Doula NYC | Birth Doula NYC

When Breastfeeding is really painful: Look for lip and tongue ties!

As you know our breastfeeding journey was quite the challenge...

Fortunately, years ago I had met a great IBCLC Barbara Cohen. Barbara introduced me to the concept of lip and tongue ties and how they can affect breastfeeding and showed me how she checks for them.

So when Peanut was born I checked to see if she had an anterior lip tie which she did not but because her latch was so strong I checked for an upper lip tie as well.

As you can see in the above picture, it did attach to the bottom of her top gum and was pulling her lip down. I showed this in the hospital but no one had ever heard of it. However I did not check for a posterior tongue tie (in the picture above, you can see Dr Siegel checking Peanut).

My midwives recommended someone in Nantes, France and we went to see her but she was uncomfortable doing anything since Riley was 6 days old. Meanwhile I was in agony literally everytime I tried to get her to latch... I took Riley to see an osteopath and she had a few sessions which help release tension in her jaw and neck due to her positioning in the womb and birth...

But I was not ready to give up!

I was pumping around the clock and bottle feeding her my milk and since the pain was so strong I got a hold of Dr Bobby Ghaheri on FB and explained the situation to him. He said my symptoms were classic posterior tongue tie problems!!!

So I called Dr Siegel who had the kindness to fit us in as soon as we got back to NYC. He did both releases with a laser. It took less than 5 minutes. He applied numbing cream first and Peanut was able to latch right after and I felt no pain. I thought maybe the numbing cream was affecting my nipples but then I realized that she could move her tongue and that was a different sensation. Before she was just chomping down on my nipple and used force to get milk out. Now things were much more gentle!!!

Later that day she seemed in pain and I kept on feeding her following her cues. It took a few days for her to get used to the new way of latching, milk was flowing out for a while :) and now as you know we are having a great experience!

Read on below for Dr Siegel's input on this all too common cause of breastfeeding issues

Was assessing lip ties and tongue ties part of your original training?

No it was not. Unfortunately the vast majority of medical and dental schools do not provide any in depth education on proper assessment for lip and tongue ties or any other soft tissue oral restrictions (collectively termed Tethered Oral Tissues or TOTs for short.)

When would you say people became more aware of the fact that ties can potentially affect breastfeeding?

This is not a new phenemonon or procedure and the awareness about how tongue ties affect breastfeeding has been documented in ancient Chinese and Egyptian literature/hyroglyphics. The awareness receded with the introduction of formula worldwide and continued to decline in the 60's, 70's and 80's. In the past decade or so as breastfeeding rates have been climbing back up there has been a renewed awareness of how tongue-ties, and also how other oral ties like lip and cheek can negatively affect breastfeeding.

Besides breastfeeding how can a lip or tongue affect a child? And how can it come into play into adulthood?

Breastfeeding is often an easier way to find a tie earlier on due to maternal nipple pain on feeding. They can also affect bottlefeeding, causing inefficient feeding. Many babies struggle in both areas, it's just that oftentimes bottles are easier for the babies to manage and the tie can go undetected.

What we have found, and the research continues to corroborate, is that many of the babies that often have a functional problem related to a tie will often have another problem as they grow and develop if the tie is untreated. We look at patterns in growth and development and function. Many times we will see an untreated tie cause a difficulty with breast/bottle feeding, the next stages in chronological age order is when the baby transitions onto solid foods.

There are many babies that often have a difficult time handling the chunkier types of foods, and this can carry into childhood. Many of these children are often labelled as 'picky eaters' by a healthcare professional, then evaluated by a feeding therapist and found to have a tie!

The next age group typically seen 18-24 months and beyond are speech related issues, usually in the form of a delay or articulation disorder. The next group of children tend to fall into oral habits such as thumbsucking, tongue thrusting, open mouth posture, mouth breathing, (oromyofunctional disorders or OMD's) as well as dental and orthodontic issues.

The issues that plague a child during growth and development do not magically disappear and adults typically have related problems as well.The most significant health risk that has been published with regard to untreated tongue-tie is the predisposition to the development of obstructive sleep apnea and sleep disordred breathing which can have serious health consequences. I often see many adults with TMJ disorders, chronic neck pain, speech issues etc related to untreated ties.

What is the main change people report noticing after an anterior tongue tie release? After a posterior tongue tie release?

Anterior and posterior tongue tie releases are grouped together as the desired outcome and reports for both are the same: improved feeding efficiency, less nipple pain, improved breastfeeding relationship and long term prevention.

And after a lip tie release?

Lip ties often make it difficult to flange the lip and many times the babies can suck in and swallow air (called aerophagia), thereby swallowing it causing excessive gas and potential reflux symptoms which are not alleviated by medications (termed Aerophagia Induced Reflux or "AIR" for short, I have published these findings and presented to the American Academy Of Pediatrics).

How do the majority of people find you?

The majority of people find me by direct referral from another healthcare provider such as a lactation consultant, feeding therapist, speech therapist, pediatrician, dentist. An increasing number of families come from a friend or family referral or from online research/social media recommendations.

What would you tell people who are hesitant to do it?

I think it comes down to understanding the basic risk vs benefit. In medicine we look at the risk/benefit ratio. For this specific procedure the actual risk is very low and both the short and long term benefit is potentially high.

We often compare this procedure to a circumcision in boys, ear piercing etc. The risk of a circumcision is quite high with regard to forming adhesions, infections etc

The true risk of a tongue or lip tie release I have dealt with in my practice is the risk of the wound healing back together (this is generally called 'Reattachment"- although the correct terminology should be scar formation). My current rates of this in my practice are about 2-3%.

Also understanding that you are not 'doing something TO your baby but helping doing something FOR your baby" to help them in the short term as well as be preventive. I typically like to counsel parents and tell them that a small intervention now is a much larger long-term prevention.

Do your research!!! Ask your provider how many of these procedures they have done, how many they do per day/week/month/year?

What their post-operative care is with regard to stretches, working with a team like a lactation consultant/bodyworker? Do they use laser or scissor?

Online resources including Facebook support groups, online reviews of the provider. Online reviews often give insight from other peers who have experienced the provider and procedure.

You can contact Dr Siegel, MD at (631) 465-0300, Barbara Cohen ICBCL at (646) 265-0826 and Emma McCabe, CLC at (347) 703-7851