The more I learn about tongue-ties and how much they affect not only breastfeeding, but so many other things, I am amazed. The more we go through all of this with Isaiah, the more I realize just how much tied tongues have impacted my life over the past 4 years. So many pieces of the puzzle are coming together. I consider myself to be one of the fortunate few that have been able to get so many questions answered.
This past weekend there was a seminar led by a pediatric dentist, Lawrence Kotlow DDS from Albany, NY. He specializes in laser dental surgery - a lot of which are tied tongues and tied lips. Although I was not able to attend, I was able to get the notes from the ladies at Edenway Birthing Center that were able to be there. It is seriously amazing.
Let's get down to basics.
The technical term for the condition of being tongue-tied is Ankyloglossia.
The tied upper lip is referred to as an abnormal maxillary lip attachment.
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| Ankyloglossia |
Here is an example of Ankyloglossia:
This is a pretty severe one. Either a class III or class IV - probably class IV, since it's all the way to the tip of the tongue - and this is what Isaiah's looked like. He now has a line under his tongue (scar tissue) from the very tip of his tongue, all the way back.
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| Abnormal maxillary lip attachment |
This is Isaiah's abnormal maxillary lip attachment Notice how the tie extends down the gum line to the point that it is actually indenting the gum line upward. This is the most severe classification (class IV) lip tie.
Both tongue and lip ties can be much less severe than these and still cause LOTs of problems.
Apparently the vast majority of OBs, pediatricians, and even lactation consultants don't think that a tongue-tie is that big of a deal. The medical community got out of practice of dealing with them routinely when the percentage of breastfeeding moms dropped dramatically throughout our century due to the cultural norm shifting to bottle-feeding. So for a long time, nobody diagnosed tongue-ties because people simply weren't breastfeeding...and no breastfeeding meant no issues with breastfeeding...so there wasn't an imminent need to diagnose them. Now, a lot of practitioners think that the tied-tongues will simply "stretch out" over time, and that lip ties just need to be taken care of by the time they are 3, so it doesn't interfere with oral development. However, this is not reality, and there really is so much more to it than what they think.
Problems that can occur if a tie is not treated:
Nutritional problems
colic or excessive gas
GI problems like reflux
drooling
gagging
sleep apnea
changes in sleep patterns
speech problems
tooth decay
jaw growth and development
psychological problems
Ssymptoms an infant may exhibit if they have a tie:
gagging
colic and/or gas
GI problems
tongue can not protrude past the gum line out of the mouth
tongue cannot touch the hard palate of the mouth
"poor sleeper"
So it isn't just breastfeeding that is affected by a tongue or lip tie, it's just one of the most significant means by which it is detected. Many of these symptoms - all of the infant symptoms - aren't any better when breastfeeding ceases. Bottle feeding could actually make a lot of these symptoms worse.
I remember what life was like with Bella and Balian as infants. Balian had really bad reflux. He also had gas, and was almost impossible to burp. He would be fine, but then as soon as I would lie him down for a nap he would get fussy. I knew his tummy hurt, but the question was always Why? was he hungry? was it gas? was it the reflux? He pretty much didn't nap during the day, then was so exhausted that he would poop out at night. This, combined with insufficient weight gain and latch problems (see below) made me think he would be better off on a bottle. Nope. It made it tons worse - and added a whole new spin on the already existing problems. He stopped sleeping through the night and always, always, always had gas. It was horrible. Once on the bottle for good, the pediatrician said that he didn't have reflux - he was just eating too much at each feeding - and that's why he was spitting up so much. Just FYI - Balian still can't really extend his tongue over his lip. It goes just about even with the front of his gum line (maybe a bit further) and can touch the inside of his lip, but that's as far as it goes.
And there was Bella, who shared all of the below symptoms with Balian...
Symptoms of a baby with a tie if breastfeeding:
cannot latch on
unsustained latch
slides off of nipple
prolonged feedings
unsatisfied after prolonged feedings
falls asleep at the breast
gumming or chewing on the nipple
poor weight gain or failure to thrive
unable to hold pacifier in mouth
She had every single one of these symptoms. And she doesn't even have a tied tongue - just a tied lip. She didn't seem to have the colic or sleeping issues that Balian did, but breastfeeding was not good. She did have some gas and reflux, but not to the same severity as Balian.
This time around, with Isaiah, we were looking for the tied tongue, and Isaiah's was bad - pretty much all the way to the front (tip of the tongue), causing his tongue to be heart-shaped. Even after Melody (midwife) clipped the front part of the tie, he still could not extend his tongue past his gum-line. He had all of the symptoms above, and I had all of the symptoms below, minus (praise the Lord) the infections or mastitis. I definitely had some bulging ducts, but used wet heat and massage to get them drained. After going to the ENT to get his tongue clipped, things definitely got a LOT better. He started gaining weight, my blisters went away, he was draining me more... I was still a little sore - nothing that I couldn't handle, but still wondering why I was still having some of the same symptoms associated with a tongue-tie, if the tongue-tie had been resolved...
Symptoms of the breastfeeding mom:
creased or blanched nipples after feeding: flattened
cracked, bruised, or blistered nipples: gives it up
bleeding nipples
severe pain with latch
incomplete breast drainage
infected nipples
plugged ducts
Mastitis and nipple thrush
Then we started having some big-time gas/colic issues with Isaiah...just like Balian. It started out not too bad...just some toots that he had no problem getting out - some spitting up - nothing horrible...and he was sleeping well, so it didn't bother me. Then, as he started eating more and growing, things began to change. It's like the more he eats, the more gas he has. He has gone up to 8 hrs. between feedings at night - but very few times. Even when he has gone that long, I've been up with him for as much as an hour or two at a time trying to get gas out - both burps and otherwise. Diet changes (mainly dairy) on my part haven't helped. The kid is almost impossible to burp because he has SO many in there - I could burp him forever and never get them all out. We've tried Mylicon at various times - before, during, and after feeds - and we've had no difference in outcome. Isaiah's sleeping has gotten worse over time. His naps aren't great, because he wakes up frequently needing to burp.
And the whole time I'm thinking "This is just like what happened with Balian..."
I called my Lactation Consultant, and asked her if the gas could be related to the lip tie. It was the only thing that seemed logical. She agreed completely.
The hard thing was what to do about it. It's a pretty difficult thing to find a practitioner who does tie corrections with a laser, but that's what is needed, especially with babies. Up to this point, the only person they (lactation consultants/midwives) knew that did the laser corrections was the pediatric dentist they found in NY(that led the seminar mentioned above)... yeah. That wasn't an option. Looking for a pediatric dentist or ENT that would correct the lip tie on a 2-month-old was a waste of time - most just simply won't do it. (they don't see it as necessary until they are older...like at least 3). And even if they were willing, the procedure would use anesthesia stitches, and would be pretty painful.
However, now they have just recently found another Dr. - Dr. Stacy Cole - a dentist in Ft. Worth that does lip and tongue ties with a laser. No anesthesia, no stitches, quick recovery...and pain dull enough to be handled with a normal dose of Tylenol. Not just for Isaiah, but at any age...meaning all 3 kids.
I've called and gotten more information about it. It isn't cheap - about the same cost as the ENT, but he charges the same amount, regardless of if he does just one or both of the procedures (tongue and lip tie together cost the same as just a lip or just a tongue.) Too bad we didn't know about this dentist before...but at least we know now! But really, getting the lip tie taken care of could save us a ton of time, money, and headache in the long-run. Less cavities/tooth decay - so less fillings and dental visits AND less gas/colic - meaning more sleep and a happier mommy!
So hopefully, we will be getting the issue resolved for Isaiah very soon. The other kids will have to wait a bit. I'll post more once we're on the other side...
***If you want a wealth of information about all of this, go to Dr. Kotlow's website - click on Articles - and you pretty much have all you've ever wanted to know about tongue and lip ties. He has done TONS of research on all of this - most of which has been through experience in his own practice. Seriously, check it out! Great information that you really can't get anywhere else.
