Wait! Maybe it's not tongue tie!
April 15th, 2019
Disclaimer: I am a firm believer that tongue tie is a very real and often missed diagnosis that can have dramatic negative effects on the nursing relationship. This purpose of this is not to downplay tongue tie, but to explore other reasons for nursing difficulties often attributed solely to tongue tie.
Please note, oral restrictions can never be diagnosed via picture. Form (how it looks) and function (how it works) are two separate things and a picture cannot tell you how a tongue functions. Please see an IBCLC if you are experiencing any of the following symptoms.
It’s 2 am. You’re exhausted. Your nipples hurt. Your baby is screaming and, when you do get him latched on, he’s pulling off and crying after a mere minute. He clamps down so hard before he does that you both end up crying. There has to be a reason.
So, what do you do? You google everything you’re experiencing and you find a list that looks like this:
Symptoms for parent:
- Sore Nipples
- Plugged Ducts
- Creased Nipples
- Recurrent Mastitis
- Concerns about milk supply because baby is always on the breast
Symptoms for baby:
- Clicking sound while nursing
- Inability to latch or maintain latch
- Poor weight gain
- Fussy, cries a lot
- Dribbling milk while drinking
Thrilled to find a list that is mirroring what you are experiencing, you hear the two words that many parents who are also googling at 2 am see: TONGUE TIE!
So, what does this mean? What do you do?
First of all (and if you are a client of mine, you will laugh because it is seriously my only parenting advice, ever): stop googling. Please, stop googling. Email me and we can chat about your symptoms and goals.
But, if you’ve already gone down the rabbit hole, here are just a couple of reasons that babies might experience any or all of these symptoms. Could it be tongue tie? Absolutely, 100% it can. Is it tongue tie all the time? Absolutely not!
Structural issues can cause:
- Painful Nipples
- Creased Nipples
- Inability to latch or poor latch
- Dribbling milk
- Clicking noise
Babies who have muscle tension can often have a difficult time feeding. Tension on one side of the neck, for example, can lead to asymmetry and tension throughout the whole body. Anyone who has woken up with a sore neck can vouch for how difficult it makes life.
This type of tension can carry into the muscles in the face and jaw. Due to this, baby can have a hard time opening his mouth and, if he does, will often clamp down because it is too awkward to maintain a position that hurts.
These are the babies who chomp nipples, cannot open their mouths wide, slip off out of a decent latch, prefer one side over the other, are “better at night or when they are basically asleep” (when everything is more relaxed), and who fuss a lot. They are also the babies that tend to do “well” on one side but refuse or scream at the other breast. They also have a tendency to dribble milk out of the corner of their mouth because their mouths are asymmetrical, causing an off centered latch and a gap at the corner of the mouth.
This gap can cause intake of air while nursing as well, which can contribute to gassiness and reflux-like symptoms. It also contributes to the clicking noise.
Cesarean or an assisted (forceps or vacuum) births, pushing for longer than 2 hours, one sided hip pain late in pregnancy or an asynclitic (crooked head) presentation are all reasons that can contribute to this tightness. It can be very helpful to be seen by a chiropractor, craniosacral therapist or a physical therapist if your pediatrician thinks it is warranted. An experienced IBCLC will be able to notice this during the oral exam and assessment portion of your visit.
Overactive Letdown can cause:
- Clicking Noises
- Dribbling Milk
- Damaged Nipples
- Pulling off frequently
What I so lovingly call “firehosing,” overactive let down and the usually accompanying abundant supply can be a blessing a curse. We like to see babies gain weight, but these can be the absolute butter ball turkey babies. They gain weight like they are trying to win a competition but they are fussy at the breast. They suck for a short period, then they start spluttering and gagging as the milk let’s down. They pull off to try and take a break but get frustrated because they really are hungry. They dribble milk to try and keep up and they are known to chomp right as let down happens to try and control the flow. Specific position changes, burping frequently, and clinically managing oversupply can help!
A poor latch can cause:
Nearly all of these symptoms!
Don’t ever let anyone tell you that our latch “looks ok.” How it looks means nothing if it hurts or if you are having issues with your supply or baby’s weight.
Even if there are no structural issues or you aren’t firehosing all over the place, a poor latch is the number one reason I see painful nipples by a long shot.
It seems overly simplistic that something as “simple” as positioning can alleviate a lot of issues with pain, but it always where I start when assess a nursing session.
So what do you do?
Call an IBCLC! If you are having any of these issues, you shouldn’t have to suffer. Breastfeeding SHOULD NOT hurt.
Please do not get a diagnosis online and then immediately go to get your baby revised. There has been a very large uptick in laser providers doing revisions and some will laser even when not clinically warranted. If a tie wasn’t the issue to begin with, unnecessary revision will just be another set-back.
I personally have a hierarchy of treatment options where I start with the least invasive measure for the case at hand. My recommendations depend on anatomy of baby and breast, age, weight gain pattern, pain or discomfort for the nursing parent, and overall goals for nursing. Care plans are a collaborative endeavor and I respect all decisions. If you do not want to revise for whatever reason (personal, financial, etc), many restricted babies CAN learn how to nurse effectively.