****this post has been updated with new information and research.***
Breastfeeding is extremely painful!! Is this how it’s going to be?
No, honey! It doesn’t have to be!
As a honey cradles her newborn, an intricate web of emotions unfolds. Am I doing this right? Is my babee getting enough milk? The first attempts at breastfeeding, a dance as old as time, take an unexpected turn when the subtle struggles arise. A diagnosis of a tongue tie can casts a heavy shadow, introducing a challenge that demands not just physical strength but emotional fortitude.
In recent news in Lactation Land The NY Times wrote a salacious and simply incorrect article about the "booming" business of tongue ties and its connection to lactation consultants pushing procedures on clients for kickbacks.
Where they do this at?
The medical term for tongue ties is Ankyloglossia. Tongue ties restrict the tongue's range of motion To move up down and side to side. The condition is present at in utero at birth, genetic and more prevalent in males.
Wait, present at birth?
Yes honey! The symptoms presenting in utero include breech or transverse fetal malpositioning, higher than normal levels of amniotic fluid and recurring hiccups in utero and postpartum. Which all makes perfect sense by the way and is backed by research that the the tongue controls to tips of toes through connective tissue called fascia.
The initial pangs of frustration are real, like the tautness of an unseen bond restricting the connection between mother and child. Yet, within these moments of vulnerability, a resilience blossoms. Honeys embark on a journey of understanding, seeking the support that becomes a lifeline amid the complexities of breastfeeding with a tongue-tied baby.
Fascia keeps you tight, honey if it is limited in space. It causes body tension which can keep your babee in fight or flight mode. Tension in newborns can be mistaken as strength such as babee lifting their head and neck up before 8 weeks, rolling around until finding a comfort site position, turning in the side, very stiff feeding, babee just doesn't seem to relax, inconsolable crying and constipation. Many soles are referred to chiropractic care which can help temporarily but in essence is just putting a bandaid on the problem.
Babees begin sucking around 12 weeks in utero and if your babee has a tongue tie thus resulting in a head turning preference. Postpartum, If a tongue-tie is restrictive enough that it begins to block a babee's airway, they may have to bring their head and neck backward or to either side to open the airway again. The body follows where the head turns and if the head cannot turn or has a head turning preference babees can possibly be malpositioned in the womb which could result in a difficult labor leading to an increased chance of a cesarean surgery.
As gestation progresses babees begin to not only suck but they begin to practice swallowing the amniotic fluid too. If these levels are higher than normal it is an indicator as a doula that the tongue may not properly function well enough to suck and swallow cohesively to reduce excess fluid.
Same with hiccups. One hypothesis is that a tongue-tie or tongue restriction causes a dysfunctional or funky swallow and through a series of nerves (vagus and phrenic nerves mainly) triggers a hiccup response in the babee. This dysfunctional swallow persists outside of the womb and continues (for months for some babees.
A short, tight band of tissue called a frenulum tethers the tongue's tip to the floor of the mouth. It can affect how a child eats and speaks, and can severely interfere even discourage some honeys from breastfeeding altogether.
Symptoms include difficulty sticking out the tongue past the lower front teeth or lifting it to the upper teeth, though many people believe they have no symptoms.
Oh, honey I cannot begin to list the symptoms of tongue-ties in babees but adults have them too but more of that later.
I began my journey with tongue ties pretty much like the consensus in this field of not receiving skilled and savvy lactation support in the early days.
BRING HER A PUMP was all they said!
Hindsight is 20/20 right? No one ever thought to look in my babees mouth or it's designed to not catch such a condition to see why he was chewing my nipples which resulted in a failed journey at two months. My second, I was able to “nurse” through an undiagnosed lip and tongue tie. Now tongue ties are tricky. Some babees can feed with oral restrictions but they are usually living off of a forceful let down. Being that he was my second child and a boy my supply was much higher than the first journey. I promise you, they will show signs of compensation through tension by pulling to one side of the body, mouth breathing, snoring and more. Challenges not only I was not educated to recognized but providers weren't trained in this area either.
Lactation consultants emerge as unsung heroes, guiding honeys through the intricate maze of latch issues and tender nursing sessions. Their words carry the weight of their experience, transforming uncertainty into confidence. In each piece of advice lies an anchor, grounding honeys amidst the storm of "will this ever get better?"
The field of lactation is ever evolving. And I'm super honored to be in the circle of ever evolving healthcare. I'm learning most information and evidence based research through clinical and holistic expertise, colleagues, continuing education seminars and more. I've learned that all of it will probably be outdated in 5 years as we discover more information from research in the field of not only lactation but healthcare.
Where do tongue ties come from?
Evolution and a chaotic gene called MTHFR!!
Tongue tie is often associated with a gene
that controls the production of an enzyme called Methyl-Tetra-Hydro-Folate-Reductase (MTHFR).
Tongue ties are often accompanied by lip ties (labial ties) preventing the anchor for attaching, cheek ties (buccal ties) preventing the mouth from opening wide enough to latch and posterior ties which prevent the tongue from cupping and sealing the breast tissue the rhythmically drain the breast efficiently. The genetic mutation of MTHFR is often responsible for midline defects like tongue tie, such as cleft lip and palate, cleft chin, having extra or missing teeth or a narrowing of the nasal passages in babees.
"The mutation of MTHFR is present as a recessive (carrier) gene in 30-50% of the population – this is called heterozygous mutation. There is a much smaller percentage of the population that are fully homozygous.
For most people with the genetic mutation, there are no side effects. However, it can cause an increase in homocysteine which contributes to heart problems. "
The mutation can also a huge deficit in folic acid, which is vItaly important for neural tube development in the embryonic phase of pregnancy. Because patients who have or are carriers of the mutation are unable to process folic acid, they should heavily manage their diets carefully. If patients with MTHFR need dental work, they should avoid using nitrous oxide at the dental office.
Tongue ties are a super new niche field with a small amount of professionals creating a model of care for babies that may suffer from TOTs. They have taken the time to learn more about the function of orofacial muscles and how it can affect the breastfeeding dyad. Learn more about tongue ties here and team effort in making the tongue work!!
I have latched over 500+ babees and majority of them were tongue tied babees. Nearly all of the clients found success with the treatment and procedures through a team work of individuals to properly train the tongue to work. The online communities and Facebook are inundated with honeys and become a sanctuary—a space where shared stories intertwine with compassion, where tears and triumphs are woven into a tapestry of understanding. Strangers become confidantes, offering not just advice but a virtual hand holdiing during those midnight feeds and tearful struggles.
This procedure isn't an instant fix. We aim for progress not perfection and it takes time for these babees to relearn the use of their tongues. But that HIGHLY depends on if your babee is receiving PRE and POST op oromyofacial therapy from skilled lactaion porfessionals and for more severe airway cases. By enhancing the procedure with post op treatment exercises the tongue not only becomes more efficient at breast and bottle feeding but infants meet their development milestones as well.
The emotional journey is layered like an onion honey and will make you cry like one too!! But GRACE!!
That same determination you used to find help is the same determination you'll need to walk this journey. There are moments of joy, small victories celebrated like precious gems, a successful latch becomes a triumph of determination, a testament to the enduring bond between mother and her babee. Amidst the struggle, there are whispers of love exchanged through lingering gazes and the gentle touch of tiny fingers.
All of my clients who were referred and went in for evaluation after challenges and assessments went on to meet their initial breastfeeding goals.
Tied babees can turn new honeys into exclusive pumpers when handled with unskilled and savvy lactation care. They just know breastfeeding was very painful and uncomfortable to feed their own babees. This leads to many internalized failed journeys and grief of the loss of the breastfeeding relationship.
What exactly does a tongue tie look like?
Well you can't always see a tongue tie. Ties should be diagnosed by how well the tongue functions notnisy by looks only. In fact, an oral evaluation and functional assessment by a skilled pediatric dentist or ENT is needed to properly diagnose oral restrictions. Many babees I come across in my practice are told "It's a small lip tie, it shouldn't affect breastfeeding." but yet these parents are still facing symptoms with the most obvious being nipple trauma.
"You simply can't keep relatching the pain away."
- Jada Metcalf
If your provider is telling you it's "a mild tie" that's like saying you're kind of pregnant. And I would encourage your find a second opinion ASAP. Here are a few pics of (1) anterior and (2) posterior tongue ties which are highly misdiagnosed or unproperly released because it can be attached deep on the floor of the mouth and pretty much buried under submucosal tissue.
An oral restriction can include more than a tongue tie or it can include all of the complications listed such as low muscle and cheek tone, improper jaw development such as a recessed chin or high palates including a cleft lip palate as well.
There are classes of tongue ties that can be easily misdiagnosed by millimeters. This is why a skilled TOTs trainedprovider can effectively screen and assess oral function in breastfeeding babees.
What symptoms are present in infants with a tongue tie?
Symptoms in infants that warrant an assessment include:
Shallow latch at breast or bottle
Falls asleep while eating
Slides or pops on and off the nipple
Clicking sound while nursing
Reflux/gassiness/spitting up
Hiccups/Prenatal + Postpartum
Overly frustrated/colicky baby
Congestion
Snoring
Feeding feels like a full-time job (frequent feeding every 1-2hrs or more)
Poor weight gain
Milk dribbles out of the mouth while nursing/bottle feeding
Mouth breathing
Symptoms in Mom/Caregiver that warrant an assessment:
Pain during latching or nursing
Flattened/lipstick shaped nipples after feeding
Blistered/sore nipples requiring nipple shield
Nipple damage
Poor/ incomplete breast drainage
Blocked ducts or mastitis
Engorgement
Nipple thrush
Decreased milk production
Is that you and our babee, honey?
Wait, there's more..
Tongue-ties affect bottle feeding too?
Bottle feeding includes the suck, swallow and breathe pattern too and if babee cannot properly latch and create a seal to grasp the nipple of the bottle.
Many parents are told to give up their journey and just feed babee with a bottle. WTF?! This is lazy lactation and provider care.
I'll say it again....
IT'S LAZY LACTATION AND/OR PROVIDER CARE
Throwing bottles at mom is a simple fix that will not solve the issues they are struggling with from the tongue-tie. Switching to a bottle takes away the maternal aspect (pain, plugged ducts, supply issues, etc.), but it does not fix the infant issues of a poor latch, milk leaking out, reflux, excessive gas, colic, and slow feeding with possible weight gain issues.
Also, the most known complications is how tongue-ties can affect speech and language but we eventually move past the breastfeeding relationship and dive into our quality of life through eating, moving and breathing properly.
Everyday activities you do in life are profoundly affected by the tongue.…
Solids with a restricted tongue can possibly lead to sensory issues, picky eaters, gagging and choking because the tongue cannot move food around the mouth to chew and swallow. I’ve seen some toddlers 18+ completely reject food because it’s just too difficult for them to manipulate with their restr tongue. These types of cases are referred to feeding therapist called an Sleep, Language Pathologist, an SLP.
What's the next step?
Finding a TOTs specialty trained lactation professional or IBCLC local or virtually, FIRST. There is a team of providers to collaborate with in reprogramming the brain such at OTs, SLP, Osteopaths, Craniosacral Therapists, Chiropractors, Pelvic Floor therapists and of course the release provider. I am TOTs trained and can properly screen and execute a model of care for sustainable optimal nursing outcomes.
TOTs training and lactation support provides
"An E3 Model of Care® for TETHERED ORAL TISSUE. This includes relevant background information on how tethered oral tissues affect oral function from birth to maturity."
- Chrysalis Oromyofacial
I am trained to screen and assess your babees oral space for visual indicators of oral restrictions. I cannot nor can any other professional diagnose tongue-ties besides a pediatric dentist or ENT.
I have over a year of clinical experience at the Tongue Tie Therapy Center in Atlanta and have latched over 300+ babees as well as assisted honeys and caregivers with immediate breastfeeding support after the surgery and getting back to breast with my Mind, Body and Babee model of care.
My weeks of ongoing support is a collaborative effort when it comes to releasing a tongue tie. It is not an instant nor easy fix. If there are complications that go beyond my scope of practice I have a web of specialty providers to refer to in order to keep the continuity of care moving. This model is aimed to keep the breastfeeding relationship in tact along with minor road bumps of parenthood. Check out some of my resources and more information on tongue ties!
Everyone doesn’t choose to release the tie as they have either been I'll advised it will rip or stretch on its own or are comfortable moving forward with their breastfeeding relationship with a few tips and tricks or exclusively pumping because the journey becomes unsustainable.
Again, tongue tied babees turn into tongue tied adults. If you are considering the procedure for your babee there should be therapy plan provided which needs to happen before AND after a release to strengthen the tongue enough to sustain milk supply management on its own. We look for progression not perfection. Coupled with coaching and practice informed evidence my approach will continue the breastfeeding relationship with progression for desirable outcomes.
If you are experiencing painful breastfeeding, book a home visit to address your breastfeeding and bottle feeding concerns. I am currently self pay and do not accept insurance.
***This blog does not replace the medical advice from your provider.***