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If you and your newborn have had any problems nursing, such as pain, a poor latch, or poor weight gain, there’s a good chance that your baby may have a tongue-tie.
Tongue-tie is fairly common in infants. My lactation consultant said that in the mothers she visits who are having nursing problems, a very large percentage of them have a tongue-tie.
I found that I read lots of blogs on breastfeeding in which a lot of mothers said they had their infant’s tongue-tie revised. But, when my own baby was diagnosed, I had no idea what long road lay ahead of me.
This is what you can expect if you decide to get your own child’s tongue fixed!
Is the Tongue-Tie Diagnosis a Fad?
When I told my pediatrician that our LC recommended that we have our daughter’s tongue-tie released, he scoffed at me, and said something along the lines of “All that tongue-tie stuff is just a fad, I’m seeing more kids than ever before diagnosed these days.”
I love my pediatrician, but he is a bit old-school.
A Brief History of Tongue-Ties
The thing is, tongue-ties are not a new problem. In fact, they’re an ancient problem! There are recordings in ancient Egyptian writings instructing midwives to “make an incision if a string is found under the tongue.”
This makes sense if you think about it – if an ancient baby had extenisve trouble breastfeeding, they would die. Formula, bottles, and breast pumps hadn’t been invented yet – a baby was either going to feed via its mother or a wet nurse, but either way it had to breastfeed.
It wasn’t just the ancient Egyptians that worried about tongue-ties. Supposedly, midwives used to check for tongue-ties at birth, and would keep one fingernail long and sharp to cut the tongue-tie immediately if it was spotted.
With the formula boom of the 1950s, most women and pediatricians likely didn’t give a thought to breastfeeding problems. And why would they? Pediatricians had relationships with formula companies, and most recommended formula over breastfeeding. Formula was actually considered superior to breastfeeding and mothers were told to feed their babies “scientifically.” (You can read the fascinating/nerdy history of breastfeeding and tongue-ties, where I got all this info here and here!)
Breastfeeding steadily declined until the 1970s when several groups were formed to promote breastfeeding. It wasn’t until 1990 that the AAP put forth an official recommendation to breastfeed infants.
So you see, the majority of infants after the 1950s were being formula fed from the start. For those that were breastfed initially, if there were any nursing issues, her baby’s tongue wasn’t examined; instead, she switched the baby to formula. Even if the tongue-tie was recognized, most doctors weren’t willing or knowledgeable on how to correct it.
Modern Day Tongue-Tie Knowledge
Now, we live in a day and age in which breastfeeding is encouraged and promoted from medical professionals and there is an abundance of breastfeeding resources. Dare I say it, but breastfeeding is even trendy now. Mothers recognize when there is a problem, and lactation consultants help diagnose the issue as a tongue-tie. All of the tongue-tie information that was lost during the formula boom is resurfacing.
Medicine has also progressed significantly such that we have a greater understanding of the effect tongue-ties have on breastfeeding. The first reliable study on how tongue-tie affects latch quality was published in 2008 using ultrasound technology.
So is the tongue-tie diagnosis a fad? No, I certainly don’t think so. The increase in diagnosis is likely just a result of a more educated public and well-trained lactation consultants.
Read more from a tongue-tie expert, Dr. Ghaheri: Diagnosing Tongue-Tie in A Baby is Not a Fad
Does Your Baby Have a Tongue-Tie?
Before you even bother reading the rest of this post, is it even relevant to you? Does your baby have a tongue-tie?
If you have any suspicions at all that your baby is tongue-tied, please have them evaluated by an IBCLC. They are the only ones qualified to give you a proper diagnosis.
Tongue-Tie Diagnosis in the Hospital
Unfortunately, you cannot rely on the labor and delivery staff at the hospital to diagnosis your baby. Nurses at the hospital do not routinely check for tongue-ties, and even if they did, they likely are not properly trained to do so. Even the lactation consultants at the hospital are usually not board-certified.
Sadly, there are also a lot of politics involved with lactation at hospitals. Many hospitals throughout the country actively prohibit the diagnosis of tongue-ties at birth. I’m not sure why this is exactly, but I have heard this from several resources, and you can read about it here.
While pediatricians are medical doctors, they have not been trained extensively on lactation and the anatomy of the tongue. There is no accreditation system in place for doctors interested in breastfeeding; any doctor who is interested in breastfeeding is responsible for staying on top of current medical information.
Some pediatricians, like mine, might recognize the tongue-tie but say it is not necessary to get it fixed. (Keep reading to learn why this is not true!) Since he has been practicing medicine since the 70s, even though he is very supportive of breastfeeding moms, he may not have read the ultrasound study from 2008, or any of the other literature on tongue-ties.
Some might diagnose the problem incorrectly as a short tongue. Others may diagnose the issue as reflux, cholic, gassiness, or failure-to-thrive, which are all symptoms of a poor latch rather than a diagnosis.
Essentially, doctors don’t know what they don’t know when it comes to this subject. You can’t assume that your doctor will alert you to a breastfeeding issue. Trust your gut as the mama: If you suspect there is a problem, there probably is, and an IBCLC is the only one qualified to help.
Anterior vs Posterior Tongue-Ties
Finally, though you may be tempted to look under your baby’s tongue yourself, you should still seek the help of an IBCLC. There are two types of tongue-ties; anterior and posterior.
Anterior tongue-ties are the ones you may be familiar with – they are visible to the naked eye, cause the tongue to be heart-shaped, and you can see the string attaching the tongue to the bottom of the mouth.
Posterior tongue-ties occur when the lining of the tongue grows over the frenulum, or the string attaching the tongue to the bottom of the mouth. So, though the baby is tongue-tied, there is nothing obviously visible to the naked eye.
In all cases, see your IBCLC! You will want to work closely with one anyway throughout the process to teach your baby how to breastfeed correctly if they are diagnosed. If they don’t have a tongue-tie, that is excellent news, and you will be given peace of mind. If they do, you will be taking steps towards a happier, healthier baby.
Should You Get the Tongue-Tie Fixed?
If your baby has been diagnosed with a tongue or lip tie, should you bother getting it fixed? After all, even if you’re passionate about breastmilk, can’t you just exclusively pump? Do you have to see your baby go through the pain of getting their tongue clipped?
I hate to break it to you, but absolutely. The tongue-tie affects much more than a baby’s ability to breastfeed.
If your child also has a lip tie, which they often will if they have a tongue-tie, this can cause a large gap in their teeth. At the least, this is thousands of dollars of braces to repair. The tongue-tie can also result in a gap between the two lower teeth, as well as the need for extensive dental work, as the tongue does not properly cover the teeth in saliva, resulting in tooth decay.
Once your baby begins eating solid foods, a tongue-tie can impair chewing and swallowing, increasing the risk of choking.
Tongue-ties also affects speech; children will likely have trouble making the d, l, r, n, s, t, th, and z sound.
Are you still not convinced? In older children and adults that have untreated tongue-ties, the entire body is affected. Because the muscles of the tongue are connected to so many other muscles throughout the head and neck, when the tongue is restricted it causes tension throughout the rest of the body.
In children, this tension can manifest itself with symptoms misdiagnosed as ADD and ADHD. In adults, this tension can cause chronic headaches or migraines, neck tension and tightness, snoring, or sleep apnea, just to name a few.
Regardless of how you choose to feed your baby, it is best to get the tongue-tie addressed while they are young, can heal quickly, and will have no memory of the procedure to prevent larger issues later in life.
The Frenectomy Appointment
When the tongue-tie is diagnosed by the IBCLC, they will likely have a list of physicians they recommend who can do the procedure. You will want to go to the office of someone who specializes in the procedure, not a primary care doctor as they might not be familiar with the anatomy of the tongue.
Would you take your baby to a primary care doctor for eye-surgery? No, of course not, because they haven’t been properly trained. The same applies to the tongue – take your child to someone who is specialized.
You may hear the tongue-tie fix also called a frenectomy, tongue-tie revision, or tongue-tie release.
When my baby was diagnosed, we were given two options for treatment: A laser procedure, or an old-fashioned scissor procedure.
The laser procedure
While the scissor method seemed kind of gruesome to us, the laser method was not covered by insurance as it was considered cosmetic surgery. The laser procedure takes place in an oral surgery office and can cost upwards of $3000 dollars if not covered by insurance.
So while I did not personally experience the laser approach by an oral surgeon, I do know the following information from my IBCLC and the resources she provided:
- A laser is used to slowly laser-away the extra skin cells under the tongue.
- The laser procedure takes longer than the scissor procedure, but has a delayed onset of pain and does not require any local anesthesia.
- Parents are not allowed to be in the room with the laser.
- The outcome of the laser procedure and the scissor procedure is the same; one is not better than the other at treating the tongue-tie.
- The healing process of both procedures is the same.
The scissor procedure: My personal experience
At our appointment, the physician, who was also an IBCLC, confirmed the diagnosis that our daughter had a posterior tongue-tie.
First, they swaddled her to keep her calm throughout the procedure. Then, they applied a numbing gel with a q-tip under her lip (she was also lip-tied) and under her tongue. The numbing gel prevented her from feeling the injection of local anesthesia for pain control that came next.
After all of the preparation, the doctor made the incision under the tongue and lip with her scissors. This was the part that was the worst for me; sometimes I actually think it would have been nice to not be allowed in the room. They asked me to hold her head still for the procedure but I made my husband do it, I admit.
After they finished the frenectomy (a.k.a. after they cut her tongue), they stopped the bleeding, and then immediately had me try to breastfeed. The feeding helped calm her down, but the feeding was also so that she would immediately begin to learn how to use her new tongue.
The entire appointment took about 30 minutes start to finish. It was slightly traumatic as a new mother, but looking back, I’m so glad we did it. It was the first of many times I had to hear my baby cry even though I was doing what was best for her (anyone who uses the NoseFrida out there knows what I mean by this!).
Honestly, the aftercare is in many ways worse than the appointment itself. This is generally agreed upon by all of the other parents I’ve talked to who’ve undergone a tongue-tie revision with their child.
The frenectomy creates a diamond-shaped wound under the tongue. Because the cells of the tongue regenerate so quickly, if you were to cut the tongue but not provide any sort of care afterward, the tongue would heal back exactly the way it was before.
This means that after the frenectomy, you have to stretch the baby’s tongue every 3-4 hours to ensure that it heals correctly. Yes, even in the middle of the night.
This is the worst part of the whole process because it makes the baby upset over and over, even at 3 am when neither of you wants to be awake. I’m not going to try to explain how to stretch the tongue, as it’s complicated and you should listen to the instructions given to you by the doctor who does your procedure. But, we did acquire some tips and tricks throughout the long six weeks of stretching:
- Coconut oil is a great lubricant for the stretches. Rub some on your two index fingers and it will help you get them in the right place under the tongue.
- Unless the baby gets too upset to feed afterward, always do the stretches before the feeding. This will continue to help them learn how to use their new tongue anatomy.
- You will drive yourself crazy if you try to stick to the clock. Babies should be eating every 3 hours as newborns anyway, so if you stretch the tongue before every feeding, you will be doing plenty. The key is not to let too much time pass between stretches, but there’s no such thing as stretching the tongue too often. So, rather than being a slave to the clock (ending up in a situation where you’ve just fed your baby, and they’re happy and content, but you have to wake them up and make them mad by stretching their tongue), just stretch their tongue before every feeding.
Fortunately, after four weeks the stretches take place only once every 6 hours. It will feel like a huge breath of fresh air!
After what will seem like weeks and weeks of stretching, you’re done! You’ll likely have a final follow-up appointment with your doctor to make sure that everything healed correctly. (This is why the stretches are so important – they may have to make another incision if the tongue-tie returns.) Some doctors may have you send a picture of your child’s tongue rather than coming into the office.
Be sure that you’re working with an IBCLC after the procedure to make sure your baby is gaining good weight and to work through any other issues that may come up along the way.
I hope this was helpful to any expecting, new, or veteran moms out there. If it was, please pass this along to other moms who might need the help!