tongue-tied

What Is Tongue-Tie? Does My Tongue-Tied Baby Need A Frenotomy?

What Is Tongue-Tie?

Tongue-tie or ankyloglossia is when a baby is born with the lower tongue tissue (frenulum), connecting your babies tongue to the bottom of the mouth, shorter or thicker than usual.

Tongue-tie can have some implications for your baby and yourself, especially if you are breastfeeding. It can be fixed with a procedure called a frenotomy.

My firstborn, Ayla, was born both tongue and lip tied (quite ironic considering how much I love to talk). It took us a few days to work this out, and we underwent a frenotomy procedure to fix her lip and tongue-tie.

After a bit of practice together, Ayla was able to feed normally, and now at almost 5 years old, has no problems from her ties or procedure. I talk openly about our experience together in this video.

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Diagnosis and Treatment

Tongue-tie is often diagnosed during observation. Doctors may use screening tools to measure different parts of the tongue and movement.

Depending on the case, some medical professionals may recommend allowing the tongue to loosen over time. This will happen in cases where the doctors believe there will be no implications or impact on the baby, from infancy right through to adulthood. 

Some medical professionals may recommend that you wait a little longer and see if there are any problems.

In more severe cases, a doctor may recommend having a frenotomy, even before your baby leaves the hospital. 

I didn’t realise that there was quite a bit of controversy surrounding this procedure. In Ayla’s case, it was quite severe, and it was stopping her from feeding properly. 

I was told that she would require a frenotomy, and the procedure was done the day after the nurses picked it up. 

She was formally diagnosed by a lactation specialist who also performed the procedure.

What Is a Frenotomy?

A frenotomy is a surgical procedure. It is a simple procedure and will most likely be done in the hospital.

What Is the Procedure for a Frenotomy?

It is done by making a quick snip of the frenulum (the tie between the tongue and lower mouth) with surgical scissors. 

It may be done with or without anaesthesia. The pain and discomfort is minimum because there are very little nerve endings in the frenulum. 

There is also minimal bleeding. If any, it will only be one or two little drops.

HINT: Put baby on the breast to breastfeed or on the bottle straight away. It will comfort your baby, and if you are using breastmilk, it is believed to be an analgesic (pain relief). 

It sounds horrible, and as a new parent, it was awful, to be honest. But then again, needles, examinations, anything that puts your baby in discomfort is a terrible thing to go through.  

Ayla was not given anaesthesia.

The lactation specialist examined her tongue, confirmed the diagnosis, and did a simple snip of her tongue. I whacked her on my breast straight away, and she calmed down after a few moments and suckled in. 

Frenuloplasty

In more severe cases of tongue-tie, your doctor may recommend a frenuloplasty. 

This procedure will be required if there are repairs needed from frenotomy (very rare), or the tongue-tie is too thick for a frenotomy.

A frenuloplasty will be done with anaesthesia. The wound will be closed with stitches or sutures designed to be absorbed by the body, so they do not have to be removed by a doctor. 

Aftercare and Helping Your Baby Heal After a Frenotomy

Stretches to release the tie and minimise reattachment

The Tongue Tie Clinic reports that research shows reattachment can happen in about 4% of frenotomy procedures.  

It is recommended to do some stretching exercises around 4x a day to minimise this.

We had to stretch the skin where the cuts had been made in Ayla’s tongue-tie and lip tie over the next few days. 

The stretching involved taking her tongue and lip and gently pushing back on them to ensure that they didn’t heal back to their position before the procedure. We opted to do it in the early morning, mid-morning, mid-afternoon, and evening, all before feeding.

It felt horrible to do it, and sometimes, it caused a little bit of bleeding. 

I simply put her on my breast as soon as the gentle stretching is over. 

HINT: You can ask someone else to do this. I also hated having to do this myself, so I made it my partner and my father’s job to do it. They felt extra special because they had such an important role. The girl’s dad also felt helpless during the first few weeks, and this allowed him to be involved.  

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How to Tell If a Baby Is Tongue-Tied

Signs to look out for from infancy include the following:

  • Trouble latching. The baby may not be able to take a good mouthful of breast tissue into its mouth and may fall off the breast often and become fussy or upset
  • Restricted movement of the tongue. The baby may not be able to lift their tongue or move it from side to side.
  • The baby cannot stick their tongue out past the teeth.
  • The baby’s tongue may appear to be ‘pulled on,’ or heart-shaped due to the tie pulling on the tongue when it is extended.

Implications of Tongue-Tie for a Baby

Breastfeeding and Correct Latch

If your baby is tongue-tied, you may find that the most immediate implications are with feeding, including getting the right latch for breastfeeding. Because the tongue-tie limits the movement of your baby’s tongue, they are not able to extend it or poke their tongue outside to get a correct latch on your nipple. This may result in incorrect latching techniques such as a shallow latch. 

Everyone told me that I would find breastfeeding easy. I had big boobs (ginormous, really) and dark features, so it would be a breeze for my baby and I. This wasn’t the case. By day 3, we still hadn’t worked it out; she was being fed through a syringe because we just couldn’t get our latching technique right. I would put her on, and Ayla would fall off.

My partner struggled to see me so upset, so he went and fetched a nurse again. She seemed frustrated as I told her that I just couldn’t get it right. She grabbed my boob into a hamburger hold, took Ayla’s head, and put her on.

“There,” she said. And left. 

I sat in my room, not letting anyone in, determined to get it right. But I was so upset that I was failing and couldn’t feed my little one. 

After several hours, he went and fetched Laura. I sat crying, so embarrassed and not wanting anyone to come near me and shame me. I had watched all the tutorials on latching techniques and tried so hard when the nurses showed me. 

Laura sat with me and gently asked me to show her how we fed together. Ayla kept falling off; she encouraged me to keep showing her. 

After about 5 minutes, Laura looked at me and simply said, “Abbey, there is no way that Ayla is going to be able to feed on your big old boobs. She is lip tied and tongue-tied.”

It was a relief to know that we weren’t doing anything wrong after all. Poor little Ayla had ties which meant she couldn’t poke out her tongue or open her mouth wide enough to get the right breastfeeding latch.

From there, I was given an appointment with a lactation specialist for a frenotomy.

Insufficient Breast Milk Intake

As a consequence of your baby not latching properly, your baby may not be receiving the right amount of milk. The stiff tie doesn’t allow your baby to get enough nipple into its mouth. It may also stop your baby from making the tongue movements that it needs to squeeze the milk ducts in your breast. 

This may mean your baby doesn’t get enough milk with each suckle and with each sitting. 

You may notice that your baby is wrestled and upset after feeding because they are not full or satisfied. 

You may do some extra things to increase your milk supply while you are supporting your baby and yourself and training together to get the correct latch.

Nipple Pain and Damage

An incorrect latch due to your tongue-tied baby may result in damage and pain to your nipple when you try to feed. 

Ayla’s incorrect latch had really destroyed my nipples. The skin around the nipple itself was so torn that the flesh underneath was exposed. It was so painful to feed her, so I opted to use nipple shields to protect my nipples and give me some relief while my nipples healed as I still wanted to breastfeed.

There is a debate that using nipple shields may cause nipple confusion, but there are things you can do to avoid and support your baby. Personally, my nipple shields were a godsend.

1, 2, 3. Pain, pain… If you have damaged or sore nipples from an incorrect latch, you know what I am talking about. I would sit tight, latch my baby, and count 1-2-3 while holding my breath, bouncing my leg on my toes, and waiting for the pain to subside.

When Ayla was 10 days old, I left my nipple shields on a plant during my connection interstate. I approached an employee completely in hysterics and bawling.

In between snot, sniffles, and shallow breaths, he announced, “Wait right here, my wife and I had a baby 2 weeks ago. I will find them.” And then he took off at rocket speed to retrieve them for me. Needless to say, I could have married this already married man.

Now, I consider myself to have a high pain threshold. By this time, I had been through an ECV (External Cephalic Version) without so much as a squeak. It is a sharp pain, and I feel for you, ladies. But there are things you can do to help reduce the pain and heal your nipples.

Tips to Help Heal Damaged Nipples:
  • Get them out in the sun for Vitamin D
  • Use a cream
  • Ice pads, cabbages

If this is your first time feeding, please know that it takes time for your nipples to harden and get used to breastfeeding. No one told me that. Even with Ayla’s tongue-tie and lip tie, I found that I should expect some soreness. The soreness is because your nipples are used quite often, and a baby with a correct latch applies a good amount of pressure. 

Do what you need to to be comfortable. With the right care, the pain and damage will heal in time, and you may find breastfeeding the most natural thing in the world. 

Decreased or Low Milk Supply

A correct latch to get proper stimulation and the frequency of nursing are two factors that contribute to your milk supply while breastfeeding or expressing.

You may be breastfeeding or nursing regularly. However, without a correct latch, your breasts may not be getting the stimulation they need to signal your body to create milk that your baby needs. 

You may find that your milk supply is becoming low. 

This is quite a hard thing to measure and find out. If your baby is gaining a healthy amount of weight on breastmilk alone, then your milk supply is most likely okay.

Some signs of a low or decreased milk supply are as follows:
  • Your baby is fussy.
  • Your baby is feeding more often. This can also mean a need for comfort or a growth spurt in your baby. If it is hot, your baby may want to feed more because they are thirsty.
  • Your baby doesn’t seem to stay on for long enough and appear upset and unsatisfied afterwards.
  • Your breasts don’t leak milk. This is not the case for everyone. I had days where I could have shot my friends on the other side of the supermarket with my milk, or I woke up wet from my breasts leaking. On other days, they were happy staying dry. This was especially the case while my breasts were settling in the first few weeks.
  • Your breasts feel softer and don’t seem to be filling up.
  • Pumping will regularly produce no or very little milk. Although, once again, I had plenty of milk after the frenotomy. But some days expressing and pumping bore no or little result due to stress, tiredness, dehydration, or pumping after a feed.

There are things that you can do to help increase your milk supply. You can read our article on how to do so here.

I also tried a number of the suggestions below with success, and sometimes I received more success than Ayla really needed.  

Products that can help increase milk supply:
  • Fancy Water

You must stay hydrated and drink more water than usual when breastfeeding. Your body uses water to make milk! You need to keep topping up. If you get sick of water, try using an infuser with fresh fruit to keep things exciting, or use it to make fresh tea. Dads and partners, it is a lovely gesture to have a nice drink available for us breastfeeding mums before we feed, first thing when we wake up, and when we go to bed at night. You can help by reminding us and preparing. This is a significant role, and it will not be forgotten!

  • Oats

Oats are high in iron, and your body needs iron to make breast milk. I am naturally low in iron, so I ate oats often while breastfeeding. I found they helped with lactation and improved my energy levels. Oats are versatile. If you want to use them to help with lactation, you can use them as cereal, throw them in a delicious smoothie, try some protein or bliss balls, or eat them as lactation cookies or bars.   

  • Fenugreek

This herbal galactagogue is excellent at increasing milk supply. Galactagogue is a substance that helps promote lactation. You can use it in cooking, add it as a powder to cereals and smoothies or take it as a tablet.

For more information on these and even more tips on increasing breast milk supply, check out our video.

Speech Difficulties

Untreated tongue-tie can result in your child having some difficulties with pronouncing different sounds.

Challenges with Oral Hygiene and Oral Activities

Mayo Clinic reports that an untreated tongue-tie may result in being unable to effectively “sweep food debris from the teeth,” and can also lead to the formation of a gap between the two bottom front teeth.

Untreated tongue-tie may also present challenges when it comes to your child using their tongue, such as whistling, licking, and playing a wind instrument.

Tips to Helping Breastfeed a Baby After a Frenotomy

  • Be patient.

Your baby may take some time to relearn to open their mouth to get the direct latch and sucking technique.

Ayla had already formed the habit of keeping her tongue in her mouth and making a small ‘o’ shape with her mouth. It took time, patience, and consistency to help her with this.

  • Recorrect latch; try and try again.

You may find your baby persisting on the incorrect latch because the habit formed due to the tongue-tie early on. It is vital to unlatch your baby as soon as you notice an incorrect latch and do what you need to support and encourage the right mouth movements and position. 

I had to take Ayla off several times the first 5 days after her frenotomy procedure. I needed to do this so that she wouldn’t continue the habit. People may refer to your baby as being ‘lazy,’ but like with many habits, it takes persistence to change and get it right.  

  • Have support.

It may just be someone to sit with you through feeding times and keep you calm. They can also help with pushing on your baby’s little tongue.

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