You make me tongue-tied

For those who wondered where Monday’s post was, do not panic there was a post – I just managed to back to the future it and post it as if posted on Saturday, so it was there but very slightly hidden by the mists of time. So here it is, back in its rightful place – apologies for those psychologically scarred by the seeming absence of a post!

When Elphie made it back to her birth weight, I decided the time had come to breastfeed properly and move away from being a bizarrely-shaped bottle accessed via the nipple shields to mother-baby direct breastfeeding action.

So I went along to the breastfeeding drop-in session at the health centre. This was a regular weekly session run by a midwife / lactation consultant and like the Hotel California it seemed it was so good that once you’d gone once you would never leave due to the camaraderie and moral support provided by a group of mums getting together once a week and breastfeeding while quietly and informally sharing their experiences. Very nice it was too and plaudits to the NHS for providing such a thing.

When my turn came for attention from the midwife, I explained my problem and she examined Elphie and said that my problem was probably not flat nipples but more that Elphie was tongue tied. This surprised me as at least one of the midwives or health visitor who had come to our flat had checked for tongue tie and declared her untied. But it seems Elphie has the posterior type and that’s harder to spot.

Tongue tie, or ankloglossia, is a congenital condition where the tongue’s movements are restricted by short lingual frenulum which is a membrane connecting your tongue to the floor of your mouth.

The incidence of tongue tie is in the eye of the beholder but is thought to be between 4-11%.

The difference between anterior and posterior tongue ties is that anterior ones connect to the front of the tongue and posterior to the back (with the lingual frenulum attached to the floor of the mouth – the closer to the front the more severe as far as I can work out). The following images from Catherine Watson Jenna show the difference:

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The main problem with tongue tie is that it can impede breastfeeding for some babies. There is a significant list of breastfeeding problems that can be attributed to tongue tie (this is the list from my health centre):

  • “Lots of wind and hiccups
  • Fussing at the breast after the initial let down has passed
  • Air being sucked in when the mouth does not seal properly
  • A clicking sound during feeding
  • A biting/grinding feeling during feeding leading to painful nipples
  • Bruises on the areola
  • A squashed nipple like a lipstick – a white crease across the nipple; nipple trauma
  • Dreading every feed due to the pain from cracked nipples
  • Noisy breathing / snoring sounds during sleep
  • Frequent breaks in feeding
  • Falling asleep at the breast after the initial let down
  • Sucking for a few minutes and feeding frequently
  • Cheeks or edges of the mouth sucked in
  • Restless baby who has difficulty sleeping and wakes frequently for feeds
  • Failure to gain weight or slow weight gain
  • The nipple slips and baby clamps or bites
  • Mastitis (blocked ducts)
  • Small mouth gape
  • Unable to attach at the breast
  • Unable to stick tongue out
  • Nipple white / cold after feeding
  • Tongue comes forward but retracts when touched
  • Opens mouth to attach but shakes head without attaching
  • And the list on milk matters is even longer!

    Because I went almost directly to nipple shields, this has hidden the problems with Elphie’s feeding. For the past week I have tried to return to normal feeding but 9 times out of 10 this results in her delatching and squawking in horror causing equal frustration for her and me.

    In terms of longer term effects, as this article from ASHA Leader explains as the tongue develops it lengthens and narrows while at the same time the lingual frenulum “recedes, stretches and may even rupture” so the restricting effects of tongue tie may diminish or disappear by the time the child is five. If this doesn’t happen then longer term effects can include halitosis, problems with licking (icecreams for instance) and snogging, and there are unconfirmed links (that that article derides) to speech problems.

    The treatment for ankloglossia is a frenulotomy where the frenulum is cut with a pair of sterile surgical scissors, often without local anaesthetic but always with a return to feeding straight away as the best comforter for babies and the best treatment for the cut due to the magic antibacterial and anti-inflammatory properties of breast milk. Back in the day tongue ties were apparently fixed at birth by the midwives with a sharp finger nail!

    The risks are small – of it not working (5%) or of infection (0.01%), although sometimes another frenulotomy is required later on if the issue is not entirely resolved.

    I have been really reassured by this post on parentdish about a posterior tongue-tie, a bit like her I am unsure whether Elphie’s tongue tie is bad enough to put her through the procedure – she’s managing on the nipple shields, is if just selfish of me to want her to feed normally? Is it more for my convenience – not having to remember nipple shields, not having the constant sterilising and worrying that I have one in the solution ready for the next feed?

    The lactation consultant explained that her tongue-tie is 60-70% i.e. it is attached quite near the front of her mouth and that the procedure is likely to make a significant difference for her. Equally there are reports of babies sleeping through the procedure so it can’t be that bad. Plus, I would feel really bad if she developed halitosis or a speech impediment later on and the tongue-tie was the cause.

    It is really hard to know what is best for your baby – should nature be prioritised over medical intervention in all cases? Do we interfere too much?

    I just hope we’re making the right call in going through with it.

    For anyone interested in a more in depth look at this issue, the following article from milk matters is a good overview.

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