Midwife & Breastfeeding Consultant

Breastfeeding and tongue tie

Posted on April 11, 2013

Breastfeeding is meant to be a pain free and enjoyable experience for both mum and baby.   However, some women experience pain with breastfeeding right from the very first feed making breastfeeding anything but enjoyable.   Pain with breastfeeding is always a sign that there is a problem and it needs to be addressed promptly with skilled breastfeeding help.    Most issues to do with painful latching can be resolved by a lactation consultant helping the mum improve the latch.  However, sometimes the latch looks great but still be causing pain to the mum!   In this situation it is possible that the baby has a tongue tie. 

 

A tongue tie occurs when the long, thin piece of tissue under the tongue, the frenulum, is not as stretchy or as long as it should be.  The frenulum should be thin and stretchy allowing the tongue to move without restriction past the lower lip, this movement is to facilitate breastfeeding and speech. When a baby has a tongue tie their frenulum is actually short and tight and this prevents the baby from breastfeeding properly as the nipple will be compressed (squished!) whilst breastfeeding and this in turn, causes pain.

 To assess if a baby has a tongue tie the lactation consultant will observe a breastfeed and examine the baby’s tongue movements.  If there is a tongue tie she will make recommendations to improve the latch and also, if needed, refer the baby to a doctor or dentist who specialise in a procedure called a frenotomy.  A frenotomy involves cutting the tight frenulum with sissors or laser and this will allow the tongue to move freely and facilitate breastfeeding.   There is no general anaesthesia required and it takes less than a minute to perform.  Once the frenotomy has been carried out the baby is put onto the breast immediately and often the mother will notice that the pain has decreased or gone away entirely.  As well as causing painful breastfeeding, tongue tie can also cause problems such as slow weight gain, very frequent feeding, unsettled baby and mastitis. 

The information about tongue tie and how it affects breastfeeding is relatively new in the medical literature and often health professionals may not realise or even recognise that a tongue tie can have such a negative impact on breastfeeding.  Most of the up to date information is coming from the UK and US, for more information go to the links section of my website: www.breastfeedingconsultant.ie.  

To illustrate how tongue tie affects breastfeeding and how frenotomy can help resolve the problem  I have asked three  mum’s to tell their story with tongue tie and breastfeeding .   Ursula is a second time mum with baby Hannah, Norma is a speech therapist her son Finn is her first baby, Ursula is a s and Miriam is a GP and her daughter Sarah is her first baby.

What problems were you experiencing with breastfeeding that led to the diagnosis of tongue tie?

Ursula :  A 'funny' latch. My nipples were sore, I had really bad thrush and Hannah never fed for more than a few minutes at a time. She also made a slapping sound when sucking and tended to slip off. Everyone around me said the latch was perfect and I was imagining it but I was adamant something was wrong

Norma: From birth, it was difficult to latch my son on to breastfeed.  When we came home from hospital the difficulties continued but the pain I felt when feeding him increased.  I expected some discomfort in the early days as family and friends had also experienced this and gone on to successfully breastfeed but I began to worry when the pain got worse instead of better and I developed an infection.  When Finn was nearly two weeks we went to Clare Boyle’s breastfeeding clinic.  Clare examined Finn’s mouth and closely observed him feeding and agreed, as I suspected, he had an anterior and posterior tongue-tie. It was actually a relief to know there was a reason for the continued intense pain and why I found it so incredibly difficult to successfully latch Finn on to breastfeed.

Miriam:  Very frequent feeding with Sarah latching on anything up to 30 times a day.  She would feed for about 20 minutes and then fall asleep at the breast, wake after 20 minutes and need to feed again. This happened from birth and she was still feeding as frequently at 10 weeks of age (frenotomy carried out then at 10 weeks). Fortunately I didn't experience any physical symptoms, apart from fatigue! 

 

How did you feel about the frenotomy before you took the baby to have it done?

Ursula:  I wanted no part of it! In my hormonal blur, I wanted to just stick at it through the pain for as long as I could, then give up, I just didn't want to put her through it. Thankfully my husband was thinking straight and we went ahead with it. 

Norma: Naturally we wanted to ensure it was a safe procedure for Finn.  As well as the information Clare provided regarding the frenotomy, we researched the procedure ourselves.  We knew beforehand he would not require an anesthetic and having it carried out at his very young age was preferable.  We also agreed having the frenotomy carried out would give us the best opportunity to continue breastfeeding.

Miriam: I was apprehensive about having the frenotomy done, and as Sarah was thriving and gaining weight well, I questioned whether it was necessary or not. I was concerned about carrying out a procedure on her that may not be needed. But given the still very frequent feeds at 10 weeks, and reading up more about tongue tie, I felt it was definitely affecting her ability to feed well and decided to proceed with the frenotomy. 

 

How did you find the procedure? 

Ursula: Dr. Roche was brilliant, so kind and understanding. It was super fast, Hannah gave one cry after it was done, but fed straight away and slept happily all the way home. 

Norma: Finn had the frenotomy carried out when he was four weeks old and it was over in seconds.  He cried when the consultant initially examined his mouth to confirm the tongue-tie but the snip itself was very quick and I breastfeed him immediately afterwards.  That breastfeed was the most comfortable I had felt since Finn’s birth and Finn was able to suck for a continuous period without needing to be relatched again.  It was bliss! 

Miriam: I found the procedure extremely straight forward and very, very quick. The consultant explained everything in detail beforehand and he allowed plenty of time for questions. We were able to remain the room while the procedure was done which I found reassuring. Sarah was swaddled in a blanket by the nurse, and the doctor quickly snipped the tongue tie using a sterile scissors. Sarah cried for 2 or 3 seconds and I latched her on and she fed straightaway and she was very calm and relaxed. There was a very small amount of blood, which stopped once she started feeding. She then slept in the car on the way home. The whole procedure from start of swaddling to Sarah latching on to feed took approximately 30 seconds. 

 

Did the frenotomy improve the breastfeeding problems?  If so,  how soon afterwards?

Ursula:  Definitely. When I fed her to comfort her immediately after the procedure, there was a noticeable difference in her latch.  Within a week it was very good and two weeks perfect. My thrush finally cleared up and all pain disappeared. Hannah started feeding for longer and more sleep was had by all!

Norma: It took a week after the frenotomy to tweak how we fed and to make each feed easier for both of us.  This was perfectly normal as Finn was learning how to move his tongue and use his tongue to breastfeed.  When Finn was five weeks, we were happily breastfeeding and haven’t looked back since!

Miriam: The feeding problems definitely improved. As I hadn't been experiencing any pain, I didn't notice any immediate change. But after about 7-10 days it was obvious that her feeds were becoming much more spaced out, and she was able to go for up to 2 hours between feeds. She seemed to now feed very efficiently for 15-20 minutes and was satisfied after a feed. She's now 6 months old, it takes her 10 minutes to feed, and feeds every 3-4 hours during the day.   

Are you glad you had the frenotomy done?

Ursula:  Absolutely.  Although Hannah was off form for the 48 hours after it and we hadn’t been told to expect that so I did worry that we had made the wrong decision but now I know how upset I would be now if I had given up breastfeeding  over such a simple procedure.  

Norma:  Absolutely! Breastfeeding is important to my husband and I and we wanted Finn to have every opportunity to experience the health benefits it brings to a baby.  Having the tongue-tie released was an effective solution for a minor issue but an issue that almost ended our breastfeeding journey.

Miriam: I'm delighted we had the frenotomy done! I feel it has made a huge difference to Sarah in terms of feeding more efficiently and being much more satisfied after a feed. It has made breast feeding much easier and more enjoyable for me as she no longer needs to feed so frequently.

 

Clare Boyle is midwife and lactation consultant in private practice in Cork.  She teaches a Preparing for Breastfeeding class for pregnant women and is available for breastfeeding consultations in her clinic she can be contacted on 087 4198764 or  www.breastfeedingconsultant.ie

 

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