Tongue Tie is a complicated and confusing topic. I have been hesitant to write about it. But as a Breastfeeding Advocate I feel like the time has finally arrived to attempt to shed some light on this issue. "Tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia." "In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems." "Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue tie. Although it is often overlooked, tongue tie can be an underlying cause of feeding problems that not only affect a child's weight gain, but lead many mothers to abandon breast feeding altogether." (American Academy of Otolaryngology-Head and Neck Surgery) Like other medical variations, there is a range of severe to more mild tongue ties. What is very important is how the tongue is functioning. The appearance is less important. Sometimes the impact or even the presence of a Tongue Tie is not realized until weeks after birth. Here are some symptoms or signs that your baby may have a restriction that is affecting your nursing relationship.
Lactation Consultants and Registered Nurses do not diagnose Ankyloglossia. We are trained to recognize it and assess it's potential impact on your baby and you and your milk supply. We are uniquely positioned to take the time to observe a full feeding and take an all important breastfeeding history. We can help refer to experienced Medical Providers to evaluate, diagnose and treat Tongue Tie. It is also very important to combine release with effective myofunctional therapy to allow any release to reach it's effective full potential. A follow up with a Lactation Consultant can help ensure a smooth transition post release.
Copyright 2018. http://www.entnet.org/content/tongue-tie-ankyloglossia. American Academy of Otolaryngology-Head and Neck Surgery. 1650 Diagonal Road, Alexandria, VA, 22314. 1-703-836-4444. Retrieved on 5/19/2018.
I help many families learn to breastfeed in the initial two weeks after birth. One theme that has emerged for many women and their partners is an expectation of perfection early on in the process. Mothers may report having some good feedings and then some difficult feeds. They express being discouraged by this. Many women feel as if they are failing their newborns. Some parents even will feel the need to supplement with formula in the first 24hr of life due to some difficult feedings. I like to think of learning to breastfeed as learning a new skill. It is not unlike learning to ride a bike. In the first week while a child is learning to ride a bike, they will fall and skin their knees a few times. There will be lots of hand holding and some stress. We don't expect our child to ride perfectly the first time they get on the bicycle. Babies have just arrived in the world for the first time. There will be imperfect attempts at nursing. This is normal. Also a well baby who is born at term can tolerate some imperfect feeds in the 24hr of life. The main concern that I have as a helping professional is the stress that mothers put on themselves to be perfect at breastfeeding immediately after the baby is born! I want to allay their fears and encourage the new mother to enjoy this time with their newborn. Let's see it as learning a new skill in the first few weeks.
There are many reasons why it may be necessary or desirable to combine nursing and bottle-feeding. The bottle may contain formula or breast milk. In the first three weeks this combination poses unique challenges but is very feasible if done with direction and care. If the baby is receiving additional supplementation after nursing or instead of an at-breast feeding, the milk supply may decrease if pumping is not initiated at the same time. It is therefore recommended that a woman pump her breasts any time the baby receives a supplement, even if she has recently breast fed. This holds true in the first three weeks after delivery to ensure an adequate milk supply. The recommendations change later on. Many women will report that they had a low milk supply with their first child. During our conversation, they relate that the they needed to supplement their first baby for some reason and they did not pump or did not pump enough. This is a very common reason to have a decreased milk supply. This person will most likely go on to produce an adequate supply with their subsequent children as long as they follow the pumping regimen if needed. These suggestions can be very overwhelming especially early on when parents are already exhausted. I always stress that the pumping is short term. When an adequate milk supply is apparent, pumping may be gradually lessened. Many parents are faced with a medical recommendation to supplement their baby and this can cause concern about a disruption in the breastfeeding experience. It is possible to preserve the breastfeeding relationship in these circumstances.
There is a common theme when I speak to women who are having some issues initiating a breastfeeding relationship. Many women who have slight difficulty with the latch will report the same experiences. They state that sometimes they allow the baby to nurse with an incorrect or shallow latch because "at least the baby is nursing" or because "the baby was so hungry" or "at least the baby is getting something".
These are counterproductive and concerning assumptions but they are also a natural response to the demanding and tiring experience of nursing a newborn. Why is a deep and correct latch so important? When the baby is latched correctly they are able to compress the milk ducts in the breast and remove the appropriate amount of milk. This will lead to proper weight gain and growth and development. A shallow latch leads to decreased milk intake. This can lead to improper weight gain. Another issue that is important in considering latch is milk production. The milk is produced by the milk being properly removed by the baby. If a mother has a repeatedly shallow or incorrect latch, her milk supply will decrease and could become compromised.
An additional very important issue to consider when speaking about a shallow latch is nipple damage. Incorrect latch can lead to blisters, cracks, fissures, bruises, bleeding and scabbing. This can put the woman at risk for infection of the nipple and of the breast itself. Damage to the nipple also is very painful due to the large amount of nerves in the nipple tissue. This can directly lead to cessation of breastfeeding due to nipple pain.
If you are aware that your baby is not attaining a correct and deep latch it is recommended that you ask for help. Also you can maintain your milk supply by pumping your breasts while looking for assistance. The baby is learning a new skill and so are you!
I have realized over time that Breastfeeding does not come naturally to many women. I do practice in the Northeast in a heavily populated area. The make up of our culture has implications for breastfeeding. The majority of my clients have never seen a woman breastfeed. Many women have not even had exposure to a newborn. Simply holding a small baby is a daunting first task that must be learned in order to successfully nurse. Other cultures in my area are very different in contrast.They likely have grown up around many young women in their family who have been breastfeeding. They have observed the techniques and normalcy of nursing and may have more experience handling newborns. These women have an advantage and often have less difficulty learning to nurse. We can overcome this lack of exposure with adequate support, teaching and practice. This does not delay the initiation of breastfeeding. I do observe that this issue can cause some additional anxiety around having a newborn and learning to hold and feed the baby. As a Lactation Consultant and a Registered Nurse, one of my goals is to empower women and their partners to feel more comfortable with their baby and become independent with feeding and care.
During my rounds as a Lactation Consultant I often come across exhausted new mothers . They often look as if they are questioning how long they can continue nursing. After a few minutes of talking I soon know why. Nursing a newborn is hard, exhausting work! Babies eat often and for very long periods of time. It is not uncommon for an infant who is two days old, to nurse for upwards of an hour. They will often nurse every one and half hours. This is called cluster feeding. They may eat like this for a couple feedings in a row and then sleep for a few hours. These time consuming feedings will slowly start to become shorter into the end of the second week of life. I can reassure my clients that nursing won't always be so exhausting. The milk volume increases over time, and the baby learns how to nurse more effectively. Most new mothers are encouraged to learn about the process and to realize that there is a light at the end of the tunnel! The baby will still need to eat frequently but not necessarily for an hour. I should mention that during growth spurts, feeding may become longer and more frequent again for a few days.