at the hospital said that some babies with heart-shaped tongues have tongue-tie, but that since our baby could stick her tongue out past her lips, that this was not the case.  Naturally, being a new mother, I was quick to accept his prognosis that nothing was wrong with my brand new perfect little baby.  While still in the hospital, a lactation consultant visited our room, and within the first few seconds of examining her, announced that my daughter would have to have her tongue-tie "clipped."  Because the pediatrician had already told us that this was not an issue, and because of the abrasiveness of this particular lactation consultant, I dismissed her assessment as uninformed.

The first two weeks of breastfeeding were an enormous challenge.  My daughter had difficulty latching on, sometimes trying ten or more times before getting a successful latch, only to pop off again.  She sputtered, coughed, and screamed in frustration through many feedings.  My nipples became extremely sore, and I, too, cried my way through feedings, both from the pain of her latch as well as feeling so sad that she was having such a difficult time.  I also had an oversupply, which contributed to her difficulty latching on and my engorgement pain, but did allow the milk to practically pour into her mouth.  I began to dread each feeding, and felt as if we would never be able to nurse anywhere but at home, since it was such an ordeal.

At her one-week appointment, she had gained back the weight she had lost after birth, plus some.  The pediatrician was thrilled, and when I described my troubles with breastfeeding, he expressed sympathy, but said that because of the weight gain, clearly we were succeeding, and it would just take time for me to get used to it.  He reiterated his feelings that if indeed she did have a slight tongue-tie, it wasn't severe enough to warrant any action, and he suggested that I try other nursing positions.  Several of my friends had warned me that breastfeeding was difficult, and so I really believe that the pain and frustration were par for the course for the first couple of weeks.  Especially since I had several people watch me feed her, and all had assured me that the positioning and latch (when it finally occurred) were correct.

Finally, after there had been little improvement after two weeks, I contacted another lactation consultant.  She was convinced immediately that our problems were due to the tongue-tie, but was able to provide my husband and me with much more information about what tongue-tie was, and about the procedure to correct it.  We were still hesitant, and it was only after talking to another lactation consultant as well as doing quite a bit of research (and after reading one article in particular from the American Academy of Pediatrics that seemed to describe our situation perfectly) that we decided to take her to an ear, nose, and throat (ENT) doctor.

The ENT told us that her tie was not severe enough to cause speech problems, but that clipping the frenulum could potentially help with feeding.  This was the second time that I felt that it had been insinuated that there wasn't that much of a problem if it was just about improving the quality of breastfeeding.  I felt so guilty, as if I were doing this for me, not for my daughter.  Despite the guilt, and still feeling nervous and a bit uncertain, we decided to go ahead with the procedure.  The procedure itself was most certainly more painful for me than for my daughter!  She fussed just as much when he clipped the frenulum as she did when he was just exploring a bit in her mouth with her fingers.  There was very little blood, and she never cried.

I was able to notice a difference immediately.  The first feeding after the procedure was like a dream - she latched on and stayed on, and it was painless.  My daughter and I now both look forward to breastfeeding as a special time together.  She even pacify-feeds now, which she never did before.  I never imagined that breastfeeding could be pleasurable!  Our pediatrician was very supportive of our decision, and assured us that he needs to hear experiences such as these to better inform his practice, as otherwise he only has his literature upon which to rely.

I'm not sure I could have continued breastfeeding if we had not gone through with this procedure.  I have come to realize that the desire to improve the breastfeeding experience for myself and for my daughter is nothing to feel guilty about...and ultimately it benefited both of us!"

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Comments

[Nola]

It's remarkable what a difference it makes when a pediatrician is supportive (or not) of breastfeeding activities. I feel like ours hasn't said anything negative but certainly isn't overly supportive.

[Amanda]

So wonderful to hear that this one has such a happy ending! I had an LC advise a frenectomy for Sam even though I don't consider him tongue-tied (the tip of his tongue is not rooted down at all - she classified him as a grade 4 meaning that the frenulum was further back). She referred me to another client who had similar problems and had the procedure done - I spoke with this woman who said that it didn't help her at all and she regretted doing it. We chose not to have it done to our son, and thankfully, our BF issues turned out to not be related to this issue. It's just so hard to understand that many of these choices are subjective and frustrating that all medical professionals aren't similarly educated.

[Louise Evans]

This is the first i've realized that there has been contention in getting the tongue clipped! I had my son at home with midwives and he was put straight on to my breast .... I remember thinking ooh this feels funny but may be i'll get use to it. A couple of days later and both nipples had blisters - This was a very painful time and also remember crying through feeds. The midwife assessed the latch and all looked good, she then checked Henry and realized he was tongue tied. She explained what this meant and if not clipped he may later have speech problems. It was done there and then no fus, no big deas. Henry didn't even notice. Feeding got better and the blisters eventually left!!