Breastfeeding and Tongue Tie

By , October 2, 2010 6:47 pm

Adorable, but kind of a problem for my nipples.

Shortly after Lazlo was born I attempted to play the “stick your tongue out” game with him: ya know, the one where newborns will show off their mad innate skills by sticking out their tongues in response to seeing an adult do the same. Dr. V.S. Ramachandran, a neuroscientist at University of California, San Diego points out that babies are programmed to imitate in order to learn the social cues in the culture that they are born into. His research shows that the early inability to perform those imitative tasks may be a early sign of autism:

“You stick your tongue out at a newborn baby, very often the newborn baby will stick its tongue out,” he says. Similarly, babies return smiles and often make sounds when someone speaks to them. A few years ago, scientists found a biological explanation for this phenomenon: specialized brain cells called mirror neurons. These neurons fire when you do things such as sticking your tongue out. They also fire when you watch someone else stick their tongue out. And mirror neurons can reflect emotions as well as physical actions. Experiments show that some of the same cells that fire when we feel pain also fire when we see another person in pain. But people with autism appear to have faulty mirror neurons. That may be why they have trouble putting themselves in someone else’s shoes. And Ramachandran says without that ability, a lot of what you can accomplish with language disappears.”

Already having one child with a history of behavioral issues, Lazlo’s lack of reciprocity in this case sent up a few red flags for me. However, attempting to snoop around in a tiny newborns mouth (well, at 11 lbs, I suppose his mouth wasn’t as tiny as some) proved to be frustrating for both of us. His objections to my explorations–in the form of crying with his mouth wide open– afforded me the opportunity to clearly see what we were dealing with: a tongue tie. Although the heart-shaped tip was beyond adorable, it could be a problem. I knew that tightly connected frenulums (either labial or lingual) could contribute to a poor latch while breastfeeding (causing me pain and making it difficult to establish an ample milk supply), jaw alignment and dental problems, along with future speech difficulties. In his older sisters case, her tightly connected labial frenulum had caused an acidic and corrosive environment for her four upper teeth. The lip was so firmly pressed against her teeth that even saliva had a difficult time getting up there, let alone a toothbrush. After much worrying, we decided to have it have her teeth and gums surgically repaired and protected from future damage.

When I was 4 weeks postpartum with Lazlo, we called the pediatrician to find out IF she could clip it in her office. Sadly, the pediatrician would have to refer us to an ENT who would have to evaluate it, then perform the procedure (possibly under general anesthesia!) and then have a follow-up appointment. We were still Babymooning in the middle of a NWPA winter! The thought of taking Lazlo out in the snow multiple times for something that was not really a problem seemed overly complicated and unnecessary. From my initial reading and research, I was under the impression that this was a SIMPLE and COMMON procedure! Further investigation revealed the cultural reasons that have made tongue tie treatment much more complicated than necessary. Anne Smith, IBCLC sums up the history behind this baffling trend in modern medicine:

Even though clipping the frenulum is a simple, safe, and uncomplicated procedure,… it may be difficult to find a doctor who is willing to perform it. Up until the nineteenth century, baby’s frenulums were clipped almost routinely. Midwives were reported to keep one fingernail sharpened so that they could sweep under the tongue and snip the frenulum of just about all newborn babies. Part of the reason frenotomies fell out of favor for many years was the fact that doctors discovered that in all but the most severe cases, speech was not affected by tongue-tie. They preferred to take a “wait and see” approach and let nature take it’s course. Most of the time, the frenulum would stretch out on its own with no intervention.

During the same time period that frenotomies were becoming less common, the rate of breastfeeding also declined dramatically. Bottle-feeding doesn’t present the same feeding difficulties for tongue-tied babies that breastfeeding does, because the mechanics are very different and extension of the tongue doesn’t play as big a role in feeding from the bottle. Since the majority of babies were bottle fed, it was easy for doctors to say that they weren’t going to perform an unnecessary procedure that didn’t interfere with feeding, and rarely caused speech problems.

Even today, with most infants in this country starting out breastfeeding, it may be difficult to find a doctor who recognizes the problem that tongue-tie can present for a nursing baby and is willing to perform a frenotomy. The procedure is seldom mentioned in the pediatric literature, and is no longer routinely taught in medical school.You may need to work at finding a health care provider who can clip the frenulum. Although any pediatrician can theoretically perform a frenotomy, many prefer to make a referral to an oral surgeon, dentist, or ENT specialist

After discussing our options with a few different breastfeeding consultants and several momma’s who had gone through this, we decided that we would wait to clip his frenulum since it was not causing any problems at the time.  I was tandem nursing; my older baby was ensuring a more than adequate milk supply. I was an experienced nursing mom; I was not bothered by the occasional poor latch or more-frequent-than-usual feedings. Lazlo was content,  gaining weight, and wetting enough diapers.

For 7 whole months, we carried on with our tandem nursing and the tongue tie was rarely noticed, let alone fretted over. Then on August 6th everything changed. We had somehow gotten thrush and the next 8 weeks of my life were essentially a living hell. Cracked, bleeding nipples. Searing pain that felt like glass being crunched up under the skin.  In the meantime, Lazlo was behaving as many babies do when mom has thrush: frequently pulling off of the breast (without unlatching. Ouch), biting (double ouch), and just simply refusing to nurse. Not fun. Multiple treatments and common remedies for the babies and for me had failed to clear it up.


Baby Chippin Pops

Right in the middle of this my teenager and my toddler both unexpectedly (and mysteriously) broke out in chicken pox. During this time, I was also upgraded to a new, much more powerful thrush Rx. Things were just about getting back to normal with nursing when Lazlo hatched his very own crop of chicken pox.

And then my aunt died the next day. Un.Be.Liev.Able.

One of the things that twenty-two years of parenting has taught me is that todays crisis is quickly replaced with tomorrows back-to-normal boredom and things eventually work themselves out given enough time, perspective, and teeth-gritting. But his nursing strike and bad nursing behavior went from bad to worse. We had begun to up his intake of solids and supplementing occasionally with hemp milk, almond milk and rice milk to ensure that he was getting enough nourishment. With the support of Kelley (NICU Nursing Goddess, Expectant Momma, and my BFF who is also a LLL Leader) we brainstormed ways to improve Lazlo’s latch and increase his time at the breast while giving my nipples time to recover. Of course,  I still had my nursing toddler to help keep my supply up, too. I was confident that we could get through this! But after very severe biting incident (one which required some skin adhesive and a butterfly strip to keep it from repeatedly breaking open and bleeding) I was beyond the point where I could just keep riding this out and waiting for things to fall back into balance. It was time to revisit the fundamentals and FIX this before our nursing relationship was prematurely and permanently ruined.

We decided that the place to start was ensuring that Lazlo was latching as best as he could. Revisiting the tongue tie was the first item on our list. Kelley told me about one of our friends who was learning to do frenulum clippings during her midwifery apprenticeship and how simple the procedure was. I contacted the midwife, Jen (who was part of our birth team when we had Tillie) and she happily agreed to come to our house and clip it the next day! No finding babysitters for the other kids and traveling to multiple appointments! He would be in his own house where he felt safe and comfortable.

To prepare, I made Lazlo a chamomile-apple juice popsicle to help reduce swelling and stop bleeding after the procedure. My friend Anne at Dou-la-la (who has a tongue-tie nursing sage to share, too) suggested homeopathic aconitum but none was to be found at the local places in time, so I got some Valerian Calm instead. After chatting for a few minutes and trying to get a glimpse of his frenulum without upsetting him, we got straight to work. I swaddled him up in a blanket to keep him as still as possible and held him on my lap. He seemed a tad confused about this part, but didn’t stir up a raucous. To hold his mouth open I put my index finger in his mouth, toward the back (where there are no teeth yet, thankfully) and Jen took the other side. Lazlo let us know that he felt like this was not what he wanted to be doing at the moment, but was still not overly upset. A bit of hollering, but nothing that triggered my protective momma-bear senses. Jen used a pair of blunt-tipped scissors to quickly clip the tiny piece of membrane under his tongue. There were about 2 drops of blood. I immediately sat him up and gave him the frozen treat Kelley had been holding nearby. Zero crying. I let him play with the popsicle for a few minutes and then allowed him to latch on.

Right away his face let me know that this was a different experience for him. His big eyes looked up at me with curiosity shining out of them like a light. He stuck his fingers in my mouth, under my tongue and then used the same hand to pat my breast several times. My mouth feels funny when I nurse now, he seemed to be saying. Later, he tried to put my fingers in his mouth while he was nursing to indicate this sentiment again! Over and over again, he stuck his tongue out PAST HIS BOTTOM LIP! It was amazing to see his tongue do that after nearly 9 months! Within 20 minutes, he was even making new noises (like raspberries and consonant sounds which he was unable to do with his shortened tongue!) We even noticed that he has a wider smile and that he actually has a dimple in his cheek!

He is not magically an expert nurser…improving his bad nursing habits will take more time. However, in just one day we have already seen many small improvements and expect that things will only get better!

Conclusion? My new advice on tongue tie is this: if you can get it done gently, in your arms, and without a lot of hassle then get it done right away. Frankly, because the medical community makes it so complicated, I was much more worried about it then I should have been. I do wish that we had done this when he was very young, but I do not regret skipping the ENT-overly-medicalized-route. Dong it at home and allowing me to participate, hold Lazlo, and nurse him right away made it a non-traumatic experience for both Lazlo and me.

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