Breast Feeding, Tongue Tie and Upper Lip Tie
Tongue Tie and Upper Lip Tie ( Tethered Oral Tissues) result in a shallow latch with inefficient milk transfer . A shallow latch will result is a baby biting a mothers nipples, resulting in painful ulceration, blocked ducts, mastitis and slow feeding. Slow feeding tires the baby who will fall asleep mid feed to wake hungry and the process of feeding begins again and can become a painful, sleep depriving treadmill of feed – sleep – feed etc.
LIP TIE and a Shallow Latch
The effect or presence of an Upper Lip is often disputed. Many Dr’s and midwifes are aware of and routinely treat tongue ties with out ever assessing upper lip ties. They may be unaware of the existence of the Upper Lip Tie or they may simply be unable to treat Upper Lip Ties as they cannot be routinely snipped as many tongue ties can. Upper Lip Ties release requires specialised equipment and training.
Upper Lip Ties do exist and a baby should be assessed for their presence if they are struggling to breast feed.
In 2004 The American Academy Of Paediatrics stated
“A baby who cannot flange his /her upper lip because of a tight upper labial frenulum may need to alter his/her nursing position or have it surgically released in order to permit effective nursing. ” click
In 2013 The Journal of Human Lactation stated
“lip-ties must be considered as an impediment to breastfeeding, recognising that they can affect a successful, painless latch and milk transfer.” click
Int Journal of Paediatric Otorhinolaryngol stated in 2015
“Anterior and posterior ankyloglossia (tongue tie) and upper–lip tie, or combinations thereof, were commonly recognised in our study…these oral cavity anomalies may contribute to breastfeeding difficulties” click
in 2016 the same journal stated
” Frenotomy for posterior Tongue Tie and Upper Lip Ties is a simple procedure that can be carried out in an outpatient setting with apparent immediate benefit.” click
THE SHALLOW LATCH
A shallow latch is usually the result of an upper lip tie. If the upper lip is excessively attached to the upper jaw ridge the lip cannot turn out or flange to allow an adequate lip seal around the breast.
Not enough of the nipple will then enter the mouth, this is a shallow latch. A shallow latch will cause the baby to move their head excessively out of frustration as they struggle and fail to find the sweet spot for feeding.
This leads on to a rapid biting action instead of a slow rhythmical suck- breath- swallow pattern. The nipple tends to be bitten. Excessive amounts of air can will be swallowed resulting in slow and inefficient feeding.
TONGUE TIE and BREASTFEEDING
For a baby to draw milk from the breast, they must develop a vacuum, not as previously thought the tongue massaging milk from a nipple. This process has been demonstrated with Ultrasound studies. Confirming that nursing involves the baby generating a vacuum within the mouth using an up and down motion of the tongue.
The palate is dome shaped, The tongue forms a floor to this dome with the nipple between. The edges of the tongue seal against the sides of the palate, leaving a cavity in the middle which the nipple occupies.
The mid-portion of the tongue then elevates and depresses within the oral cavity resulting in the creation of a vacuum. This is how the baby draws milk out of the breast.
The baby pushes their tongue up towards the palate and then depress it, creating a vacuum. ( its a bellows effect in reverse). There is no actual compression of the nipple.
If a baby has a tongue tie, it restricts the ability of the baby to elevate and depress the tongue and therefore it creates a weak vacuum.
This link brings you to a video to demonstrate this process
Please watch the following ultrasound vireo which will demonstrate this vacuum effect
This demonstrates that the depth of nipple insertion into the mouth and the ability of the tongue to elevate and depress are the important factors.
The ability of the tongue to protrude out of the mouth is not in itself a significant factor in assessing tongue tie. It is the upward motion which is important.
SIGNS AND SYMPTOMS OF TONGUE TIE
If a tongue tie is severe enough when the tongue is depressed the tongue is pulled off the palate completely resulting in a clicking noise, the vacuum is lost and the whole process grinds to a halt.
Why do Tongue Tie babies DRIBBLE milk from the mouth?
Milk should be drawn onto the tongue and be transferred to the back of the mouth and swallowed. If the tongue is not cupping or sealing against the palate, milk will fall off the tongue and be seen dribbling from the corners of the mouth.
Why does tongue tie result in LONG FEEDING sessions?
If a baby has a weak vacuum and occasionally looses the vacuum altogether, the babies efforts are wasted and little milk is transferred. This results in prolonged feeding.
Why does lip tie result in a BREAST NOT BEING EMPTY
If the baby is transferring small quantities of milk, the breast will not be emptied before the baby falls asleep out of exhaustion.
Why will a Tongue Tie baby FALL ASLEEP DURING FEEDING
The baby will eventually tire out due to exhaustion and fall asleep. They have not fed properly and will soon wake hungry and want to re feed and at this stage are often full of wind!!! which compounds the problem.
EXCESS AIR SWALLOWED during breast feeding
Lip Tie often accompanies tongue tie. If there is a poor lip seal air is drawn into the mouth and swallowed.
If you are having problems breast feeding the first step is to seek help from a Lactation Consultant or Public Health Nurse.
Difficulties with tongue tie and breast feeding for baby include:
- Shallow or poor latching on resulting in baby becoming frustrated
- Frantic feeding with quick biting movements instead of a slow rhythm
- Feeding will loose efficiency becoming prolonged, with the baby remaining hungry and irritable
- Baby exhausted by feeding, sleeps on finishing feeding to wake hungry
- Excessive dribbling (opinions differ on this point)
- Mothers report a clicking sound as the elastic tongue tie snaps the tongue down inside the mouth when the tongue is attempting to stretch up
- Swallowing excessive amounts of wind (opinions differ on this point) resulting in an irritable baby
- Most tongue ties do not appear to affect speech, but each case must be individually assessed by an appropriate professional
Difficulties tongue tie cause for Mother may include:
- Distortion and or compression of the nipples resulting in pain, damage, loss of tissue
- Painful feeding for mum
- Bleeding nipples
- Ulcerated nipples
- Incomplete milk transfer by baby resulting in engorgement and/or mastitis
- Poor initiation and maintenance of maternal milk supply.
Speech and Tongue Tie
Speech difficulties associated with tongue -tie vary enormously, and speech therapy is advised before surgical intervention to eliminate any other possible problems is advised. Many tongue tied individuals speak very well while others suffer inability to articulate specific sounds which requires lingual (tongue) elevation such as T, D, and N, in rapid speech, stressful situtations and forceful phonation. Following tongue tie release, speech therapy is again advised to make sure the full benefit of the procedure is achieved. You should not view the tongue tie release as a magic bullet but part of a process to correct a speech problem.
Carmen Fernando, a speech-language pathologist based in Sydney, has written a book devoted to this subject and also hosts a very detailed web site which is worth a look. http://www.tonguetie.net
DENTAL PROBLEMS WITH UPPER LIP TIE
Dental problems as a result of tongue and lip tie can normally be corrected in children and young adults when they present and potential dental problems do not warrant a surgical intervention in an infant.
- The reported problems include spacing between the front teeth (Diastema) as a result of the upper lip tie attaching to the dental arch between the 2 upper front teeth and preventing these teeth coming together. This problem can usually be avoided by releasing the upper lip tie usually before the age of 12 years.If the gap is allowed to develop, it can be closed later by removing the lip tie and forcing the teeth together with braces.
- A tight lip tie can make oral hygiene difficult. If the lip tie prevents the lip from rising up away from the teeth it will be very difficult to brush the front teeth. Food and bacteria may also pack under the lip causing dental decay on the upper front teeth. Babies of mothers who breast feed for longer periods are at a higher risk of developing decay on their front baby teeth if there is a lip tie as the milk can rest on the teeth under the lip and rot these front teeth.
Lip and tongue ties when they attaches close to the gum edges can pull the gum off the front teeth. This puts these teeth at risk of gum disease, poor hygiene, dental decay and ultimately the teeth are at risk of being lost.