Tongue and Lip Tie
Undiagnosed tongue and lip ties can lead to the mother battling on with sore nipples, mastitis, an unhappy baby and in many times being told that their is an issue with the way she is holding the baby, her milk supply, her nipple size and somehow she is to blame. I find this so unfair and just awful for a new mum to deal with.
Symptoms are many and varied.
Low weight gain
Reflux or colic
Makes clicking noises while sucking
On and off the breast/difficulty latching
Choking on milk
Dribbling milk out of the mouth while feeding
Feeding takes a long time
Falling asleep early on during a feed
Cracked, sore, bleeding nipples
I work alongside Dr Martin Minnee and Dr Sam Illing at Hokowhitu Medical centre.
I believe having both a GP and a Lactation Consultant to assist and support the family during a tongue tie clipping (frenotomy) achieves a greater result for both mama and babe. I think that it is a necessity to have lactation support before, during and after a frenotomy.
You are welcome to bring support people with you. The cost is $90.
When you arrive in the practice you will be asked to fill out a form (bring your well child book)
You will see me first and I will make notes on what is happening with feeding, and will discuss any other issues that come up.
Dr Minnee or Dr Illing will then talk with you and examine your baby.
I will wrap baby in a Velcro cuff to prevent him/her moving.
We begin by checking his palate, suck and tongue response. We will also lift the lip and of course lift the tongue.
Dr Minnee lifts the tongue mainly just with his gloved fingers, and sometimes with a grooved director (pictured below)
We then talk to you about what we have found, and diccuss with you the treatment options.
If your baby has an anterior tongue tie the Dr will then clip the tongue using sissors.
The procedure takes only a few seconds. Baby’s reactions vary. There is some blood and baby may cry for a few seconds.
If your baby has a posterior (see below) or submucosal tongue tie, then Dr Minnee will apply a clamp, and then clip. Again, this process only takes a few seconds. There will be some bleeding, that I will settle with a swab, and baby is back in mama's arms immediately. We then move put baby to the breast (or bottle) In some cases we may use a local injection to numb.
If the local injection is used, baby willl be numb for around 40 mins, though may still be able to feed.
In some more severe posterior tongue tie cases baby may take a few days to settle. In most cases baby is quite settled within a few minutes of having the procedure
Inside your mouth, there is a small fold of tissue which runs between your upper lip and gum (you can feel it with your tongue). This is called the maxillary labial frenulum (or frenum).
Sometimes this frenulum attaches further down the gum, or runs between the front teeth and attaches behind them, causing restricted movement of the upper lip.
It can also cause a gap between the front two teeth. It's similar to tongue tie, but involving the upper lip and gum instead.
An upper labial tie generally occurs in conjunction with a tongue tie.
The tightness of the frenulum can vary and the degree of tightness can make a major difference.
How does a lip tie effect breastfeeding?
Because an upper labial tie restricts movement of the upper lip, it may be difficult for the baby to latch effectively to the breast.
Once latched onto the breast, the baby's upper lip may be tucked inwards, resulting in a shallow latch.
Your baby may be a 'clicky' feeder who takes in a lot of air during a feed. Breastfeeding may be painful for the mother. An older baby's upper teeth may dig into the breast during a feed, causing indentations or damage. It is important to get baby diagnosed as soon as possible, to prevent milk supply issues and further damage.
For more information contact:
Jackie Wheeler-Lactation Consultant IBCLC
Ph. 027 3685222
Tongue Tie practitioner:
Dr Martin Minnee, Dr Sam Illing (anterior, posterior tongue tie and lip tie: any age)
Hokowhitu Medical Centre, 8 Pahiatua St, Ph.: 06 3572092 Cost: $90
This baby has an anterior tongue tie. You can see the membrane right at the front of the tongue, and you can see how it makes it hard for him to lift his tongue up.
Posterior tongue tie. These can be much harder to recognise.
These photos show the severly restricted tongue of an 8 year old before, and immediatly after the frenotomy - revised at our clinic
This video shows how tongue tie and upper lip tie may lead to ineffective breastfeeding which can be easily and quickly corrected.
A triple lip tie!
Frenotomy Aftercare and Exercises
See video below
Breastfeeding as soon as possible after the procedure is recommended as breastfeeding will reassure and soothe the baby. Do not be alarmed if latching is difficult at first, your baby will need to get used to the new movement that his/her tongue has. The local injection used for the lip and posterior tongue tie can take up to around 40 minutes to wear off.
Most babies experience only minimal discomfort after the procedure, and breastfeeding and skin to skin contact will provide natural pain relief. If however, your baby seems uncomfortable, Rescue Remedy, Hypercal spray (available from me ,$20), Kid Calm or Paracetamol can be given to help with the discomfort. Please speak to your doctor or pharmacist if you are unsure about what dose of medication to give, and remember that medication dosages should always be based on your baby’s weight.
Stretching Exercises (tongue)
Your baby’s mouth heals quickly, and stretching exercises are very important after the procedure to make sure that the area that was released doesn’t heal back together.
Sometimes babies can become sensitive to anyone touching inside their mouths after a lip of tongue tie, so try and make the exercises quick and effective. Before starting the exercises, make sure that your hands are clean, and your fingernails are trimmed. The exercises involve lifting your baby's tongue up at the base and lifting up. (see photo) Aim to do this 3 times every 3 hours for a week. Even when your baby is asleep, the exercises still should be done. The first 1 or 2 times the site may bleed a little, but this will ease quickly.
Play with your baby, run your finger inside the gumline, poke your tongue out to encourage your baby to mimic you. Touch your finger on your baby’s chin, upper lip and then each cheek, she/he may follow your movements inside her mouth with his/her tongue. After playing, insert 2 fingers inside the mouth and lift the tongue up, as close to base as you can get.
The exercises are not meant to be forceful or prolonged. If your baby is resisting the exercises, then stop and try again later. Stretching exercises with quick and precise movements are best. The area under the tongue that was cut should form a diamond shape. This will go white, then sometimes yellow, before pinking up-in around 7-10 days.
You may want to consider seeing an Osteopath for oral work. This can help to free up any tight muscles in the oral area.
Upper Lip Stretches
This is the easier of the 2 sites to stretch and if you are doing both lip and tongue, start with the lip.
Place your finger under the lip and move it up as high as it will go, until you feel resistance. Then gently sweep from side to side for several seconds. Remember, the goal is to open the opposing surfaces of the lip and gum so they cannot stick together.
Try and lift the lip, and keep it lifted during feeding. You should be able to see the pink of the lips.
Straight after the frenotomy
This baby's tongue doesn't lift while he is crying....this is an indication of a tongue tie
Photos used with permission
from Larry Kotlow DDS and some grateful mothers, fathers and children seen at our clinic.