Tethered Oral Tissues (aka tongue and lip ties)

As an International Board Certified Lactation Consultant (IBCLC), I often encounter tongue and lip ties. A tongue tie is a condition where the thin piece of tissue (called the lingual frenulum) that connects the bottom of the tongue to the floor of the mouth is shorter, thicker, or tighter than usual. A lip site is a condition where the labial frenulum restricts the lip's ability to flare out like a Pringle. This can restrict the movement of the tongue and affect your baby’s ability to breastfeed effectively.

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Do any of these symptoms sound familiar?

• Shallow latch at breast or bottle

• Falls asleep in the middle of a feed

• Slides or pops on and off the nipple

• Gagging, choking, or coughing when eating

• Poor or slow weight gain

• Hiccups often

• Lots of in utero hiccups

• Gumming or chewing the nipple

• Persistent white coating on tongue

• Pacifier falls out easily or won’t stay in

• Snoring, noisy breathing, or mouth breathing

• Short sleeping and waking often

• Baby moves a lot in sleep/restless sleep

• Baby seems always hungry and not full

• Lip curls under when nursing or taking a bottle

• Clicking or smacking noises when eating

• Sucking blisters or callouses on lips

• Colic symptoms / Baby cries a lot

• Reflux symptoms

• Spits up often? 

• Gassy / Fussy often

• Milk leaks out of the mouth when nursing/bottle

• Nose sounds congested often

• Baby is frustrated at the breast or bottle

• Creased, flattened, or blanched nipples

• Lipstick-shaped nipples

• Blistered or cut nipples

• Pain during nursing

• Poor or incomplete breast drainage

• Decreasing milk supply

• Plugged ducts / engorgement / mastitis

• Using a nipple shield

• Baby prefers one side over the other

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Your baby might have a tongue and/or lip tie!

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How Tongue Tie Affects Breastfeeding:

1. Latching Issues: A baby with a tongue tie might have difficulty latching onto the breast deeply enough. This can lead to shallow latches, which may cause nipple pain and damage for the mother, as well as inadequate milk transfer for the baby.

2. Milk Transfer Problems: Since the baby’s tongue may not move freely, they might not be able to efficiently express milk from the breast. This can lead to poor weight gain, frequent feeding, or frustration at the breast.

3. Milk Supply Concerns: If the baby isn’t removing milk effectively, it can lead to a decrease in milk supply over time. Your body produces milk based on the demand from your baby, so less milk removal can signal your body to produce less milk.

4. Comfort and Bonding: Breastfeeding is not just about nutrition; it’s also a significant part of bonding and comfort. If your baby is struggling to breastfeed due to tongue tie, it can be frustrating and distressing for both of you.

 

What We Can Do:

1. Assessment: I begin by carefully assessing your baby’s latch, tongue function, and breastfeeding behavior. If a tongue tie is suspected, I may refer you to a preferred provider for further evaluation and possible treatment.

2. Management Strategies: Sometimes, tongue ties can be managed with positioning and latch techniques that help your baby feed more effectively. We might explore different breastfeeding positions, like the laid-back position, which can help your baby latch more deeply.

3. Frenotomy: In cases where the tongue tie is severe and significantly impacts breastfeeding, a simple procedure called a frenotomy might be recommended. This involves releasing the frenulum to release the tongue and allow for better movement. It’s a quick procedure and often results in immediate improvements in breastfeeding.

4. Ongoing Support: Whether or not your baby undergoes a frenotomy, ongoing breastfeeding support is crucial. We’ll continue to work together on latch, positioning, and milk supply to ensure that you and your baby have a successful breastfeeding journey.

 

My goal is to help you understand what’s happening with your baby and to support you in making the best decisions for your family. Whether that means adjusting breastfeeding techniques or exploring treatment options, I’m here to guide you every step of the way.