Friday, October 12, 2012

Tongue Tie – Gentleness and Compassion for the Baby - Part 1

Lately I am getting more and more emails, private messages and phone calls from mothers and professionals regarding tongue-tie.  The concerns are the same and actually kind of frightening and sad at the same time.  I will discuss these shortly in Part 2 but first let’s lay some groundwork so we all understand what we are talking about.

What is tongue-tie?

The ‘lingual frenum' (or lingual frenulum) is the cord that stretches from under the tongue to the floor of the mouth. 

‘Tongue tie', ‘Ankyloglossia' or ‘short frenum' are the terms used when the lingual frenum is short and restricts the mobility of the tongue.  

Tongue-ties can cause all sorts of problems or none at all.  If there are problems with breastfeeding (or feeding in general) and tongue-tie is determined to be the cause, a frenotomy is usually recommended.  A frenotomy is also known as:  Clipping, revision, or frenulectomy depending on who you are speaking with.  I have heard all of the above.  

Clipping simply means the frenulum is snipped (ether by a scissors or laser) – kind of like snipping a string in two.  It is generally painless for the baby and bleeding is typically minimal.  Only rarely and in extreme cases will a baby need general anesthesia to have a frenotomy done.  Most all frenotomies can be done with the child awake with little to no anesthetic.  Babies typically are angrier because someone has their fingers in their mouth than they are about the actual procedure – which is generally very fast.  And as soon as the procedure is done, baby can breastfeed which will help calm the baby and encourage proper tongue motion and mobility.  Follow-up with bodywork, such as Chiropractic, Bowen, an Osteopath or Cranio Sacral Therapy is strongly recommended.

There can be long term consequences of not having a tongue-tie that is causing problems clipped.  Speech issues (lisping), sleep apnea, snoring are just a few long term possible challenges.  However, if there are no feeding issues with a tongue-tie and parents are unsure about clipping, the decision to clip or not needs to be discussed with someone who is knowledgeable about tongue-ties and their potential long term effects.  Sometimes it is simply a 'wait and see' situation.  Many babies have been tongue-tied and gone on to breastfeed just fine (or with minimal discomfort to mom) and there were no long term consequences observed.  

However, just because there are times when there doesn’t seem to be an issue, we still need to monitor baby’s weight gain and moms milk supply.  It can be difficult at times to know for sure that baby is transferring milk well on his own or if he is getting milk primarily because of mom’s healthy let-down reflex.  If baby in unable to transfer milk well on his own, mom will notice a decrease in her supply at some point in time.   If that happens other steps will need to be taken to preserve the supply and baby’s intake.  At this point a frenotomy may definitely be in order.  As long as the parents are aware of the risks and know what to watch for, how they choose to handle their situation is entirely up to them.
If parents decide to proceed with a frenotomy they should be well informed, by their Lactation Consultant (IBCLC) and the Dr. doing the frenotomy of the procedure itself as not all Dr.’s do frenotomies the same way.  Aftercare exercises and possibly needed pain relief for the baby will need to be discussed.

The aftercare exercises are where we start running into trouble and are the point of this article.  Many LC’s and Dr.’s recommend stretching of the tongue to prevent the wound from healing ‘down’ or the frenulum from ‘reattaching’.  Other exercises may also be discussed to work with tongue mobility.  I am focusing on the stretching because it seems to be the biggest issue. 

What I and many other IBCLC’s are hearing and seeing is increasing cases of oral aversion in babies directly caused by excessive/aggressive stretching of the frenotomy site.  Frenotomy wounds are being stretched open, to the point of bleeding, repeatedly each day causing baby pain and distress, day after day, for up to weeks on end.  Babies are being reported crying for hours after stretching exercises and even closing their little mouths up tight when they see a finger coming towards them.  Some babies even learn to recognize the ‘stretching position’ and begin to protest and cry immediately when placed in that position.   Sometimes breastfeeding does not get better, and in fact sometimes gets worse, and in some cases ends completely as the baby flat out refuses to nurse due to oral aversion.  What that means is baby is so averse to having anything in the mouth because of trauma that they refuse to nurse or eat, and/or scream anytime the breast, a bottle or finger approaches the mouth.  

So why is this happening?   See Part 2 for the rest of this story...