Tongue ties occur in about 5% of the population in varying degrees of severity. They are genetic "midline defects" - things that go a bit wrong when the body is forming, and can run in families. Sometimes they have no effect. Other times they can cause difficulty with breastfeeding for infants, difficulty with speech or eating for children, and speech and muscle tension issues for adults.
A number of things made me suspect that perhaps Dom was troubled in this area, starting about three weeks ago.
* When brestfeeding, his latch was lousy and seemed to be getting worse.
* He didn't produce enough suction to retain a pacifier or a nipple without help.
* His top lip is supposed to flare out when nursing. His wouldn't, no matter how much I tried to prod it into position.
* He always clicked, squeaked, spluttered, and occasionally choked slightly while nursing. He didn't have a good seal on the breast and would leak milk from the corners of his mouth.
* He would take in a lot of air while nursing, leading to gassiness, bloating, reflux and general discomfort.
The "problem" was that he was gaining weight well, which is the main medical marker for breastfeeding problems like tongue ties. If there's good weight gain many practitioners assume everything must be fine. But I think he was relying on the strong milk let-down and just "drinking" rather than proper nursing most of the time, and as we get farther out from the birth and my supply is regulating, that's not happening anymore. He started to get frustrated while nursing.
So, research time. I saw an IBCLC at Parenting Now (a weekly baby group) who said she saw enough tissue to warrant an evaluation, and I found out that there's a nationally renown tongue tie expert in Portland, who also released one of my friends' son's ties two years ago - his was spotted at birth. I contacted his office and although the next official appointment was December 1st, he was able to get me in a mere three business days after calling.
Once there, Dom was evaluated:
This shows his lip tie, pulling up the upper lip put so much pressure on the gums that they "blanched" and turned white. There was also a small gap in his gumline from the tension, which you can see in the next photo. We saw that gap at his birth and asked the midwife about it but none of us recognised it as a lip tie.
In about 90% of cases, lip ties are accompanied by tongue ties. Sure enough:
This is called an anterior tongue tie, because the strand under tension is visible in the front of the tongue. An anterior tie is always accompanied by a posterior one, within the body of the tongue. Both need to be cut to allow full motion.
Ties are genetic. As it turns out, I have an anterior tie as well, though not as tight as Dominic's. I always thought everyone's tongue had a strand underneath it like that. If I wanted, I could get it released. I don't see the need at the moment but some adults do get it done.
Once identified, the ties need to be cut. There are two ways to do this - scissors, or a laser. The specialist I chose uses a laser which allows for better precision, less pain during the cut, and less bleeding. The procedure only took about three minutes. He was in enough pain to be crying but after abut five minutes settled down enough to nurse.
During the drive home he was able to eat and sleep normally. I was told that 4-6 hours afterward was when the inflammation pain would kick in, and sure enough at 5 hours post-op he was pretty inconsolable - he wanted to nurse to feel better (and may have been hungry) but nursing hurt. I took the risk of giving him Tylenol/acetaminophen, which we'd been avoiding with the boys due to Martin's allergy, and he was able to fall asleep. We carefully watching him during that dose and the next dose but he shows no signs of allergy. Yay!)
This is day two and for the most part he is comfortable. Four to six times a day I have to massage the wounds in his mouth to prevent them from sticking together and healing incorrectly. That's less comfortable and I'm not sure which of us hates it more. Here are some pictures from the first evening:
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| Site of lip tie release |
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| Site of tongue tie release |
By the first afternoon he was able to open his mouth more and lift his tongue more when crying. He has an overactive gag reflex in the front of his mouth, the doctor said, because that area of the palate was not getting desensitized with tongue movement. I guess that might have caused problems with solids later.
By the first evening he was making more variety of vocalizations, had a more defined upper lip profile, was taking in less air when nursing, and showed interest in lifting his head while on his belly for the first time.
Today was the second day and he's figuring out a little bit of how to nurse more efficiently, but we need to meet with a lactation consultant to help him unlearn some of the habits he's formed. He's already doing better without training.
The hardest part of the whole thing is the series of mouth exercises I have to do with him for the next three to four weeks. Because raw surfaces that are in contact with each other will fuse together as they heal, I have to manually separate them several times a day to prevent reattachment. Imagine someone sticking a finger into your mouth sore several times a day and you'll have an inkling of what poor Dom has to deal with. But he's pretty good about it, and I use a teething gel which helps to numb his gums and take away the pain after a little bit. The numbing does prevent him from being able to nurse afterward, but he's a champ about all of it.
I think getting this procedure done (a frenectomy, as the tissue under the tongue is called a frenulum) was the right choice. Hopefully he will continue to tolerate the exercises, nothing will reattach, and he will be happier for having a freed tongue and lip.
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