Tongue and Lip Tie Issues While Breastfeeding

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 lip's ability to flare out.  A severe lip tie can hamper the feeding process by making it difficult for the baby to latch onto the breast.

A 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, affecting the tongue's movement.  A tongue tie is congenital, which is present at birth and 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.

Medical professionals have differing opinions concerning lip and tongue ties and how they affect breastfeeding.  Some pediatricians believe that the lip and tongue tie does not impact breastfeeding.  Others think 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 evaluated 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 breastfeeding needs to be observed by a practitioner who knows what they are looking for.

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Symptoms to Check for

• Intense nipple pain.
• Nipples are flat or creased after feedings.
• Nipples are cracked, blistered, and or bleeding.
• The nipple has a white stripe at the end, like a paler end to the nipple.
• Naturally, this all causes significant discomfort while breastfeeding.
• Painful breasts, where mastitis, thrush, and blocked ducts may be present.
• The feeding doesn’t adequately drain the breast.
• Very poor latching and sucking ability.
• When the 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 sounds as they feed due to poor suction.
• The baby doesn’t seem to swallow as frequently while feeding.
• Poor weight gain and eventually perhaps leading to weight loss.
• The baby may seem fussy during feeding time and 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 to create suction.
• Breastfeeding is incredibly messy – the baby spills milk quite a bit during feeding, and there’s a lot of coughing, gulping, and choking.
• Excessive drooling is present.
• If the baby already has teeth, they often bite 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 the baby always seems dissatisfied. Lip ties do not only adversely affect breastfeeding.  It can also affect the jaw and dental development, which can affect chewing, swallowing, and digestion.

Some babies can 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 causes 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 the discomfort is minimal.  

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

You may also find that their ability to latch improves as your baby grows. 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.

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/.