TONGUE TIED

YOUR BABY Laura’s little girl’s feeding issues were fixed up in one simple procedure

You would think that having breastfed three children, albeit for brief periods, would have made doing it with baby number four a walk in the park. Turns out it was actually harder. As a newborn Emma was latching and she seemed to be drinking well, but I was in extreme pain each time she nursed. My nipples started cracking almost immediately and when I asked the nurses about it they bought me a sample of nipple cream to apply and said it was pretty normal, so I didn’t think much more about it. If only it had worked!

MY BABY HAD A TONGUE TIE!

While I was still in hospital I sent my mom a few photos of Emma and she replied to one of them asking me if Emma was tongue tied. I replied immediately that she wasn’t but I actually had no idea what it was, and I assumed that if there was a problem the paediatrician or the nurses would have picked it up.

Breastfeeding just got progressively worse for me. My nipples were extremely cracked despite having applied various nipple creams and using a nipple shield, and the pain was almost unbearable. My mom stood her ground and was adamant that Emma was tongue tied. In her opinion that’s why she wasn’t latching properly. I was just as adamant that because she was drinking and sleeping well, she was latching just fine and I just had to suck it up. Eventually after crying my way through another feed I looked up tongue tie on the internet. It took me all of five seconds to

realise my mom was right; Emma was in fact tongue tied. This was confirmed by our paediatrician at Emma’s six week post birth checkup.

WHAT DOES THAT MEAN?

A simple definition of tongue tie, officially called ankyloglossia, is a malformation that restricts the movement of the tongue, which is caused by a short lingual frenum – that little flap of skin under your tongue. “A tongue tie is present when the frenulum is attached to the tip of the tongue. Normally the frenulum is far from the tip of the tongue, attaching at a point below the tongue,” explains Laura Sayce, an international board certified lactation consultant. Once you know what to look for, it is actually very easy to pick up. Emma had a little line down the middle of the tip of her tongue, creating a heart shape. There were also other signs:

She would break suction while breastfeeding, making feeds go on for up to an hour at a time.

She made a clicking noise while she fed.

I had severe nipple pain when she latched.

In older children the signs of tongue tie include being unable to stick their tongue out past their mouth, and a tongue that may not be able to touch the roof of their mouth or move from side to side.

EFFECTS ON FEEDING

Breastfeeding is not impossible with a tongue tied baby, says Laura Sayce. “Some babies have no issues from the start, while others can get it right with a little guidance on latching and positioning. It depends on the degree of the tongue tie and the mother’s breasts – medium to small nipples and more elastic breast tissue are found to be better,” she explains.

While Emma was managing to drink enough breastmilk for her growing body, some babies with tongue tie do not get enough nutrition. This can result in a slow growth rate and in turn cause a decrease in your milk supply.

Older kids with tongue tie are likely to develop speech problems, especially in the pronunciation of some sounds.

IN A CATCH 22

Correcting this condition was not as simple as I had hoped, especially after my mother had told me both my brother and I had had ours “snipped” at birth. My paediatrician was happy to confirm that Emma was in fact tongue tied but was not willing to do anything about it. As with anything to do with babies, the professionals are divided about how to go about dealing with ankyloglossia. Our paediatrician was of the school

of thought that feels you leave it until it causes a problem, but she was happy to refer me to an ENT for a second opinion.

It is indeed possible for a baby to thrive while being tongue tied and there are many cases where it does correct itself and causes no problems. This is possibly why many professionals prefer to take the wait-and-see approach.

When I mentioned to friends that Emma was tongue tied, it turned out that a large number of their babies had had it too. Each one had been treated differently and at different ages. Very few had been diagnosed at birth, and in most cases it was the mothers who had picked it up. Nabilah, mom to Zahara, struggled for 12 days. “I finally called my paed and the receptionist suggested I visit a lactation consultant. As soon as I got there and the nurse had a look at her mouth they saw she was tongue tied,” she recalls.

WHAT WE DID

Among the doctors who do correct it, however, there is further division when it comes to when and how to correct it. Some babies simply have their tongue tie snipped in a doctor’s rooms, some have local anaesthetic, and others go under general anaesthetic. The ENT we were referred to puts babies under general anaesthetic, cuts the lingual frenum and puts in a few stitches. He explained his reason for doing this was to ensure that it does not recur, so he basically cuts it enough so that it cannot “tie” again.

Emma was five months old when she had it done. We decided to wait until then for the procedure because she was thriving and showing no signs of discomfort until we introduced her to solids. While she was getting food in, it would take a while for her to swallow it because she couldn’t use her tongue. In hindsight we should have done it earlier simply because she probably would have handled the anaesthetic better. The procedure itself was fairly simple. She was under anaesthetic for about 20 minutes as they cut the lingual frenum, releasing the tongue and giving it more movement, before putting in a couple of dissolving stitches. We were back at home the same day and we stopped giving Emma the pain medication about three days after the procedure. The difference was immediate; the whole shape of her mouth as she sucked her bottle changed and eating solids was so much easier because she was able to take her food in easily.

While I do respect our paediatrician’s decision not to correct this condition, I do think that she should have informed us of it at Emma’s birth so that we could have made a decision about a course of action. Of course, it may not have been possible. “A paediatrician is trained in overall health and is looking for certain things. They may not see baby cry – which is a good time to identify the heart’s shape. Similarly, they may not examine baby long enough on the oral aspects to see that baby does not extend their tongue,” says Laura.

With Emma’s tongue corrected all is as it should be, but it was still not a pleasant experience for either of us. YB

as soon as i got there and the nurse had a look at her mouth they saw she was tongue tied