Thursday, November 29, 2012

Breastfeeding problems? Check inside your baby's mouth!

Today we are so excited to bring you another wonderfully informative post from our local friend and lactation expert Emily Heldt who runs Tree of Life Breastfeeding Counseling in Salem Oregon. Sometimes what some people might consider a "normal" hiccup in breastfeeding might actually be more of an issue. Lip tie and tongue tie are a common problem and today Emily will be explaining common signs and steps to treat it. 

Breastfeeding hurts. My newborn keeps biting me - it feels like she has teeth!
My nipples are cracked and bleeding
We have chronic thrush
My baby has a short tongue
I’ve had chronic clogged ducts and mastitis
My baby has reflux, colic, fussiness and gas
My baby isn’t gaining enough weight
My baby sleeps through most of the feedings
My baby can’t latch or can only latch with a nipple shield
There is a clicking sound during feedings
Baby chokes a lot during feedings
I’ve always had difficulty with supply
My milk supply “dried up” when my baby was 3-4 months old
Once her teeth came in, I had to wean because it was so painful
Everybody says things are fine, but something just doesn’t feel right
Do any of these sound familiar? Have you ever examined inside of your baby’s mouth?
All of these things can be linked to a lip tie (LT) and tongue tie (TT), which usually come together. Most of us have frenulums in our mouths, which are pieces of tissue that help anchor our tongue or lip. Having a frenulum isn’t a problem unless it is tight enough to restrict normal function.
LT/TT can be very frustrating and very complicated. What can make it worse is that many providers, including IBCLCs, ENTs and pediatricians may have never heard of LT/TT or may only look for the more classic heart-shaped TT when there are several different types (including posterior tongue ties that can be incredibly difficult to spot) that can cause restriction and lead to problems with breastfeeding. What I often see in my practice are moms who have seen multiple providers, tried various things and breastfeeding still isn’t going quite right. I recently saw a mother who had seen 6 lactation consultants before me as well as their pediatrician who all said there was no LT/TT when in fact her baby had a significant one.
Historically, ties were snipped often right after the birth by midwives or in the nursery without the parents even knowing that it had been done. As we got away from breastfeeding being the norm, knowledge on ties kind of fell by the wayside.
LT/TT can impact each mom and baby differently. Some babies may not be able to latch at all while others seem to do okay for a while. Babies are incredibly smart and can sometimes compensate for their inability to feed well by developing different habits, but often these compensations lead to other problems (lip blisters, easily exhausted at breast, painful for mother, biting, etc.) or they may only be able to compensate for so long until it becomes obvious that they aren’t breastfeeding as well as they should be.
Outside of breastfeeding, there are many things that LT/TT can also impact – speech, reflux, palate development, need for orthodontia work due to crowding or diastema (space between teeth) plus lots more.
So what if your baby has a LT/TT? It is important to know that there is no one magic treatment; however, a procedure where the frenulum is either clipped by scissors or lasered is an important part of normalizing function. My favorite resource to connect families to is the Tongue Tie Babies Support Group on Facebook. This is an amazing group that maintains an up-to-date listing of LT/TT knowledgeable providers who clip or laser frenulums all over the world. They also have files on pre and post treatment recommendations that include supportive homeopathy and bodywork. If you haven’t already, find a local IBCLC who is knowledgeable about the different types of ties who can evaluate in person what the ties look like and how they function, assist with latch, discuss resources in your area and help with suck training.

Thank you Emily for this great post and link to resources that may help a few mama's that are struggling with breastfeeding with little improvement. As Emily suggested if things don't feel right seek local help. 

Emily Heldt, IBCLC is a former doula and homebirth midwife who now works as a lactation consultant near Salem, Oregon. She teaches childbirth preparation and breastfeeding classes for families as well as classes for medical providers on how to better support breastfeeding mothers and babies in their practice. She is passionate about early identification of LT/TT and has recently started teaching classes to help other providers recognize them. For more information, check out Emily's site for Tree of Life Breastfeeding Counseling at or on her Facebook page