Two months in: Tongue Tie – Little Mouth, Big Decision!

Reading Time: 9 minutes

I promised myself I would try to write short and sweet blog posts, as I can’t even find the time or muster up the attention span to read anything lengthy, even on my favourite parenting topics. So for this post I will stick to one topic that has pretty much been our focus for the past few months. Sorry if it still turns out to be long! This would be the ever-so talked about tongue tie and lip tie ‘controversy’, if you will.

Let me preface this by saying that this is not meant to be expert advice in the least. I have no expertise in this area, and am not even attempting to cover all of the latest research on this topic to compile it for you here. This decision can be a difficult one, and as an example I just want to offer all of the advice I encountered. The main take-away of my story (as I hope always will be coming from Intuition Parenting Support Services) is for you to get all the information you believe necessary to collect, and then follow YOUR intuition.

Hannah’s Mouth

Our tongue tie and lip tie journey started 3 years ago with Hannah, where I had toe-curling pain while nursing for the first few months of her life. Two Internationally Board Certified Lactation Consultants (IBCLCs) passed it off as positioning issues, and finally the third IBCLC I saw actually put gloves on and assessed Hannah’s mouth, felt her latch, and diagnosed a posterior tongue tie and upper lip tie at 4 weeks. It was of course a few days from Christmas and Dr. Fayad, the renown dentist in the area who was recommended to me, was on holidays. Fast-forward to going ahead with the releases at 6 weeks, my nipples being fully healed by 8 weeks, and I never felt nipple pain again for the rest of our ‘full-term’ nursing relationship.

The take-away from our story with Hannah is that I believe in releasing ties, first-hand, as it saved our nursing relationship. It was night and day prior to release and afterwards, watching my tissues finally heal and continue to improve daily, until fully healed which is when all pain dissipated. I could finally learn to nurse more on the go and in the side-lying position. My life as a new mother improved tremendously.

Avery’s Mouth

So then on day 2 when I notice that Avery has the exact same mouth, when my nipples are already blistering and bruising along the peak line he leaves after latching, leaving my nipples in that lipstick shape, with the dreaded knife-like stab of pain with every nipple chomp…why don’t I immediately call and book an appointment? For me personally it was for a few reasons:

1. Over the past few years I have grown to question interventions, wanting to make sure they are truly necessary with the benefits and risks properly weighed before going ahead.
2. I didn’t know Avery yet, didn’t know his little mannerisms, feeding or sleeping behaviour, and felt I needed to know who he was a little bit before changing something about him – so that I could truly understand how it was affecting him.
3. Honestly, I hoped deep down that I would not have to put him through this, as I had a few things going for me; my milk coming in more quickly this time after only 32 hours, as well as being vigilant about positioning from the beginning, both of which helped minimize damage. Also, my knowledge this time that bodywork could potentially help relieve tensions leading to nursing issues or diagnose and treat other unrelated causes (such as torticollis) had me want to try that route first.

Why is it so difficult to know what to do? There are so many varying and contradictory positions:

This of course is all anecdotal, from me collecting information from every source possible in hopes that it would help me figure out my decision. These may come across as blanket statements but they are the collection of what was presented to ME, and all that was floating around in my head when I was trying to decide what to do:

• A lengthy article by a La Leche League (LLL) leader and International Board Certified Lactation Consultant (IBCLC), with over 250 additional references listed, goes in depth on many topics about tongue and lip ties. The author dedicated her Master’s degree to developing the Assessment Tool for Lingual Frenulum Function and authored a book titled Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment. She even provides free screening for tongue ties in babies out of her practice – so her interest doesn’t seem financially driven BUT there are comments on the article itself by other IBCLCs that can’t even believe LLL would endorse her work (I have also heard this first hand from another IBCLC).
  • The author of the article noted above describes that posterior ties are far less common than the rate at which they are actually being diagnosed, and also describes how the post-procedure stretches are completely unnecessary and can cause more damage, whereas the main dentist who does the work locally (any many others, including others who perform the procedure and other IBCLCs) do fully recommend the stretches. Our local dentist mentioned above now recommends doing the stretches every 3-4 hours for 3 weeks (compared to 2 weeks when we had it done for Hannah three years ago). This discrepancy in the stretching and exercise advice is a BIG deal, some parties claiming it’s actually detrimental to do them and the other side stressing how important they are. How are parents to know what to do? There is also a lack of research for evidence to support either claim. Please see an entire section on the post-procedure stretching below.
• Pediatricians tend to ‘believe in’ anterior ties and will cut them with sterile scissors, but tend to not ‘believe in’ posterior ties as much, nor how they are being treated with lasers by dentists.
• Despite the above point, not all pediatric dentists even agree with what some are doing by treating with laser, and when asked about it have actually used statements along the lines of worrying that someone will get sued at some point and no one will be able to do the procedure after that at all.
• The gist of it: NOBODY AGREES and parents are hearing contradictory information from everyone!!

Potential risks of not doing the releases:

• Continued nursing issues:
  • not being able to properly extract milk which leads to:
    • potentially not gaining weight properly
    • potentially seeing a drop in supply
  • continued nipple pain and damage
• Issues with food manipulation and in protecting airway (preventing choking)
• Speech development issues
• Oral development issues in terms of gaps in front teeth from upper lip ties, receding of gums from buccal ties, improper formation of the upper palate from improper tongue placement, all possibly requiring dental work/orthodontics
• inability to clean your teeth with your tongue (run tongue along teeth and gums)

Advice on the timeline of WHEN to do the procedure:

My hopes were that we would avoid doing it until it became evident that it was necessary by noticing that Avery was either no longer gaining appropriately, my supply was dipping, him having a hard time manipulating his food, speech issues etc. When inquiring about timelines however, the following was brought to my attention from three different IBCLCs and other encounters:

• The latching and sucking reflexes, where the baby will turn to a finger or breast brushing their cheek, and suck on something when it touches the roof of their mouth, ‘expires’ around 9 weeks and becomes more of a learned behaviour. It isn’t a drastic cut-off, instead more of a increasingly voluntary behaviour, but this is still an indication to release any ties before this time so that they can have the benefit of the reflexes to re-learn an improved latch after the revisions.
• Advice from another IBCLC was to do it before 3 months if you are going to do it.
• Muscle memory of the mouth indicates that the longer time using the mouth ‘improperly’ can lead to more difficulty re-learning to nurse once released.
• I have witnessed difficulties in doing it later if the child is old enough to refuse the stretches (bites fingers for example), go on nursing strikes when not yet consuming enough food and breastfeeding is still their main source of food, yet on the other hand I know of adults who have had it done with zero regrets.

So how did we decide?

As I mentioned, before going ahead we went to various bodyworkers (chiropractic, massage, craniosacral therapy, osteopathy) to be sure it couldn’t be resolved by that route. By three weeks in Avery was given a ‘clean bill of health’ in these regards, and no amount of good positioning was improving his latch enough to get us by. I then accepted the fact that he was truly tied, and that releases could benefit him and our nursing relationship.

I knew that if I kept listening, my gut would help me know what to do one way or another, I would either continue not being sure enough to go ahead, or things would shift to deciding to have the procedure done. When the latter occurred we booked our appointment for the procedure.

My last piece of information gathering went as follows – I went back to my IBCLC, and walked in at the same moment as a mother of a 9 month old who had had his ties released a week prior. He was having a hard time nursing due the pain, despite still being on a rotating schedule of advil and tylenol. He was swollen. He wasn’t yet consuming much solid food so that couldn’t sustain him. He did not allow the stretches to be done. He was of an age and level of awareness to know that his mouth hurt when he nursed, and did not have infant reflexes on his side to help him along. His loving mother was calm, collected, reaching out for advice, and doing everything right.

I thought of this little boy that night and it finally became clear to me that I had enough information that supported going ahead, and that if I was going to do it, it would be now.

My only advice is to really listen in. Gather all of your information, and trust your intuition. The most amazing part of your intuition is it’s never just one puzzle piece. That is what our intuition does for us, it pieces it all together, considers things our conscious mind couldn’t, and guides us to our answer.

Our Outcome

I have absolutely no regrets and know that for me I made the right decision.

We had the procedure done when Avery was 3 weeks 5 days old. I cried while he was having it done but soon was able to comfort him and nurse him. I felt immediate pain relief with the first nurse, which may be rare due to tissue damage, but I had a sharp drawing pain come all the way from my back with his small restricted latch (the same pain I had in the past with a pumping flange that was too small) and I haven’t felt it since the releases. My nipples fully healed within a week and I recall even on day 2 texting my mother and Grant with the statement that “nursing now feels like a nipple massage rather than a chomping stabbing knife-like pinch”. Unbelievable.

My opinion on the post-procedure stretches

This sub-topic of the tongue tie and lip tie world is something that I have read a lot about and would like to summarize for you here (please contact me for references/links).

There is complete consensus that there is a lack of evidence guiding post-procedure protocols, and all practitioners seem to recommend different protocols. I made a little visual of the different stretch frequency and duration protocols encountered in a quick internet search. Each dotted line represents a recommended protocol showing frequency of stretches (number of stretches per day) and associated duration (number of weeks to do them). Imagine the confusion of parents who question the recommended stretches and take to their own internet research.

The considerable amount of conflicting information leaves parents following their gut which often results in less stretches being done. A variety of reasons may cause this including new postpartum hormones at play, sleep deprivation which causes missed night stretches, being unwilling to wake a baby to inflict discomfort or pain, fear of causing oral aversion, and most importantly, it simply being emotionally difficult for new parents. There are also IBCLCs discussing the issue at length online, and posing some well-grounded research questions that cause uncertainty for readers. Many of these questions should be addressed by the field.

At one end of the spectrum it is said that the stretches are absolutely necessary to prevent reattachment and potential subsequent procedures, and on the other end, the wound healing literature directs against manipulating the wound bed and that doing so could in fact be detrimental. When we consider that this latter recommendation exists we can see how this may give parents the out their hearts desire if the stretches are too daunting for them.

My difficulty with the existence of different opinions on this matter from various seemingly reputable sources is that, as I believe, parents should follow their guts. I believe in collecting information, and making informed decisions that ring true with your intuition. The most difficult situations are when your information collecting presents conflicting advice (and I’m sorry to say it often does) because this can really impact your actions.

With Hannah, I gathered less information, and more or less fully trusted the person who conducted the procedure and did my best to follow his routine in fear of ever having to start from the beginning. With Avery, I let the other side of the spectrum sway me somewhat and carried out a strict schedule at the beginning, with the exception of skipping the first overnight stretches out of fear that he would reject the breast as he had for the first afternoon (and later found that one of the experts actually recommends skipping the first night – go intuition!!) . I scared myself partway through when his latch began to feel chompy and I tightened the schedule slightly again. From there, my schedule strictness tapered until I was sure the wounds were healed.

In other words, I followed my own protocol which is likely not recommended by the practitioners, but a hint at what parents are actually doing. I have hopes and dreams of supporting the research that is necessary to create an evidence-based post procedure protocol – wish me luck and stay-tuned!

Support, Support, Support

One thing I will absolutely recommend is to have at least one person with breastfeeding knowledge ready on hand to connect with afterwards. This is in addition to seeing an IBCLC in the days following the procedure. What you need is someone you can text or call if it/when it gets hard.

I was texting two LLL leaders who are friends of mine and I am so grateful that they took the time to be there for me. Despite having already been through this once before, having read multiple books on breastfeeding and understanding nursing strikes, being partway through my breastfeeding training course etc., it still rocked me to my core when Avery couldn’t and wouldn’t latch the first afternoon for 2.5 hours. It doesn’t even sound like long now since babies can go longer than that without eating, but he had already gone a few hours and was ravenous and in too much pain to latch. With every attempt he would fling his head backward wailing. It was horrible. You really need some great moral support during these hours.

I wish you all the best of luck on your tongue tie and lip tie journeys, should this be something that affects your life. Please don’t hesitate to contact me should you need some support!