The 411 on Tongue and Lip Ties

Tongue ties (ankyloglossia) and lip ties (ankylolabia) are often under-diagnosed or dismissed as of minor importance unless the tie is severe. However, even a minor tongue tie can have a major physical and emotional strain on mother and baby. An infant with a tongue tie may struggle to get a good latch during breastfeeding, resulting in sore, cracked, blanched, or bleeding nipples for the mother and inadequate milk intake for baby. Sometimes these babies are diagnosed as Failure to Thrive; a diagnosis that only adds more pressure to the nursing relationship and may leave a mother feeling guilty and inadequate. If a tongue tie is left untreated, the mother may see a drop in milk supply because the baby cannot form the proper mouth and tongue movement to stimulate milk production. However, the problems associated with tongue ties are not limited only to breastfeeding. Some individuals may have speech and dental problems to contend with as they grow older as well.

The pain and emotional frustration associated with tongue ties–both for the bottle-fed and breastfed baby– can be overwhelming for both mom and baby.

Degrees of tongue ties vary dramatically which can make spotting them challenging. The most apparent ties are those in which the frenulum, the membrane that attaches the tongue to the base of the mouth, extends the length of the tongue. Usually the tips of these tongues are drawn in and make a heart shape or a forked tongue. However, tongue ties can anchor the tongue from any point from the base of the tongue to the tip. Most of the time a gentle swipe with a pinky finger under an infant’s tongue can detect a tie, but sometimes the tie lies under the membrane at the back of the tongue. Usually in diagnosing a tie, the following factors are considered: the appearance and range of movement of the tongue (whether it can extend beyond the lips or touch the roof of the mouth), pain during nursing for the mother, gagging or vomiting, and low weight gain. A pediatrician, midwife, or IBCLC should be able to assist in getting a diagnosis, however; it should be noted that while a provider should be able to diagnose, many are not trained in detection. If a parent wishes, they can seek a second opinion from a provider who is trained in lip/tongue tie detection.

The Fayetteville Doulas has a trained and knowledgeable IBCLC ready to help. 

Lip ties can also pose a problem when the lip is anchored too tight to flange out and create a suction around the breast. The most apparent tie will extend to the top of the gums where the two front teeth will eventually develop. In untreated ties, the lip tie can cause a gap in the teeth. One way to tell if a lip tie will pose a problem in breastfeeding is to extend the lip up towards the tip of the baby’s nose. If the lip can touch, breastfeeding should not be affected.

Tongue and lip ties don’t just affect breastfeeding. Ties can affect babies who are bottle fed as well. The tie can prevent baby from forming a tight seal around the bottle nipple. This can cause milk to leak out of the mouth and allow aerophagia (swallowing of air) which can lead to reflux symptoms, belly distention, and over all discomfort. Sometimes these issues are seen as a dairy intolerance and often result in switching from a milk-based formula to a soy-based formula. 

The pain and emotional frustration associated with tongue ties–both for the bottle-fed and breastfed baby– can be overwhelming for both mom and baby. However, there are many strong support teams out there to encourage you to get the help you and your baby need. With so many options it can be hard to determine the best course, but an IBCLC, postpartum doula, or midwife can keep you abreast of the most relevant information and refer you to knowledgable medical providers who can provide an appropriate diagnosis and aftercare instructions. 

 

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