Tongue and Lip Tie Issues while Breastfeeding


My Baby is just Not Feeding! Could it be a Lip Tie??

What is a lip tie?

A lip tie is when the top lip is tied to or attached to the upper part of the gum.  A piece of skin called a frenulum connects the underside of the top lip and the upper gum.  When this frenulum is too tight or situated too low, it affects the lips ability to flare out.  A serious lip tie can hamper the feeding process by making it difficult for the baby to latch onto the breast.

tongue tie is when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth), is too short or tight and this affects the movement of the tongue.  A tongue tie is congenital, meaning that it is present at birth, and it can be hereditary.  A lip tie is not as common or severe as a tongue tie.  Studies show that a lip tie can usually come right as the child grows.  As the permanent teeth come in, the tie may fix itself.

There is a bit of a clash of opinions amongst medical professionals with regards to a lip and tongue tie and how they affect breastfeeding.  Some paediatricians believe that the lip and tongue tie does not impact breastfeeding at all.  Others believe that it impacts feeding quite negatively and causes many difficulties.  A tongue and lip tie has to be diagnosed by having the baby assessed and the impact of the tie can only be assessed by watching how the baby feeds.  Very often a doctor, who is not concerned about ties, will do neither of these.  A detailed and comprehensive examination needs to be done on the mouth and the breastfeeding needs to be observed by a practitioner who knows what they are looking for.



Wondering if your baby is drinking enough breast milk? Find out here



Symptoms to check for on the mother:

  • Nipples are flat or creased after feedings.
  • Intense nipple pain.
  • Nipples are cracked, blistered, and or bleeding.
  • The nipple has a white stripe at the end, like a paler end to the nipple.
  • Obviously this all causes great discomfort while breastfeeding.
  • Painful breasts, where mastitis, thrush, and or blocked ducts may be present.
  • The breast isn’t properly drained by the feeding.

Symptoms to look for with baby:

  • Very poor latching and sucking ability.
  • When baby is latched, the lip may be tucked inwards, which causes the latch to be shallow.
  • Falls off the breast easily.
  • Chews at the nipple while trying to feed.
  • Gas and reflux – baby swallows lots of air as they try to feed.
  • Clicking sound as they feed due to the poor suction.
  • Baby doesn’t seem to swallow as frequently while feeding.
  • Poor weight gain and eventually perhaps leading to weight loss.
  • The baby may seem quite fussy during feeding time and might arch away from the breast.
  • Seems to get tired very quickly from the feeding effort.
  • Has problems keeping a suction onto the breast.
  • Tries to put a lot of the breast into his mouth while feeding in an attempt to create suction.
  • Breastfeeding is extremely messy – baby spills milk quite a bit during feeding, there’s a lot of coughing, gulping and choking during the feed.
  • Excessive drooling present.
  • If the baby already has teeth, often they are biting in order to stay on the breast.

Some babies with lip tie may manage to feed and gain weight adequately in the first few weeks, but as they grow, they may struggle to maintain a full milk supply.  Feeds are often long and frequent throughout the day and baby always seems to be dissatisfied.  Lip ties do not only adversely affect breastfeeding.  It can also affect jaw and dental development, and this in turn can affect chewing, swallowing and digestion.

Some babies will be able to breastfeed with a lip tie, while others will have immense difficulties.  This is because the tightness of the frenulum may be different in children, and the degree of tightness is what causes the varying consequences.


What can be done?

A frenectomy (external wikipedia link) (also known as a frenulectomy or a frenotomy) can be performed to remove a frenulum.  The procedure is quick and discomfort is minimal.  

Also, experimenting with different breastfeeding holds may also bring some success at feeding.  For example, this method has helped various lip tied babies in latching more securely during breastfeeding:

    If you are right handed: cup underneath your right breast with your right hand.  (This is trickier if your breasts are very small).To make the breast bulge forward, use your thumb to tilt the nipple away from baby’s nose.When baby’s mouth is open to latch, his chin and bottom lip should touch the breast first.Using your thumb, roll your nipple forward into the roof of your baby’s mouth.Use your thumb to catch the baby’s upper lip and gently flick it outwards.  That almost positions the lip up and over the nipple for better latching.

You may also find that as your baby gets bigger; their ability to latch also improves.  Breastfeeding compressions have also been found to help during feeds.  Please consult your health care practitioner for further advice and treatment if you suspect a lip or tongue tie.


Other pages on breastfeeding problems you might like to read


References

1. Spitzfaden, Laura. Feed the baby LLC. [Online] http://feedthebabyllc.com/tongue-and-lip-tie/.

2. The funny-shaped woman. [Online] 2011. http://thefunnyshapedwoman.blogspot.co.za/2011/03/introducing-maxillary-labial-frenulum.html.

3. David, Louise. [Online] http://louisedavidlc.blogspot.co.za/2014/06/tongue-tie-and-upper-lip-tie-assessment.html.

4. Maaser, Stacey. Embracing Motherhood. [Online] http://embracing-motherhood.com/how-to-identify-and-deal-with-lip-tie-and-tongue-tie/.

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