Dealing With Tongue-Tie

A tongue-tie is a piece of skin under the tongue, the frenulum, which restricts the full movement of the tongue. It may be attached to the tip of the tongue causing a typical heart shaped tongue or it can be subtle and invisible to the untrained eye but still cause significant breastfeeding problems.

QUESTION:
I have a son with tongue-tie who is nine weeks old. He finds it very hard to settle and won’t sleep on his back at night, so I often have to sleep sitting down with him. He has difficulty latching on for feeds and cries a lot. Should we get it cut, or will it just sort itself out?
ANSWER:
An extended latch technique may be supportive of your baby getting onto the breast deeper if he is struggling to
attach himself. It takes a little practice but as successful breastfeeding depends on your baby latching onto your breast correctly it is worth the effort. When an excessive amount of air reaches the stomach due to a poor latch, abdominal distension, belching, and flatulence often develop. Babies who suffer from reflux and excessive wind are often treated with medication but many no longer require the medication once the tongue-tie has been divided. If you find your baby struggles to settle lying down, it may be helpful to tilt the cot up at the head end, ensuring the baby has his feet at the bottom of the cot for safety, until you can get an assessment of the tongue-tie. Experience has shown that tongue-ties are not outgrown, stretch or separate spontaneously as many tongue-tie babies have a mum or dad with intact tongue-ties. Therefore, if the tongue-tie is symptomatic, it should be assessed as early as possible for prompt division. Finally, remember falling asleep on a sofa with your baby is one of the biggest risks of cot death, so make sure if you are cuddling him to sleep that you ensure he cannot slide off you. A baby wrap will keep him safe using the kangaroo care principles.

QUESTION:
My daughter, who’s three weeks old, has tongue-tie. She becomes unlatched very easily when breastfeeding, which makes it sore for me. What would you suggest I do to alleviate the pain before she has it corrected?
ANSWER:
If you feel you are unable to breastfeed, due to the nipple trauma, expressing a minimum of eight to ten times in 24 hours and giving your baby all your milk will ensure a good supply is maintained until she is able to feed painlessly. The way your body uses hormones to produce and supply milk will be enhanced if you take time out to continue with lots of skin on skin contact with your baby. Ask a skilled breastfeeding supporter to demonstrate the extended latch, which helps your baby get a deeper latch onto the breast by flipping the nipple into the open mouth. Some babies benefit from lying on top of their mother and using gravity to help them get a deeper and more comfortable latch, also known as laid back breastfeeding. Using nipple shields may be an option, but it is important that a skilled lactation expert supports you, as evidence shows shields have a negative effect on milk production used inappropriately or in long term. Finally, if you have sore nipples, you may get some comfort from using a pure lanolin ointment, sparingly on the nipples to prevent them sticking to your breast pads.

QUESTION:
My daughter is now eleven months old and was diagnosed with tongue-tie when she was two weeks old. As an older baby, should we consider getting it treated now, or have we left it too late?
ANSWER:
Worldwide evidence demonstrates the wide range of issues tongue-tied babies can experience right through until adulthood. Whilst a tongue-tie is not usually life threatening in its effects, it can be life affecting. A baby requires a good range of tongue movement to move food and liquid around the mouth and during swallowing it is vital to control bolus of food to ensure it reached the food pipe and not the windpipe. If your daughter struggles with thicker foods, a referral for assessment would be beneficial. Your General Practitioner may prefer to refer your baby to a dietician for coping strategies as in time your baby will adapt to eating solids and eat a normal diet. If a tongue-tie division is recommended, your doctor may recommend a light general anaesthetic to carry out the procedure safely. Older babies usually have teeth, which although small can be very sharp and dangerous to fingers, and eleven-month-old children can also be very wriggly!

Suzanne Barber has worked for the NHS for over two decades as a midwife and more recently, a lactation consultant, chairing the new Association of Tongue-tie Practitioners. Her NHS work includes promoting best practice supporting breastfeeding and providing a tongue-tie service. As a lactation consultant, in private practice, Suzanne facilitates clinics where the service is not readily available on the NHS. She is married with two daughters and it was the breastfeeding difficulties she experienced with her second child that motivated her to help others. For individual advice you can contact Suzanne Barber direct at: Greatvine.com/suzanne-barber
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