Tongue and lip ties are present in about 5-15% of the population. As it’s a genetically inherited trait, this can vary wildly between regions. 40 or more years ago in both the US and UK or more it was semi routine (if on the way out) to snip a baby’s frenulum as part of the post birth care. With the rise in bottle feeding in the 1970’s the practice fell out of favour and professionals lost the ability to detect tongue ties.
Signs of tongue ties:
- Pain while breastfeeding. A normal latch may hurt at first, but pain should subside within a minute after latching and certainly be getting better after a few weeks.
- Ongoing damage to the nipple- this can manifest as persistent thrush, a clamped compressed look to the nipple and ongoing pain. Again, some damage and cracking can be normal but normal damage and pain should show signs of improvement over time.
- Inability to latch to a bare breast
- A visible tie, forked tip or heart shaped tongue.
- Weight loss in the newborn above acceptable (10%) levels that does not correct itself with other management techniques.
- Poor weight gain in the infant.
- Loss of milk supply in the mother. Undiagnosed tongue ties are probably one of the largest causes of low supply.
- Recurrent mastitis or blocked ducts–especially coupled with infant weight loss or poor gain.
- Low bodily output in the infant.
- A clicking noise while feeding from the breast or bottle.
- Milk running out the sides of the mouth whilst bottle feeding.
- Swallowing difficulties resulting in intake of air, increased stomach upset, reflux symptoms and discomfort in the infant. This can present as spluttering, coughing and choking after initial let down.
- Slipping off the breast.
Potential later life issues:
- Speech problems
- Dental issues
- Issues with weaning- swallowing difficulties
- Gastrointestinal issues such as gas, bloating and reflux
Not all babies with tongue ties will experience all or sometimes any of these difficulties. Some babies are able to breastfeed normally, usually owing to the mother having a nipple and breast shape that works well with the tie, as well as an adequate initial milk supply and letdown. However, many infants with tongue tie will present with some of the issues.
Tongue mobility is key, so even a baby able to stick out their tongue may have a tie if they cannot raise their tongue or move it freely in the mouth.
For breastfeeding there are several key tongue motions- the tongue must be able to protrude over the lower lip, it must be able to reach the top of the mouth while the jaw is dropped and it must be able to undulate to create the peristaltic action required for removing milk (so be free to move midway to the back of the tongue). Again this can vary based on mother’s breast shape, let down etc.
Further compounding the problem is that many modern practitioners are not able to detect the tongue tie. Despite experiencing these problems you may be told that your baby does not have a tongue tie even when they do. There are several types. The most obvious is the anterior tongue tie. Posterior or submucosal tongue ties can cause just as much difficulty.
Where to get help above and beyond your midwife, GP, or paediatrician:
In the UK:
I’d also suggest asking LLL leaders if they can recommend anyone. I wasn’t able to find much private in Canada, likely due to the way the health system is.
In the US:
Dr Kotlow- if this is far away from you you might try contacting him and asking if he knows anyone in your area.http://www.kiddsteeth.com/. I’ve heard that he’ll write letters of support to your doctors as well.
Dr Robert Wesman at Children’s Hospital in Oakland, Ca http://www.robertwesman.com/
Catharine Watson Genna, IBCLC specialist in infant oral issues. http://www.cwgenna.com/
There are loads of laser dentistry places that do tongue ties, but these three I’ve seen people be really happy with their skill, so if they aren’t in your area you might ask them if they can recommend someone who is.
Again, loads of laser dentistry places that do tongue ties.
Here are some more general lists
(if anyone has anyone to recommend I’ll add them)
You may find resistance to getting the tongue tie snipped and it may be easier and quicker, if you can afford it, to pay for the snipping privately. It is a relatively quick and easy procedure for a young baby, but can require anaesthetics with an older child. There is a small risk of bleeding issues or other damage but in my opinion the benefits far outweigh the risks.
Your best bet is to search for laser dentistry, paediatric dentistry, some paediatricians, some midwives, ear nose throat specialists, speech therapists, call IBCLCs and ask if they have experience with posterior tongue or lip ties (if you suspect a sneaky tie) and go armed with pictures as seen in the links above.
Tongue tie after care: After your baby’s tongue tie is snipped you may feel an immediate difference or you may not. If you do not, give your baby 2-4 weeks to adjust to their ‘new’ tongue and then call the person who performed the tie for a recheck. You should be given exercises to do with your baby to keep the tie from growing back together. This may involve using a clean finger to lift your baby’s tongue, getting them to touch the roof of their mouth and stick their tongue out. You should do these until the cut has fully healed.