“Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying, “I will try again tomorrow.”
~ Mary Anne Radmacher
Yesterday I smiled at a a green-eyed blonde in gorgeous leather riding boots while wiping a Charlie Chaplin-style snot mustache from Micah’s lip. Wait! I forgot to tell you the best part: I wiped the snot blob with my sleeve. Oh yes, I am one of THOSE moms. The one who does NOT have a bandaid, wet wipe or [insert responsible mom paraphernalia] when zombie ducks attack. The one who can’t even get fake ducks all in a row and is still getting the hang of this mothering thing.
If you are feeling this way about breastfeeding, read on. Yesterday we covered why tongue and lip ties are often sources of misery like colic, reflux, low milk supply, early weaning, tooth decay, frequent night wakings and gapped teeth. Today I’m going to show you how to make an at-home diagnosis, get a consult with the leading expert in the U.S. for FREE, and seek out treatment options. What you learn could be the vital piece of information someone around you needs to help them on their journey or relieve regret and guilt when things don’t go as planned. As Joy shared yesterday, understanding ties can be a very powerful thing:
My son was born almost 8 months ago… I FOUGHT with everything I had to BF him….I cried, I searched the internet, I prayed, I talked to friends, lactation consultants and finally gave up and have been EP’ing [exclusively pumping] since 4 1/2 months… your article popped up in my feed this am and I clicked on it thinking it would tell me that I needed to pump more and eat this and eat that blah blah blah… MY SON IS LIP TIED!!!! and NOONE caught it!!! (%&#(&#$(&%(%$ is all I have to say right now… the guilt I felt was killing me… I am sure when I wake up tomorrow I will be relieved beyond words that it wasn’t about me as a mother or my milk supply… (emphasis mine)
Let’s get started, shall we?
Step One: Make An Informal Diagnosis
For lip ties, you’ll see band of tissue that connects the gums to the lip. The photos below depict ties of varying degrees, with the least severe on the left and most severe on the right. Here are some things to look for:
- Difficulty latching on or falls off the breast easily
- Gumming our chewing the nipple while nursing
- Unable to hold a paci or bottle
- Gassy (babies with ties often swallow a lot of air because they cannot maintain suction properly)
- Poor weight gain
- Excessive drooling
- Baby is not able to fully drain breast
- Creased/flat/blanched nipple after feedings
- Cracked/blistered/bleeding nipples
- Discomfort while nursing
- Plugged ducts
Complications of Tongue and Lip Ties
- Babies may not be able to stimulate milk production through vigorous nursing, leading to low milk supply
- Painful nursing/early weaning because child gets too frustrated
- Improper tongue mobility may prevent babies from clearing milk from their mouth, causing tooth decay (especially in the front teeth)
- sleep apnea
- abnormal sleep patterns (Micah woke every two hours to feed at five months old because he was hugry ALL the time)
- Speech difficulties
- Gap between teeth/jaw issues
For more info click here.
Feeling a little overwhelmed? Take a deep breath and . . . . EXHALE. Now, I have good news for you: Early intervention resolves all of these problems and it’s easy to make an informal diagnosis for your baby with this pictorial guide. If you think there might be an issue check out my lip tie Q&A for more photos and answers to commonly asked questions.
Diagnosing tongue-ties can be a bit more tricky. Sometimes the tie is obvious, like when the membrane is visible or the tongue makes a cupped/heart shape when lifted (this happens because the center of the tongue is anchored by the tie, so the only parts free to move are the sides). Other times, like in the bottom right photo, the tie is hiding underneath the mouth floor.
Ready to check your baby for a tie? Great! Here is a step-by-step exam guide from lactation consultant Catherine Genna. And here’s a video in which Dr. Kotlow (considered the foremost expert in the U.S. on tongue/lip ties) demonstrates how to get a sneaky posterior tie to reveal itself:
Step 2: Get a FREE Email Consult From the Leading Tongue/Lip Tie Specialist in the U.S.
Step 3: Evalutate Treatment Options
Laser Revision - An erbium laser is able to effectively “vaporize” the extra tissue without any instruments actually coming in contact with the mouth. Babies usually feel little or no discomfort throughout the process (though they may protest at being swaddled – a safety measure to keep them still), and there is very little bleeding. Babies are encouraged to nurse immediately following the procedure and healing is very quick.
The photo on the right was taken 30 minutes after my son had the laser revision done by Dr. Kotlow (the quickie update I posted that morning is here). The rest of the day was spent strolling through Essex Village in Connecticut with my snuggly boy in the Boba. A great experience overall.
Unfortunately, few doctors/dentists currently use laser instruments so travel is often required. Here is the list of tongue-tie specialists currently using lasers (if you know of someone I’ve missed please let me know!)
- Lawrence Kotlow, DDS, PC – Albany, New York
- Hugh Oser, DDS – Keller, Texas
- Stacy Cole, DDS (Holistic Dentistry) – Fort Worth, Texas
- Dr. James Jesse is a friend of Dr. Kotlow’s that has been recommended by several mamas. He is in San Bernadino, California.
- Lindsey from Crunchy Savings went to Dr. Notestine in Dayton Ohio
- Dr. Martin Kaplan of Kid Care Dental in Stoughton, MA. was trained by Dr. Kotlow
- Robert Wynn, DDS in Peoria, IL was recommended by a Jen S
Note: So you don’t miss it I am adding this comment from Mellanie Sheppard (who discovered Micah’s tie): “Recovery is not easy for every baby. For many babies, they first 24 hours can be pretty rough – very fussy and not wanting to nurse. This probably hinges on how thick/fibrous/deep the tie runs. Also, it is not a miracle cure. Some babies will need suck training afterwards (sometimes with an occupational therapist or speech therapist). Most babies will benefit from CST (cranio-sacral therapy) or chiropractic support afterwards. A tongue that is restricted is creating the wrong “pull” on the muscles in the floor of the mouth, which can in turn lead to subtle misalignment in the jaw, neck, etc.”
Scissor Method – Scissors cannot penetrate as deeply as lasers and do not remove the extra tissue, but if travel is out of the question seek out a highly qualified professional in your area – usually an ear/nose/throat doc or a pediatric dentist – to do the scissor method. Then follow through with the stretching exercises described in the post-op section of this article. Most likely you will not receive instructions to do this but it is absolutely critical to the success of the procedure.
Micah first procedure was a frenectomy using scissors at 5 months. We were not given any instruction for post-op care and the tie grew back together with scar tissue on top, which is why we took him to Dr. Kotlow at 8 months.
Note: Mellanie’s statement about the above procedure applies here, too.
Other Beneficial Therapies – Cranio-sacral therapy and chiropractic care are both excellent complementary treatments to tongue/lip tie revision.
Breastfeeding a Tongue-Tied Baby – If for whatever reason neither procedures are available here are some tips on breastfeeding a tongue-tied baby
Well, that’s it.
If you have questions, insights or doctor recommendations please share them in the comments!
More breastfeeding support:
- Read Part 1: Why Our Mothers Shouldn’t Have Listened To Theirs
- Mellanie Sheppard, For Babies Sake (Dallas/Fort Worth)
- Kathy O’Brien, 4 Hearts Services (Dallas/Fort Worth)
Photo credit: Lamour Michelle Photogray
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