Since I started as a Private Practice Lactation Consultant I would say 90% of the issues with breastfeeding have been because of tongue and lip tie. I was really lucky to have worked alongside some wonderful Lactation Consultants in a major Maternity Hospital so I knew what I was looking for and knew how much it impacted on breastfeeding. Alarm bells start ringing when I see the nipples of a Mum with a tongue and/or lip tied baby. They are often so traumatised (cracked, bruised, bleeding) that the Mother is beside herself with pain and the thought of latching the baby sends her into a panic! If the Mum has been experiencing this for a while and has tried to get help, she has often been treated for candida albicans (thrush) or a staphylococcal infection or may have been told it is NORMAL to have cracked nipples and pain???
It appears that some Doctors and Paediatricians have very little Lactation education and just as little experience helping a breastfeeding Mother. I have had Mothers tell me that their Doctor advised them to stop breastfeeding because it wasn’t working. They can’t offer an explanation or any help and often don’t even refer them to an LC or Clinic. Even more disappointing is that some nurses and midwives have not completed the appropriate recommended training to help breastfeeding Mothers. So many Mothers are given inconsistent advice or information from the different midwives they see in hospital. They become so confused that they don’t know who to listen to. I think this impacts negatively on their confidence and belief in themselves. I have I have even had one midwife tell me that “ANYONE” can help a Mother breastfeed. Oh dear, I thought we were all striving for the same thing – SUPPORTING MOTHERS AND BABIES.
If we are lucky, the Mum calls a competent person (LC, Midwife or Doctor) to say “Something’s not right, can you help me?” If we are lucky, this call happens within the first week or two and the trauma is not yet enormous and the Mum is still persevering with breastfeeding. When I am the person they call, I tell these Mums they are breastfeeding CHAMPIONS!!!!! They peal off their breast pad and reveal awful, awful damage which makes me cringe but they have kept going, kept trying and here they are – asking for help!!! I tell them they’re champions and congratulate them for their hard work and effort. Some of them have been expressing because latching is just excruciating and they can’t do it any more. Some of them have been giving their breastmilk via a bottle and others have been spoon or finger feeding using a tube. Amazing effort all of you. Well done!!!!
After we have a bit of a chat about what’s been happening I start to see the same picture forming:
- Baby has had trouble “getting on and staying on” the breast
- Baby doesn’t open his mouth very wide so latch is often shallow
- When he does latch well, he slides down to the nipple or off completely
- A clicking noise is often heard throughout the breastfeed
- Suction is sometime really strong but because the latch is shallow, it is the nipple that is being sucked – excruciating!
- Tongue movement is limited so it rubs/taps on the nipple causing excoriation
- The Tongue doesn’t cover gums so gums “chomp” or “clamp” on the nipple/areola
- Suction is variable so milk dribbles from the corner of baby’s mouth
- Lip seal is poor so lots of air is ingested – lots of wind = lots of pain
- Baby can’t draw the nipple back to the junction of the soft and hard palate so his milk removal is not efficient and the nipple is not protected.
- Baby can’t empty breast efficiently so is constantly hungry and constantly feeding (feeds can run for 2-3 hours and run into each other)
- Nipples get increasing damage because they’re not in the right place to be protected and the pain for the Mother is unbearable
- Breasts are not emptied so milk supply begins to drop (supply and demand)
- Mother’s breasts are often full, lumpy and uncomfortable – risk of mastitis and blocked ducts
- Baby does not gain weight or gains very little
- Baby often has symptoms of reflux (vomiting, swallowing,pain)
- Baby often pushes away from breast in frustration
- If Mother expresses and bottle feeds weight gain may be better if she can maintain supply (teat and nipple utilize very different sucking techniques)
- If Mother has a strong let down (Milk Ejection Reflex) the baby may do well for a few weeks just drinking what is pouring out of her breasts but signs of difficulty appear around 4-6 weeks when the let down settles. When baby has to work for the milk, he just can’t do it
- Baby only naps because he rarely gets a full tummy of milk in one sitting
- Mother becomes exhausted from lack of sleep and feeding around the clock
- Mother seeks help OR Mother stops breastfeeding!
If I have this type of conversation with a Mother I will do a thorough oral examination and observe a breastfeed. If I suspect lip and/or tongue tie I will immediately discuss this with the parents and then refer them to an appropriate person for consultation and treatment. I consult in Brisbane so I can only give the details of the professionals I know locally.
If anyone out there is experiencing any of these symptoms, please seek the help of a Lactation Consultant or suitably trained Maternal, Family and Child Health Nurse or Midwife – many hold extra qualifications or training in lactation or breastfeeding and should be aware of the evidence supporting the impact of lip and tongue tie on breastfeeding. Hang in there, you will be heard and you will be given every assistance to continue on your breastfeeding journey. The above Medical and Dental Practitioners are also up-to-date with tongue tie issues.
“When a Mother tells me something’s not right – she’s usually right!”