Breastfeeding & Identifying Posterior Tongue-Tie

August 23, 2016

Both of my boys had and have a posterior tongue tie. Both were difficult to breastfeed.  When I say difficult, I mean painful.  I suffered from painful shredded nippes, blocked ducts and vasospasms during our feeding journey.

“Tongue-tie (ankyloglossia) is a problem affecting some babies with a tight piece of skin between the underside of their tongue and the floor of their mouth (lingual frenulum). It can sometimes affect the baby’s feeding, making it hard for them to attach properly to their mother’s breast.”

NHS Choices

The problem was the lack of support knowledge.  Don’t get me wrong, there are some wonderful peer supporters and breastfeeding groups in the UK, in fact, where we used to live in North Kent I could have attended a different breastfeeding group every day.  When I experienced pain breastfeeding my first child, Chaos (who is now 3 1/2) nobody ever thought to examine him.  I meanwhile was examined a little too much…Exposing my boobs in public in front of complete strangers daily trying to get help breastfeeding!

I saw everyone you could ever image possible and was constantly told, it’s all about positioning, it will get better, try the rugby hold, use the ‘flipple’, squeeze and present your boob like a burger so the baby has a full mouth…do this…do that.  Actually whereas positioning to achieve a deeper latch did help reduce the pain somewhat my nipples were still shredded because the tongue-tie wasn’t going away by itself.  It took me 8 long and painful weeks to research for myself and discover my this, too long!  You can read more about my breastfeeding journey here.

Your nipples do take a little time to adjust to your little chomper, but if you are in pain breastfeeding after the first week, don’t wait as long as I did, please see a tongue tie specialist as soon as you can.

I hope I can save you doing some research by giving you some tips:

Examine your baby:

• Lie your baby down, slide your finger (trimmed fingernail!) under your baby’s tongue.
• Sweep your finger from one side of the underside of the tongue to the other, whilst applying slight pressure pushing your finger towards the back of the baby’s tongue.
• If you can sweep your finger left to right without feeling an obstruction then there  is probably no tie.  If you finger is stopped by a tie in the middle of the tongue then your baby could have a Posterior Tongue Tie (PTT).

It is notoriously difficult to identify a PTT so if in doubt, seek help from a professional, details listed in the ‘what are my options’ section below.

Examine yourself:

Tongue ties are generally genetic.  If you baby has one then it is more than likely that you, or your baby’s daddy has one.  When I found out Chaos had a PTT I had no idea at all that I actually had one too!

• Open your mouth as wide as you can.
• When your mouth is at it’s widest try and touch the tip of your tongue to the roof of your mouth
• If you can’t touch the roof of your mouth, you tongue is most likely restricted.

All I can say on this one is that some restrictions obviously cause more problems that others.  I would never have known about my PTT if it wasn’t for the boys.  I was bottle fed as an infant.  I have always been able to lick ice cream.  I occasionally catch my frenulum in between my teeth and bite the underside of my tongue.  My bottom teeth are also all crooked, the ‘eiffel tower’ effect, all pulled in from the tie.  Many also believe you are more prone to migraines and TMJ if you have a tie as basically your tongue is pulled down, which in turn pulls your jaw down and it effects your whole jaw, neck and shoulder area.

What are my options?:

1. NHS or private?

• NHS:  See your infant feeding co-ordintor at the hospital.  Some hospitals have breastfeeding groups run by the infant feeding co-ordinator, with others you have to make appointments.  If you don’t know who to contact, ask your midwife to point you in the right direction.  In my experience there is no point going to your doctor, unless you already have some sort of referral, also available from La Leche League (see details below).  You should then be referred to a tongue tie clinic at your local hospital.  We had our boys ties divided in Hastings and Kings College London.
• Private: Check with the Association of Tongue Tie Practitioners for your nearest, qualified professional.  I would recommend also choosing a practitioner who is a Internationally Board Certified Lactation Consultant (IBCLC), or one that offers support from an IBCLC.  To become an IBCLC you need to pass several exams and know your stuff when it comes to breastfeeding.  If you are paying for a division, it is worth paying for a expert who can also help you with breastfeeding advice and give advice managing your supply and positioning.  We used a private practitioner from Kent and London for around £150 (2013+2015).  Divisions of reattachments should be done for free.

2. Tongue tie division

• Scissors: The traditional method of dividing the tongue tie. The baby is usually swaddled and the head secured, the practitioner will use blunt ended scissors to snip the lingual frenulum.  There is little or no blood and you feed your baby straight afterwards.  If the baby is older, or if the procedure is on a child or adult general anaesthetic can be required.
• Laser:  Using a laser to divide a tongue tie is really popular in the United States, not as common here.  The only person currently dividing ties using a laser is Dr Malcolm Levinkind in Harley Street and his own private practise in East Finchley, London I believe this costs over £300.  A much pricier option but some feel that laser is less likely to reattach, read what Dr Bobby Ghaheri’s opinion here.

3. Post division Exercises

• After the tongue tie is divided you may be advised to complete daily or twice daily exercises to ensure that the tongue tie does not reattach.  Open oral wounds want to close, the tongue wants to heal itself.  Both of my boy’s ties reattached, I didn’t do any exercises with my first, I did with my second, so go figure!  Some practitioners insist it is necessary and give you a schedule of aggressive wound management (King’s is notorious for this), others may say it is up to you, or just encourage regular feeding.  To date there is currently no research that confirms either way that post revision exercises prevent reattachment.  Kings College London, who are great advocates of post division exercises are currently undertaking a lengthy study.  Some great information over at Analytical Armadillo and Dr Bobby Ghaheri’s sites.

4. Reattachment:

• King’s quote that there is at least a 4% chance of a tongue tie reoccurring.  Both of my  boys had three tongue tie divisions.  Both boys still have a slight posterior tongue tie.  I know for a fact that on one of my boys his tie was divided, further frenulum buried deep in the muscle at the base of the tongue may moved forward (one theory).  Another theory is that sometimes the tissue simply re-grows.

5. Do your own research:

• As much as some health professionals are well meaning, PTTs are still dismissed and not widely recognised as causing breastfeeding problems.  Arm yourself with facts so that you can challenge and back up your findings with evidence.  I found these websites and groups invaluable:
• Infant Tongue Tie, UK, Ireland & Europe (Facebook)
• Tongue Tie Babies Support (Facebook)
• Dr Bobby Ghaheri, the expert dentist and dad with babies who had tongue ties
• La Lache League, a great place for information, better still if you have a meeting near to you, go and visit, the leaders and groups are fantastic!
• Dr Jack Newman, world renowned expert on breast feeding, he even responds to some emails!
• Analytical Armadillo, a wonderful breastfeeding resource with well researched opinions

Further thoughts:

There is also a huge debate over wether lip ties cause ineffectual painful breastfeeding, but that is a whole other can of worms…

Not all ties cause problems, even if your baby has a tongue tie or lip tie, they may not be affected by it now, or in later life.  I personally would not hesitate in having my babies Posterior tongue ties divided again, but it really is your person choice as a parent.  Just go with your mama instincts and do what is best for you and your baby!

Give yourself a break it is not the end of the world if you can’t exclusively breastfeed.  I made the decision to switch to formula with my first after 12 weeks, as it was too painful to continue and it really worked for us!  However, I am still happily breastfeeding my second at 22 months…and yes he still has a tongue tie.

What’s your opinion?  Were you or somebody you know let down by the NHS? Have you experience of a baby with tongue tie?

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