The mindboggling issue… Tongue tie

My thoughts on tongue tie.

A super controversial topic these days, as there isn’t ONE official approach, a ONE SIZE FITS ALL piece of advice or a neat flow chart that you can go to, in order to decide what is going on and what the next steps might be.

It’s a messy area of research, where even the professionals don’t agree with each other.

I see mums in my practice on a daily basis, who struggle with the idea of tongue tie.

PROBLEM 1:

Even getting a diagnosis is messy these days. One midwife says the latch looks fine. Another says there’s a small tie that is unlikely to affect feeding. A doctor says the baby is gaining well so no problems. Everyone ignores mum saying her nipples are hurting. ‘A bit of pain is normal in the early days’ – they say. What exacty IS a BIT of pain? I ask.

SOLUTION:

– Trust your instinct. Does it FEEL painful? Is your instinct telling you there’s something wrong?

– Seek out a second and a third opinion. Find a professional who will give you the BIGGER PICTURE, alternatives, choices, subtle guidance on pros and cons and who is qualified to perform an oral examination on your baby. YOU CAN’T TELL BY LOOKING! It’s oral function that needs to be checked: tongue mobility in all direction, strength and efficiency of suck, palate, tightness in jaw etc.

– Tongue tie is NOT all or nothing. The devil really IS in the detail. An obvious looking anterior tie may cause fewer issues as it may be a lot more elastic, then a ‘hidden’ posterior one that is thick and rigid.

• Use the BRAIN model for decision making (B=benefits, R=risks, A=alternatives, I=intuition, N=doing Nothing)

PROBLEM 2:

Sometimes we hear that the ‘snip’ will be an immediate solution, a quick fix. It hardly ever is.

SOLUTION:

Ask questions of your practitioner BEFORE the procedure. Ask about the prognosis and aftercare.

Look for qualified breastfeeding support, BEFORE and AFTER the procedure. You will need ongoing support and strategies to achieve a better latch while baby is relearning his or her tongue movement in a new way, and develops muscles where there were none before.

SOLUTION:

Look into body work. Tummy time, babywearing, oral exercises and cranial osteopathy are just a few approaches that compliment surgery. They can be highly effective to support baby’s jaw and tongue in achieving a more effective latch and milk removal.

PROBLEM 3:

Mum is still sore.

SOLUTION:

• Get a face to face feeding assessment and plan. You may need some extra strategies for nipple healing while you and baby is re-learning the skill of breastfeeding. These include moist nipple healing techniques which are proven to be most effective alongside improving positioning and latching.
• Be patient. It can take up to 2 weeks for everything to fall into place, and unfortunately it can get worse before it gets better initially. 
• Take pain relief as you need it (over the counter painkillers are compatible with breastfeeding, but if in doubt, check on the Breastfeeding Network website) and keep the area clean to avoid bacteria entering via open cracks/wounds (clean water, and gentle soap is fine, and make sure everything that gets into contact with the breast is clean)
• If things don’t improve, seek further help from someone who is qualified in infant feeding, as well as a follow up appointment with your tongue tie practitioner

If you decide NOT to have the frenulotomy:

• Give extra attention to the best positioning and deepest latch possible, like the koala position
• Check your flow: is your milk flow too fast or slow for baby? If so, get help with tackling these issues to avoid further nipple pain and possible weight gain issues in baby
• Did you have a difficult birth? A very slow or fast labour, instrumental birth or a C section? Your baby may potentially benefit from body work (see above)
• Mindful Breastfeeding: it may be that you could do with some support around you and within you. Look into getting the help you need, with your own mental health (mindful breastfeeding or counselling), or indeed practical support with older children and household chores. This can, in turn, make you drop your shoulders and breath just a bit more freely: baby will follow.

Is there anything that make a difference to YOU with your tongue tied baby?

Did you decide to cut or not to cut? What was your reasoning behind your decision?

Please share to help others.