When an infant is tongue tied

When an infant is tongue tied

by Margaret Winkeler, RN, CEIM, IBCLC The Birth Education Center of Okinawa
Stripes Guam
It happens every day on this paradise island we call Okinawa: A couple discovers that they are expecting a baby in about 9 months.  In the 9 months of excitement, growth and preparation, a lot of topics are discussed.  Some of the topics include what kind of car seat to buy, how many baby diapers, and most importantly, which method to feed the baby?
Currently there are two basic methods of feeding a baby that don’t require hospital intervention.  These methods include breastfeeding and formula.   Formula is “easy” to understand, just follow the directions on the can of formula, place in bottle and off you go.  Yet breastfeeding tends to cause a lot of heartache and struggles in the first days to months of breastfeeding.  Why is that?
There are two fundamental individuals that are part of the breastfeeding relationship.  The mother and baby.  When looking at the mother for effective breastfeeding, we as lactation consultants and health professionals evaluate the medical history of the mother and the breast anatomy, just to name a few.  Medical history is important because several factors may impact breastfeeding.  Anatomy of the breast to include areola and nipple is important due to housing the milk producing glands and tubules in which breast milk is produced and eventually provided to the baby.
Assessing the infant is extremely important.  The baby is unable to verbalize how it’s feeling and only communicates by crying, pooping/peeing and body movement.  The infant mouth and tongue are vitally important to a successful latch and the breastfeeding story.  
A typical scenario that is witnessed by health care providers is as follows:  mother delivers baby, and is exhausted but happy to put baby to breast following infant cues (fist to mouth, turning face to breast, and rooting).  Baby loses weight.
Parents get stressed.  Parents are tired but this is expected, though they are wondering why the baby is feeding so frequently.  By day four to seven of life, baby continues to lose weight, is jaundiced, and parents are more stressed.   Mother is experiencing pain and has bilateral nipple cracks, blisters, and reports bleeding.  When the couple goes to the doctor, the “easy” solution is to feed the baby formula.  By why not just go the easier route and fix the problem?
The problem often is a tongue-tie. To rule out tongue-tie professionals will go through a myriad of probable solutions to include correcting maternal breastfeeding position, baby position, and breast care, to name a few.  If the solutions don’t immediately work, closer inspection of the infant is warranted.  The frenulum is a little bit of mucous membrane that connects the floor of the mouth to the underside of the tongue.  Somewhere this little pesky membrane has to attach to the tongue.  The problem arises when the frenulum attaches at the tip of the tongue, or at the base of the tongue, or anywhere in between which compromises effective latch and draining of breast milk from the breast.  So what will be seen in the doctor’s office that proves that the latch is ineffective?
Typical symptoms that the mother will experience include painful breastfeeding sessions, plugged ducts, mastitis, observation of compressed nipples after a feeding, feeding sessions that last 10 minutes, but occur every hour.  Or baby on the breast for as long as 45 minutes with pain. Baby may present with reflux, colic, excessive gas, clicking sound when baby is feeding, popping on and off the breast, weight loss or slow weight gain, and stressed body position to include hands near face with fingers extended and splayed.  Please note, all of or only a few of these symptoms may be present when a baby is tongue tied, which places an accurate oral baby assessment as a high priority.  Maternal breast milk supply is regulated in the first 3 months by hormones and “supply and demand.” So if mother has an over abundant breast milk supply, weight loss in the infant may not be observed, other symptoms such as infant green poop, fussiness, colic, and excessive crying is seen.  However, after 3 months and beyond, the breast milk supply is regulated by the efficiency of the infant to suck and remove breast milk from the breast, and at this point, if the tongue tie is undiagnosed the parents may notice that the infant is slowing down on weight gain which is frequently attributed to mother’s “low milk supply.”  When in fact the whole time it was an undiagnosed tongue-tie. 
So what is the bottom line?  To treat the tongue-tie or not to treat? The bottom line is what the parents feel would fit into their family routine.  Not what will fit in the medical environment routine.  Typically the mother may feel the need to continue breastfeeding, but feels that she would be inconveniencing her medical providers or family.  By providing accurate and up to date resources the family can make the decision and feel reassured that they are doing what is best for their baby and family.  The following links are from:  

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