Tongue Ties and Breastfeeding: A Feeding Therapist’s Personal Journey
My experience breastfeeding my second child changed my life and the course of my career. As a pediatric OT specializing in early intervention/infant feeding and a mom who successfully breastfed her first child (for 18 months!), I didn’t anticipate any difficulties nursing. I knew tons about infant feeding and was experienced. What could go wrong?
Well, after birth, he latched….and ouch. Pretty soon, my nipples were raw, red, and blistered. Nursing was agony. Nurses came by to try to help me manually latch, with little success. When lactation support visited, I was frustrated to hear, “That latch looks great!” I got the idea in my postpartum haze to check his mouth, having recently learned how to do so. And there they were…tongue and lip ties. My son had a classic tie, the type that no one usually disputes…to the tip of his tongue. I asked the pediatrician on call for a referral to ENT, and she told me she didn’t see a tie. I insisted she check again, and we got a referral before leaving the hospital.
At the ENT appointment, our ENT dismissed the lip as a non-issue and clipped my son’s tongue. We were given no aftercare instructions, and I felt very little change after the “snip.” I nursed 16-17 times a day for an hour at a time in great pain. My son gained weight like a champ, but I was exhausted and my nipples were in shreds. I decided to visit the dentist I had previous experiences with from patients for a second opinion. That provider’s process involved a feeding evaluation (with a therapist) to examine the whole picture. We ended up getting a second release procedure, this time both the tongue and lip…and voila. Latch was better almost immediately. In a few weeks, nursing was pain free. The second release saved our nursing relationship.
My experience lit a fire in me to help breastfeeding mothers. I saw how my concerns had been dismissed and felt lucky I knew who to turn to for help and that I had the background knowledge I did. I would not have made it far without intervention to alleviate pain, and I know that without support, I would have weaned much sooner than I intended. I thought that if moms want to breastfeed their babies, they should be given adequate support to do so.
I took every continuing education course I could on tongue ties and breastfeeding. I became a CLC (certified lactation counselor) so I could better help breastfeeding families. I networked and collaborated with other professionals in the community and beyond, including dentists, ENT’s, therapists, and lactation consultants to build a team of providers to meet the needs of local babies and families.
Both personally and clinically, I have learned that much misinformation exists about breastfeeding and tongue ties. It’s a subject filled with controversy, both in and out of the medical community, for lots of reasons. I’d like to share a few thoughts:
Tongue tie is not a fad. Much like autism, awareness of ties has increased, which may be why it seems they are everywhere now. Everyone talks about them, and social media has definitely played a role in this. But ties are not new; midwives used to keep a nail sharp to cut them in the “old days.” Formula feeding was encouraged in the generations of our parents and grandparents, so I suspect there are many adults walking around with ties that were never identified. Ties can impact not just breastfeeding, but issues along the lifespan, and that’s beyond the scope of this blog post. Varying levels of education on breastfeeding and infant sucking mechanics, along with a fragmented healthcare system tend to further cloud the picture. Health professionals tend to look at problems through the lens of their experience and expertise, and getting a “whole picture” perspective on infant feeding can be tough.
On that note, people sometimes hear or get the perception that release providers, therapists, or other professionals seeing these families are “tongue tie happy” or are out to perform releases for financial gain. Every professional has “good apples” and “bad apples”….but good providers are listening to their patients, exercising caution before recommending a release, and evaluating the picture as a whole. Infant feeding is complex, and breastfeeding evaluation must take into both account mom issues and baby issues. Good providers seek to help families find the root cause of problems and are not dismissive of concerns. I know of wonderful providers, and have heard stories of others who are doing things I am not comfortable with. Find a provider you trust if tongue tie is a concern for you!
Function matters, not appearance. It doesn’t matter what it looks like under the lip and tongue. What matters is function. If a mom has gotten help with latch and is doing everything short of standing on her head to make breastfeeding work and things are still rough, it points to an oral motor issue as a possible culprit, and someone should look in the baby’s mouth and assess oral function. Oral motor issues often go undetected as a cause of breastfeeding problems, and women can be left feeling bewildered about why breastfeeding didn’t work for them and why their supply dropped.
Maybe the problem is a tie, maybe not. Maybe a tie is only a small piece of the bigger puzzle. In my experience, there are often multiple issues that need to be addressed to make feeding work well, including positioning, latch technique, baby body alignment, and oral motor skills, to name a few.
It doesn’t matter what the latch looks like. Latch can look fine but feel like razorblades. Sometimes it isn’t painful at all, but it’s still ineffective. Ineffective latches can compromise supply over time.
Weight gain isn’t the only thing that matters. Everyone is rightly concerned when babies don’t gain enough, but some women are dismissed if they mention feeding issues because weight gain is fine. Breastfeeding is a two-person activity. It has to be easy for both mom and baby to be sustainable; feedings should not feel like a full-time job or be miserable. If feeding is causing you considerable distress or frustration, an assessment is in order.
Babies aren’t “lazy” and it doesn’t matter if they can stick out their tongues. No baby is simply choosing not to feed well. The most important motion of the tongue for breastfeeding is lifting UP, in the middle. If babies can’t do that, they compensate…they might clamp on mom’s nipple to grip the breast with the lips (ouch). They might just fall asleep because it’s exhausting. Some nurse 24/7 but never get enough….and so on.
A release procedure is not a “quick fix.” The tongue is a bunch of muscles, which take time to learn new patterns and build strength. That’s why therapy and lactation support before and after a release can make a big difference. If you expect a release to make instant changes, you are likely to be disappointed. A complete release, or releasing the entire restricted portion of the tie (not just the tip, like my son received with his initial snip), is important for the best outcomes as well. If you are considering a release, interview your provider about their experiences with posterior ties. Find a provider who is willing to listen to your concerns.
It’s also important to know that muscle tension (i.e. tension in the mouth and face) can mimic a tie…and releasing a tie does not make that tension go away. I can’t stress enough how important looking at the big picture is when considering feeding!
The tool used matters less than the provider who wields it. I am sometimes asked if laser or scissors are better for releases, and honestly…that’s not in my scope of practice nor is it my judgement call to make. I know fantastic release providers who use both methods…some started with scissors and transitioned to laser. Others still use only scissors… others only laser. From my standpoint, what matters most is the provider’s knowledge, experience, and willingness to collaborate and recognize that feeding is a very multifaceted problem, as well as that provider’s understanding of sucking mechanics.
There are some phenomenal resources out there for anyone wanting more info on ties. I recommend Dr. Bobby Ghaheri’s website (ENT) (www.drghaheri.com) or the book Tongue Tied by Richard Baxter, DMD, MS.