Tuesday, October 12, 2010

Tongue-tie and other breastfeeding issues

At our discharge from the hospital, we were told that our daughter has a tied tongue; however, they assured us that it’s presented in a mild form and isn’t supposed to interfere with breastfeeding.

Back then, before my milk really “came in”, I didn’t feel any difference between breastfeeding my first and second baby. However, once the milk started flowing, I noticed a number of issues which may, or may not, have something to do with Tehilla being tongue-tied.

First off, I must say she is able to breastfeed, and in fact does quite effectively. I’ve read stories online about babies who had tongue-tie in such a severe form that it hardly let them feed and they were dehydrated and rapidly losing weight before the problem was fixed. Tongue is a major player in extracting milk from the breast, and when it isn't functioning effectively, it results in uncomfortable latch and difficulty in breastfeeding.

I did notice that she swallows quite a lot of air when feeding, much more than Shira did, which results in lots of gas and frequent spit-ups. Shira simply did not spit up; I bragged about hardly having to do any laundry for her before we started solids, and voiced my expectation for the same this time around. Well, I had to eat my words – I can hardly count the times I’ve changed Tehilla’s clothes and sheets (and mine, too!) this past week.

She also has a hard time dealing with letdown of milk. I must note that this time, I feel a stronger letdown reflex, and once milk begins to flow, she usually pulls off the breast, gasping and choking, while the spray of milk soaks her, myself, and everything around. Once the flow slows down, she returns to the breast with no problems. I don’t go long between feedings and don’t have any engorgement or particular feeling of fullness.

Again, these aren’t very serious problems compared to what other mothers are facing, and I’m not sure whether this has to do with tongue-tie. A tied tongue can be easily fixed, so I’ve read up, by clipping the frenulum (the tissue attaching bottom of the tongue to the mouth). I have not heard of any risks, but so far, we’re taking the “wait and see” approach.


Gothelittle Rose said...

The gasping and choking is definitely tied directly to the strong let-down reflex. I had strong let-down with Tricia, but not that strong. So I heard from plenty of other moms who did, and that's common. Extra gas and burping also happens with strong let-down.

For what good it'll do to know. :)

Lucky me, Tricia is a reflux baby, so we had plenty of issues, but I breastfed her very successfully (after a rocky start) near-exclusively to 10mo and half-and-half until 15.

Anonymous said...

I have a severely tied tounge which was diagnosed as a child after a school speech therapist evaluated all the kids and noticed I have a slight lisp. She advised I have it corrected but after speaking with the dentist my parents decided against it. It can be a painful procedure, the dentist said, and he did not see any reason to put me through that. I am in my late thirties now, and the dentist was right. I just can't stick my tounge out very far, but that is not something people should be doing anyway!

One of my children had to have a frenectomy on the tissue connecting his upper lip to his gums. It was necessary and done as part of extensive orthodontic work. The procedure was pretty grueling for a young child to go through. He required some strong anesthesia (half awake, half asleep) and the procedure was unpleasant - the excess tissue was basically burned away. As a parent, it is not something I would recommend you put yourself or a child through unless it is absolutely necessary.

LeAnna said...

I think my son was mildly tongue tied as a newborn (and that it has stretched out over time) he had a very hard time with latching the first 4-6 weeks, we had to use a nipple shield. I had extreme over-active letdown, which caused many of the issues you've mentioned. I had to let down into a towel or something for a minute or two before latching him on, otherwise he would get too much foremilk which is high in starches and sugar (and contributes to the excess gas). Upon doing some research online, I found there are several exercises you can do with them to help naturally stretch the frenulum. He is 21 months now, and his speech seems to be on track so we're not worrying about it.

Matushka Anna said...

I don't *think* this has anything to do with being tongue-tied. A lot of women have different experiences with breastfeeding from one baby to the next. When my oldest was a newborn, she too had the experience of trying to drink from a fire hose! We were both wet more hours of the day than I care to remember - both from milk and spit-up. As far as swallowing air and therefore spitting up, I think this is just one of those individual differences. Some of mine spit up lots more than others. My second baby was what I called a "chokey" baby because she'd choke on anything. Even as a toddler I got used to snatching her up from her high chair and turning her upside down to dislodge something that had gone the wrong way. It happened so often that I actually lost my panic over it. Her father never did (c; !

It sounds like you are both doing fine (although a bit damp) and I'd be willing to bet that this sorts itself out as she gets older.

leah Brand-Burks said...

First things first: My husband AND his older brother were tongue-tied, and they BOTH were 'clipped' almost immediately. Secondly, remember as your milk supply regulates, and her mouth gets bigger, she will be better able to handle the milk flow. Also, this could just be a little reflux that comes with a tiny, newly-developing cardiac sphincter. She'll probably outgrow all these things! You're doing a great job!

momto9 said...

Sometimes we all have to eat our own words don't we:) Oh well it's all part of growing in motherhood and as a person!

Hope it all goes will with your little one and the problem will be corrected.

How is Shira adjusting to having a sibling?

Serena said...

That is interesting. A friend's first two babies were tongue-tied, and it was not a big deal at all to have it clipped. You're so on top of things, that I'm sure you'll make a wise decision.

Thia said...

Just to reassure you, the reaction to let down, unlatching to choke and sputter, is common in my babies, all four of them and there were no issues like tongue tie.

Lisa said...

Hi Anna,

My friend's two year had tongue-tie and they also took the wait and see approach. It did not interfere with her feeding at all and they didn't decide to do the "snipping" procedure to correct it until she was just about to turn two. Her's was not a mild case, but not a severe case either. They finally decided to do the procedure because it was a strong enough case that they didn't want it to interfere with her speech development. Rest assured, it was a simple, out patient procedure, and she was back to her usual two-year-old self the next day!

And she was able to lick her top lip for the first time!

There's no harm in taking a wait and see approach.

Anonymous said...

Some moms with overactive letdown take the baby off the breast and catch the spray with a diaper during letdown until the flow slows enough for the baby.

Dana said...

I am usually a lurker on your blog, but felt inclined to respond as I have experience with tongue-tie in two of my three children. My first daughter had a mild tongue-tie causing painful nursing for me, but my third born just 13 months ago had a severe tongue tie and couldn't nurse or suck on a bottle. I had to feed her with a preemie tube and syringe along my finger. If you would like to know more about what research I found and my experience, please email me at serfass@hotmail.com


Sharon said...

For what it's worth, I had my frenulum clipped as an adult. It was a quick, painless (with local anesthetic), and inexpensive procedure. I would imagine that it would be even easier for an infant.

However, that said, some babies just do spit up more than others, and it may not have anything to do with her frenulum. I have noticed, personally, a correlation between spitting up and a rapid flow of milk.

I hope that you will be able to continue blogging at least occasionally, now that your hands are fuller with two little ones. :)

Laura said...

If she's nursing well, I wouldn't worry about getting her frenulum clipped. But that's me. I think the "wait and see" approach is usually best unless it's severe.

Just a side note, my second child did not have any tongue-tie at all and we had very nearly the same first experience and seemingly second experience as you are having. My first never needed to be burped (only occasionally), never ever spit up, and had no issue whatsoever with letdown. With my second, I had the same things happen. My second was a VERY frequent spitter-upper, needed burped frequently, and got completely doused with my much stronger letdown. I don't know what it is about nursing the second time around, but I agree, the letdown was SO much stronger!

I don't know how much of your different experience is due to tongue-tie either, but it's funny that my experience is mirroring yours now!

Emily G. said...

My daughter is not tongue tied so I have no input there.

However, I did have very fast letdown and the same issues that you are describing, so I wonder if Tehilla's problems are related to your changed letdown and not her tongue. When she was >3 mos old, Maria would pull off repeatedly when she first started a feeding and my letdown was occuring. I'd have three or four sprays going in different directions, she'd be gasping and panting. Usually I just used a cloth to catch the flow until it stopped or slowed to a dribble, and she latched back on to continue nursing. She also had tons of air in her stomach after a feeding. I think it may have something to do with how fast they have to breath and swallow when you are letting down really hard.

Anyway, I just thought I'd share that in case it helps a bit.

All that extra laundry is a nuisance, I know. I had to wash my PJ's every day because I'd wake up soaked in milk. Maria spit up a lot, there were all the burp cloths and milk soaked cloths from feedings...it's a lot of wash.

Good luck and I hope things get better for you and little Tehilla.

Miss Tatiana said...

I was born with this condition and my tongue eventually ended up having to be snipped but not until I was about 7 years old. It only became a problem when it was creating a lisp-- you might notice that your daughter has one too (just heads up).

I remember the tongue snipping and while it was painful I don't remember it hurting me for more than a day or two. Your husband and yourself might want to decide to do this sooner than later because of how the tongue might have issues with speech later on.

But thank G-d for a healthy baby!! :)

~Miss Tatiana

Joie said...

Patrick was horrible at nursing unless it was the middle of the night and he was pretty much asleep. I had incredible let down even while tense. He was tongue-tied and had reflux -- and maybe those are related -- and I ended up pumping for a year but since he didn't really like the bottle either, I ended up opening up the all night boobie cafe. Now, to my point. My husband was tongue-tied and finally when he was an adult he got it fixed when having his wisdom teeth out. Wait and see or not but she might end up wanting it fixed later anyway.

J in VA said...


My dh and his brother were tongue-tied. My dh did not have his tongue clipped until age 3. His mom says he could not BF, and was a very fussy baby.His tongue was not clipped until his speech had been affected by it and he required speech therapy until age 12. His brother, who is 6 years younger, had his clipped inthe nursery prior to discharge from the hospital. He never had speech issues.

When my dd was born, we took her to be evaluated for tongue tie (it tends to run in families). We were told that the function of the tongue is a better gauge than appearance. Can she stick her tongue beyond the gum line? Some babies have a stretchier frenulum than others. As far as I know, there is no risk to clipping other than the slight risk of bleeding and infection--which would be for any procedure of that sort. I have been told that most babies nurse better immediately and that seems to provide enough pressure to have it clot off quickly and without difficulty.

J in VA

Anonymous said...

I'm so glad to hear you and the baby are doing well.

About the tied-tounge: my cousin had the same problem. If I remember right the parents waited pretty late to clip the frenulum, and my mother, a speech therapist, was worried he might have a speech problem. However, he is now fine. The procedure is super low risk as long as everything is sanitary.

thecurryseven said...

Congratulations on your new baby! I think some babies are just more prone to spitting up than others. My third child was a spitter... sometimes it was quite impressive. It wasn't a health issue for her, just a huge laundry issue for me. Changing a baby (and oneself) just becomes wearisome. She did eventurally outgrow it.

AwaydownSouth said...

I hope your little one improves.

Joie said...

Oh, and we did have the procedure done on Patrick's tongue and he never seemed to have any pain as a result. Since this was done after 6 mos., I think we would have noticed if he seemed stressed by it. By the time we got it taken care of, however, he was afraid of breast and bottle. It was a very rough year.

tanya.lopez75 said...

As a first-time commenter, let me first express my appreciation for your blog, it is encouraging to read about your journey making a tranquil and joyous home for your family, and let me congratulate you on your newest little one.

On the topic of tongue ties, you may want to look into the nutritional side of the issue a bit. They can be related to folate status, they seem to be a mild form of midline defect (ankyloglossia clusters with other, more serious midline defects). And I wanted to mention it because some people need more folate (not folic acid) than others, there are some genetic variations involved--not rare stuff, fairly common. And since tongue ties often seem to get more severe with subsequent children (and I saw you've done some posts on Nourishing Traditions and Weston Price), I thought I'd mention the nutrition aspect.

You've probably already talked with your healthcare provider about clipping, my understanding is that the frenulum is thinner in young infants, which is why they seem to nurse better so quickly. I wish I had recognized and clipped my son's tongue tie, he's 4 now and we are, for now, just trying to compensate for his tongue's poor mobility.

Thank you for your blog, and blessings to your family.

Jenny said...

Congratulations on the birth of your daughter! I have no advice regarding the tongue issue, but my little boy was the master of spitting up. He is five now and I can still remember how that felt. Not very pleasant!

That is the time I began wearing aprons. It was a life saver for my clothing.

Good luck! Sounds like you are adjusting well.

mother in israel said...

Hi Anna,
I suggest going for an evaluation.

Some babies with sucking issues do fine at the beginning when the mother's hormones are strong.But if the baby isn't emptying the breasts properly there can be issues down the line.
Is the baby growing well? Do you have any pain?
To the commenter who said that you don't need to stick out your tongue: If you have lack of motion in your tongue, you can have trouble cleaning your teeth (something we all do without thinking about it), leading to dental problems. Not to mention speech. Each case is different, which is why I suggest an evaluation.
Anna, feel free to email.

Mrs. Anna T said...

Mother in Israel, I have no pain (if I did I'd run to a lac. consultant because it's unbearable to put up with nipple pain for a long time) and she does empty the breast well; however, we'll probably get evaluated anyway, if not for feeding then for other issues.

RedBird in VA said...

I was pleasantly reminded of my first son's reaction to my very strong letdown. The first time, he backed off, startled, and started crying. The next time we nursed and the milk let down just as strongly, he backed off and laughed while it sprayed across the room -- then latched on. After that our only troubles (other than gulping and burping) were laundry and cleaning.

Many blessings to you and your family.

Penniless Parenting said...

I know you're busy, but I just had to comment this and hope that you read it.
My sisters, brothers, and I and mother have a tongue tie. We all needed to go for speech therapy. We almost all needed palate spreaders and braces and had sinus issues. Why am I mentioning this?

Both my sons had tongue ties; one the doctor didn't notice but I did, and once the baby was 2 weeks old, I started noticing his nursing skills weren't as good, so took him to get his tongue tie snipped. It was a quick 5 second procedure, he nursed right afterward, and once he was done nursing, there was no more bleeding and no more crying.
For my second son, I diagnosed it in the hospital and the hospital sent someone up from pediatrics to snip it.

Why snip a tongue tie? Because it can affect nursing. Even if not as much when your lactation hormones are really strong right after birth, after a little bit when you're not as engorged it can cause problems. And it very frequently can cause speech problems. But if you wait till the kid is older, it is more complicated and painful.
There's some research being done on tongue ties, and there might be a strong connection between tongue ties and misshapen palates. If the tongue doesn't have freedom of movement, it won't lie flat against the top of the palate, resulting in a flatter, lower palate, I think, necessitating in palate spreaders because the jaw doesn't grow big enough to accommodate all the kid's teeth.
A misshapen palate can exert pressure on the sinuses, causing lots of sinus issues.
Not to mention that tongue tie is connected to snoring, and if I'm not mistaken, sleep apnea.
Its a quick and virtually painless procedure. Why not do it if you have that option?