It’s a very emotive topic and one close to my heart as I have seen countless women suffer needlessly. Dismissed by some medical professionals and the cause of physical and mental pain to many a mother. Ignoring the problem can lead to a mother terminating breast feeding early, slow weight gain for baby and in the most severe cases dehydration in the baby.
You can have either anterior or posterior tongue tie where the frenulum (little fold of mucosa connecting tongue to floor of mouth) is unusually thick, tight or short.
There are lots of images on the internet demonstrating this, like these (Please see images at bottom of blog)
Anterior tongue tie can make the tongue look heart shaped whereas posterior is less obvious beyond the fact your baby will struggle to stick their tongue out. The issue I have noticed in clinic over the years is that babies very rarely actually follow these ‘textbook’ presentations and tongue ties can be very difficult to spot so often go missed or dismissed.
Diagnosis should be done on observation and analysis of feeding difficulties.
Ideally a tie should be cut in the first 2-3 days before lactation is established. Some medical professionals argue that doing nothing the first few weeks is the best course of action as infants learn to feed more efficiently anyway in the first days and weeks of feeding but this approach risks:
*Blocked ducts and mastitis
*Cessation of breast feeding all together
*Sore and damaged nipples
*Post natal depression and severe guilt and anxiety in mothers unable to feed
Sadly, I do end up having to refer many patients to private clinics for frenulotomy’s because it isn’t always available on the NHS or the waiting lists are too long. BUT there is help available and no mother should be left alone and desperate and in pain.
I’m writing this during lockdown (3.0) so I’m aware that appointments with health visitors, midwives, GP’s and lactation consultants are hard to come by.
Other online resources that are useful (and free) are:
https://gentlebirthsandbeyond.co.uk/
If you’re a Gloucestershire parent please contact me and I’ll do all I can to help.
Cranial Osteopathy is wonderful to help baby with feeding but again, in conjunction with a frenulotomy.
There are some osteopaths who argue that treatment alone can improve feeding but again, it brings me back to the points I raised above. It takes time and a women bleeding from both nipples in agony with every feed, maybe even resenting feeding her infant; doesn’t have time.
After a tongue tie has been cut after care is really important to support feeding and to check/prevent reattachment.
Cranial osteopathy looks at that tongue and all its attachments in to the floor of the mouth and hyoid bone (front of throat)
The breast and your baby have a beautiful system to allow for efficient, pain free feeding. The nipple elongates during each suck, pulling in further breast tissue and covering the lower gum. In this way the nipple is protected from damage and pain at the back of the baby’s mouth. The lower jaw then elevates putting pressure on the milk duct under the areola (that’s why midwives are obsessed with your baby getting that areola tissue in their mouth!!!).
It’s then a case of milk being drawn into the mouth by creation of negative pressure generated by the downward movement of the back of the tongue and lower jaw. This process is also facilitated by your let down.
It’s like a really complicated dance routine between the baby and the breast. So imagine if one of your dancers has a broken toe… the routine won’t work and the dancers will tread on one another’s toes breaking more toes and everything is a mess…..God I’m good at scientific analogies.
So what I do is look at any birth strains a baby may have suffered that might hinder baby learning to use their tongue properly. Quite often, for example, a forceps baby might have a tight jaw from application of the forceps on the temporal or cheek bone area.
To be honest, the examples of birth strains that affect feeding mechanics are endless. To put it bluntly, think of the state of your vagina or the pain you feel after a C-section…..well your baby went through all that too! And more often than not, it’s their head that gets the worst of it!
To surmise, tongue tie is serious for mum and baby. It’s not always easy to spot and you might have to fight a bit to be heard but help os out there! Do not end your breast feeding journey against your will.
Anterior tongue tie
Posterior tongue tie
