What is a lip or tongue tie and why does it affect breastfeeding? A restriction or “tie” prevents the baby from properly latching to the breast. This can be caused by a combination of factors including the baby not being able to open his or her mouth wide enough, the tongue isn’t able to cup around the breast, or the tongue cannot move in the ways needed to efficiently extract the milk. Instead of breastfeeding, the baby ends up “Nipple Feeding”.

Understandably, this can result in a very frustrated mother and baby. Some babies can breastfeed efficiently with a restriction, but many will struggle with breastfeeding and even bottle feeding.

Here are some signs you can look for:

• Your baby is having difficulty latching or staying latched at the breast

• Your baby “chomps” or “chews” the nipple, rather than sucking

• Baby’s top lip can not flange around the top of the breast 

• Your baby is making a “clicking” noise during feeding

• Baby is sucking, but not swallowing or you may see milk dribbling out of baby’s mouth 

• Your baby may stay at the breast for a long time, sucking inefficiently, getting frustrated, or even falling asleep but wanting to eat again shortly 

• Your baby seems to always be unsettled or unsatisfied, even after being at the breast for long periods of time 

• Your baby may be gaining weight too slowly

• Your Baby may have the same trouble staying latched or maybe “chewing” on artificial nipples

• A baby may take a very long time to remove milk from a bottle

• Mom may have nipple pain, even cracking or bleeding

• Mom may feel pain or a pinching feeling throughout the feeding

• The nipple may be misshapen when the baby breaks latch – often looking flattened on one side, like a tube of lipstick. You may even hear the term “lipstick nipple” used when speaking about ties

• Mom may feel very full after feeding like no milk was removed

• Mom may experience frequent clogged ducts or Mastitis 

• Mom may notice her supply starting to dwindle because milk is not being removed efficiently 

It is important to remember that all these things can be signs of a tongue and lip tie, but ties are not the only thing that can cause these things to happen.

Not all breastfeeding issues are caused by ties, and many can be resolved by something as simple as a position change or supporting your baby differently as they come to latch at the breast. Tongue and lip ties are one of, but not the only thing that can cause some of these symptoms to happen. A lactation professional can help you determine if an evaluation for restrictions is necessary.

You have read all the articles, paid close attention and you think your baby may have a tongue or lip tie. What comes next?  

The first step is to get a diagnosis from a provider who is well educated and experienced in oral ties. You can start with a lactation professional; although they will not be able to give you a diagnosis (unless they have other credentials), they can assess your baby during feeding and refer you to a provider, or help support you if the issue is not a restriction. A general physician, pediatrician, or pediatric dentist can give you a diagnosis and perform the revision or “clipping” of the tie. When it comes to the dental health of the mother some might have some problems because of weakened gums and a dentist might recommend dental implants.

How do you find a tie-savvy provider?

Your local lactation professionals are a great place to start. They often work closely with these providers and will know the best ones near you. Asking other parents in your area is another option, especially those that have personal experience. You can also search this list of providers considered “preferred” by The Tongue and Lip Tie Support Network. The list is not inclusive of all skilled providers who are familiar with the signs of a tongue tie, but it is a great reference tool. No matter where you find your provider, it is important to ask them questions like how often they do revisions, how they plan to do the revision, do they allow you to be in the room with your baby, and what they suggest for aftercare. All of this information will help you decide which provider is best for you. 

Laser vs. scissor, does it really matter? 

The short answer is no, it really doesn’t matter. The skill and experience of your provider is much more important. There are benefits to both options: with laser, there is less bleeding, with scissors it is a quicker procedure. Ultimately you want to find a provider you trust, and they will be able to suggest what is best for your situation. 

Aftercare – what to expect

It is important to remember that it can be a team effort getting through a tongue or lip tie and the revision. Many providers suggest working with a lactation professional who is experienced with oral restrictions and a bodywork specialist. A bodyworker is a professional who has a hands-on license to touch and extensive continuing education hours in CranioSacral therapy, Myofascial Release, etc. A licensed professional may be an occupational, physical or speech therapist, chiropractor, osteopath, nurse, or massage therapist.  Using all of these resources will help treat the issue as a whole, not just fix one part of what may be going on.  

Is it a “quick fix”?

Most of the time, your baby can nurse immediately after the procedure. And most parents report that there is a noticeable difference right away. A baby may have some discomfort the 1-2 days following the procedure. Your doctor will discuss the appropriate usage and dosage of pain medicine with you. You can also use frozen breast milk to help soothe the baby’s mouth, and lots of skin to skin snuggles to help the baby relax. 

There may also be some situations where it seems like it gets worse before it gets better. Remember that your baby has learned to use his or her tongue and oral muscles with this restriction or tightness, so having a new range of motion can be strange and may take some time for your baby to get used to. Don’t give up if you don’t have an “immediate” fix. Work with your team, take it one day and one feeding at a time, and you will get there. 

Many providers suggest doing special stretches after the procedure. These are gentle, and the point is not to stretch out the wound, or cause pain, but to ensure that the wound heals properly and doesn’t reattach. They are simple and should only take a few seconds out of the days following the procedure. Your doctor may give you specific instructions, but this great article from Dr. Ghaheri (a known breastfeeding supportive ENT) shows an example of aftercare. 

Tongue and lip tie revisions should not be scary

Not all breastfeeding issues are caused by ties, and most can be resolved by something as simple as a position change or supporting your baby differently as they come to latch at the breast. If you are experiencing any of the above and feel like your breastfeeding struggles may be caused by a tongue or lip tie, it is very important to get professional help. A lactation professional can help support you and refer you to a doctor or dentist who can properly diagnose and treat a tie if necessary. 

As a parent, you want to keep your baby safe and out of harm’s way, and a procedure like this can be nerve-racking. Be sure to go in with a plan, and have a provider and support team you trust to get you through it. Ending your feeding struggles will be well worth it!

If you need help finding lactation support in your area, we are happy to help connect you with someone. Our lactation team is available to answer your questions any time via email at lc@staging-kiindecom.kinsta.cloud

Aryn

Aryn is a Certified Lactation Counselor on the Kiinde Lactation team. She is also a mother of two, writer, and maternal mental health advocate.