Increasing Success of the Breastfeeding Dyad : Addressing Tongue and Lip Tie Concerns
Oct 01, 2016 11:51PM
● By Risa Sloves
As mothers, we have great expectations for parenthood. Many of us have done countless hours of reading; birthing education classes; meet-and-greets to choose the best midwives, doctors, doulas and pediatricians; classes for new nursing moms; research on products; and so much more. Finally, a beautiful baby is born and we feel empowered! We did it, and, if we are lucky, it went according to the “plan” and we hopefully have a healthy and thriving newborn.
Unfortunately, for many moms, especially those who plan to breastfeed, it is often not what they expected. Nursing can be a painful journey that is difficult and frustrating for “the nursing dyad” of mom and baby. Many of the issues causing problems are often overlooked and never properly diagnosed even by the most well-meaning specialists. In the worst of cases, the mom feels she has exhausted all options and may stop nursing altogether. In the best case scenario, she is able to find a team of providers that can work together to help the breastfeeding dyad be successful.
Tongue tie (medically called ankyloglossia) is when the tissue under the tongue—which attaches the tongue to the floor of the mouth—is tighter and thicker than normal; it may extend out farther than normal toward the tip of the tongue. As a result, it has an effect on the tongue’s mobility. Lip ties occur when there is tissue in the midline of the lip and it attaches the lip to the gum and prevents normal mobility of the lips and unsuccessful latch. An upper lip tie, known as maxillary, is more commonly problematic than the lower lip tie (mandibular). A cheek tie, or buccal tie, occurs when there are remnants of tissue tethering the cheeks to the gum; it may affect the ability of the infant’s cheeks to move properly and create an abnormal suck and latch.
It is critical to have a thorough oral exam in addition to having someone, such as a pediatric chiropractor, examine the baby while paying particular attention to the baby’s head, neck, spine and oral structure and function. For trained chiropractors, there are subtle newborn presentations that often are keys to the underlying problem. For example, when a post-natal mom comes in with her newborn for their first check-up, just observing how the baby is sitting in his/her carseat can give the first clues that something is posturally wrong.
Does the baby hold his/her head tilted or turned to one side? This may be a sign of torticollis due to misaligned joints in the neck or tight muscles. If it is not diagnosed promptly and treated properly, it can affect nursing and even lead to plagiocephaly, which is a flattening or asymmetry in the shape of the head and/or face.
Are the bones of the baby’s head aligned symmetrically or is there a slight overlap of two bones? Does one side appear slightly elevated or flat compared to the other? Does the baby lay flat or do the hips and legs favor one side when resting? Infants, whether delivered vaginally or by Cesarean section, may undergo significant stress that creates these misalignments.
Does the newborn’s chin appear to be set back or recessed in relationship to the face? This may be a sign of a tongue tie because the tongue sits in the floor of the mouth; if it is tethered and restricted in motion, it may be pulling the mandible, or lower jaw, back in its position.
Does the newborn have a blister in the middle of the upper or lower lip? This may be a sign of a lip tie which, when present, does not allow the lip to flange properly and can cause a poor, shallow latch.
Is the tip of the infant’s tongue heart-shaped instead of rounded? This may also indicate a tongue tie due to the tethering of the tongue to the floor of the mouth and a short, restricted tongue can prevent an infant from achieving a tight, effective latch.
Simply observing a newborn can give important clues to structure and function of their head, neck, spine and jaw. According to Lawrence Kotlow, DDS, a pediatric dentist, some of the common symptoms of tethered oral tissues in infants include a shallow latch, frequent and unsuccessful attempts at nursing, and colic/reflux/gassiness with a possible enlarged/full belly due to the amount of air being swallowed from a poor latch. Nasal congestion associated with silent reflux; clicking, swallowing air or leaking milk when feeding; and a failure to gain appropriate weight are other signs. Nursing moms often complain of severe breast pain, bleeding/cracked/blanched nipples, clogged ducts and mastitis, and the possible onset of post-partum depression as a result of the frustration and difficulty associated with nursing.
If a nursing mom or her baby is suffering with symptoms such as these, they should be encouraged to have another detailed evaluation by a specially trained professional even if they already were checked. Sometimes these conditions are very subtle and are not easily diagnosed initially; they become more apparent as time passes and new symptoms begin to appear. As an example, a toddler can nurse well and gain weight successfully, yet when they begin to eat more solid foods, they have difficulties chewing or with speech development. Additionally, tooth development can be affected with a tethered upper lip in an infant who nurses during the night; milk may accumulate between the lip and upper front teeth, which may cause decay. In cases of older children, a significant lip tie can affect proper alignment and spacing of their upper front teeth, which may impact orthodontics.
Like most conditions, the sooner they are diagnosed, the quicker they can undergo treatment if necessary; establishing a good team of practitioners is vitally important. All newborns should be evaluated regardless of whether they are born at home, at a birthing center or in a hospital. Not all babies with tongue and/or lip ties require treatment. However, if a potential problem is present, they should be referred to an appropriately trained specialist such as a pediatric dentist, oral surgeon, ENT or a pediatrician to consider whether a revision is necessary to improve function. This procedure can often be performed with a laser to significantly reduce bleeding and risk of infection. It generally takes just a few minutes and the baby often latches and nurses better immediately. However, if the baby had issues such as “reflux or colic”—which likely could have been the result of sucking more air in due to an improper latch—it may take a bit longer for them to adapt to their newly acquired mobility and establish better nursing. Moms should then follow up with their international board-certified lactation consultant to make sure that a proper latch and positioning has occurred. They should also see a pediatric chiropractor to ensure that the proper gentle body work is performed to improve head, neck, spinal and oral function by loosening muscles and improving joint mobility. The team will also perform stretches to enhance healing and prevent the tissues from reattaching and ensure that the parents are comfortable in performing these stretches at home.
Dr. Risa Sloves is one of nine chiropractic physicians in Connecticut with a three-year post-doctorate degree and board certification in pediatric and maternity care. She has been in practice for over 27 years with her husband, Dr. Mark Joachim, at their Norwalk office, Associates in Family Chiropractic and Natural Health Care, P.C. She can be reached at 203-838-1555. See ad, page 41.