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?
From
TongueTie.net
‘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.
