Breastfeeding an Older Infant with an Untreated Posterior Tongue-Tie

The last time I posted about my baby daughter’s tongue-tie, she was 2 1/2 months old. She is now nearly 7 1/2 months old and I wanted to give an update.

We never had her frenulum clipped (frenotomy) and instead, I chose to nurse through any discomfort or peculiar behaviors. Here were some of those peculiarities and where they stand now:

  • Shallow latch – Not an issue anymore. Her mouth has grown (along with the rest of her!) and her latch is comfortable for me.
  • Clicking – Also not an issue anymore. I believe the clicking stopped when she turned about 6 months old.
  • Sore nipples (pain level 1-3 out of 10) – I rarely have sore nipples now. The only time they get sore is when she sprouts teeth. She got her two bottom front teeth when she was about 4 months old; now she’s working on her two top teeth. Her latch changes as she gets a new tooth; but this is not because of the tongue-tie. The latch usually feels different when the new teeth come in, tongue-tie or no.
  • Stuffy nose/sneezing – She doesn’t get stuffy anymore, but she does occasionally still sneeze after a nursing session. My lactation consultant (LC) said that this is because she “micro-aspirates” the milk as she feeds, due to the tongue-tie.
  • Tucking of the chin – Not an issue.
  • Jerking of the head – Not an issue.
  • Refusing to nurse side-lying with right breast – Not an issue.

Other items to note:

  • Squirmy while nursing – Ever since about 6 months, S has taken a liking to squirming during nursing. I usually have her in a cradle hold and she loves to push on the couch or bed with her feet, which makes nursing very uncomfortable, as it results in tugging of the nipple. I have to constantly coax her to relax and say “gentle with mama’s milkies.” I have no idea why she does this. I am guessing that a lactation consultant would say that this is her way of stimulating the letdown more quickly, perhaps compensating for a less-than-optimal suck.
  • Upper lip tie – I still often have to flip out her upper lip after she latches on. She sometimes curls her upper lip in due to her (class III) upper lip tie. After I flip it, it remains out and does not curl back in.
  • Side-lying – We can now nurse on both sides while lying down. And I don’t even have to move her from side to side! I can simply lean over and she can nurse from the top boob. Hallelujah! This is a good thing. Now I don’t have to sit up in bed to nurse her. That means more rest for both of us.

If you read my last post, you may be wondering what happened with the osteopathic manipulations and whether or not we continued with them, or if they “worked,” i.e., treated her above tongue-tie symptoms. Well, after three visits, I chose to discontinue treatment. I really was not comfortable with S’s crying screaming during these appointments. Actually, that’s a whopper of an understatement. After these visits, S wasn’t the only one in tears, my son T and I were, too. It was awful. I am not saying that all osteopathic manipulation is bad. It just wasn’t for us.

(I admit, I do sometimes wonder if perhaps I did my daughter a disservice by ceasing these treatments. According to our DO, many little patients do loudly and fervently protest the manipulations in the beginning but after their symptoms show improvement, their crying decreases and some even come to look forward to and enjoy the treatments. I wasn’t willing to stick it out to see if S would be one of those babies. Her crying rocked me to my core and I had to listen to my instinct and get her out of there!)

Anyway. That’s where we are with nursing now. I stand by my decision to NOT clip her tongue-tie.

Oh sure, there are the potential future problems to worry about, such as refusal of solid foods (not a problem for S), easy gag reflex, dental problems, speech problems, etc. But we’re not there yet. And even if these problems are commonly associated with tongue-tie, I’m not convinced that they will be problems for my daughter. I just don’t buy the whole “get it clipped now or else you’ll face problems X, Y, and Z down the line” argument. My philosophy is, “If it ain’t broke, don’t fix it.” Yes, we had problems early on. It was painful in the beginning, but my pain subsided and she gained weight like a champ and is still at the top of the charts in terms of weight and height. Some LC’s would say that it’s all due to my “oversupply” of milk, like it’s an anomaly that I have lots of milk. The way I see it, my body knows exactly what my baby needs, and provides it. Her anatomy and my anatomy are working in harmony together, the way nature intended, and I thank my lucky stars that everything is working out as it should, without unneccessary medical intervention.

But let’s be absolutely, crystal clear–I am NOT saying that all tongue-ties do not require a frenotomy. Egads, no! On the contrary, there are many, many instances when a frenotomy is the ONLY solution: When the baby is not gaining weight well and/or when mom is in pain or sustains nipple damage. Countless babies, moms, and breastfeeding relationships have been saved thanks to properly diagnosed and treated tongue-ties.

I’m just saying that there are gray areas, too. Our situation was one of those gray areas. My daughter gained weight amazingly well, and my nipple pain was minimal (not counting the excruciating pain during the first few weeks as we perfected the latch), yet she had an obvious posterior type 3 tongue tie that any seasoned LC would recommend for frenotomy. It was a difficult decision for me. For weeks and weeks, I’d obsess over whether or not to have her clipped to avoid future problems, like decreased milk supply. It was agonizing. Only now am I 99% sure that we will have a happy and long nursing relationship, until S decides to self-wean. (What’s up with that 1%? Well, that’s just me being paranoid. You know what they say, nothing’s 100% certain except for death and taxes.)

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11 Responses to Breastfeeding an Older Infant with an Untreated Posterior Tongue-Tie

  1. Ashley says:

    Hi Sophia! I saw you left a comment on my breaded tempeh post, but needed a GF/egg-free version. I didn’t have your email, so I headed here to send you this link – http://www.edibleperspective.com/home/2011/10/13/herb-crusted-tempeh.html Hope that works for the whole family! :)

    • MamaSayMamaSo says:

      Oh yum, thanks so much Ashley. That looks awesome. I confess, I *did* make tempeh tonight, but didn’t have anything to “bread” with, so just did it my boring old way (a wannabe teriyaki glaze). I will definitely keep this recipe on hand though when I go grocery shopping so I can get all the fixings! Thank you! :o )

  2. Jamieson says:

    I found your post through google… My son was tongue tied and couldn’t latch (wasn’t getting any milk at all), so we had him clipped. Sadly, it didn’t help, even with lactation consultants, so I pumped until 5 months. Just now, at 7.5 months, I find he has an upper lip tie — which would probably explain why he couldn’t flip his lip out to latch and chomped down instead of sucking properly (couldn’t even suck properly on a bottle until 3-4 months). I agree, if you can nurse without doing it, don’t clip it. However, I wish I would have known about lip tie, because I strongly believe that clipping it would have greatly increased our chances of getting my son to latch and suck.

    • MamaSayMamaSo says:

      Jamieson, I hear that lip ties and tongue ties often occur together, but unfortunately, are not often diagnosed. In addition to LC’s, I think midwives, labor & delivery docs, and pediatricians should all be trained to look for these things in every newborn. Could save many moms and babes a lot of pain and frustration. Kudos to you for sticking with pumping for so long. I never did get the hang of it. Remember that ANY amount of breastmilk is better than none at all. Thanks for chiming in.

  3. Msav says:

    I have a question for you. Did your babies tongue NOT extend over their gum, creating a biting/chomping feeling when nursing? My baby is 9 weeks and I’ve been told she has posterior tt. She can extend her tongue above her gum but when she nurses she doesn’t keep it there. She uses her gums to get milk out. If your baby had the same habit, then I have further questions. One of many would be, did baby eventually learn to place tongue above gum to avoid painful teeth bites. Thanks so much for the post. So many moms clip them and I feel like I’m the only one leaving it alone and dealing with the pain! She’s gaining and seems pretty content minus the small gassy episodes that occur.

    • MamaSayMamaSo says:

      Msav, my daughter has always been able to extend her tongue over her lower gum, and even well past her lower lip. Her type of tongue-tie makes it difficult for her to *elevate*, or lift, her tongue towards the roof of her mouth. This can become a problem during breastfeeding if the tongue cannot effectively grasp the nipple/areola enough to massage out milk (the tongue does a rhythmic series of lifts/undulations during nursing — see this great Ameda video that animates the mechanics of nursing). Sometimes this can lead to “clicking” or “smacking” noises, and/or an irritating scraping sensation on the nipples during nursing.

      Sounds like your daughter has a different issue, however; her tongue cannot protrude OUT of the mouth enough to cup/manipulate the areola/nipple. I have no direct experience with this type of tongue-tie, but when you say she is using her gums to nurse, it sounds like she is “chomping” to me, rather than nursing. On a pain scale from 0 to 10, how painful is it for you? Is she able to transfer milk efficiently? How is her weight gain? How are her bowel movements? Have you been seen by a lactation consultant?

      I should be totally clear and upfront about this — I DO NOT advocate nursing through any pain. Every nursing relationship is different. And even within a particular nursing relationship, the dynamics between mom and baby change, for whatever reason — the baby’s development/preferences, the mother’s tolerance for discomfort (hormones, etc.) — it really is an ever-evolving relationship. What is happening today may not happen tomorrow, and it is so hard to predict exactly what will happen.

      As for whether your sweet girl will eventually “learn” to place her tongue above her gum, who’s to say? From what I understand, the frenulum is capable of stretching over time and with the baby’s growth, but I would really, REALLY hesitate to tell you that it will for sure happen.

      I am not an IBCLC or medical professional so I cannot give out any medical advice. But from one nursing mom to another, here are a few things you may wish to consider:

      a) Closely analyze your daughter’s health status – is she gaining weight well? (although it’s important to note that some tongue-tied babies gain weight amazingly well *in the beginning* because they are getting milk from mom’s oversupply or forceful letdown, but then when mom’s milk supply regulates or slows down (usually around 3 months, sometimes later), baby may have a more difficult time extracting milk without the forceful letdown and weight gain can drop off. Also, does she nurse *comfortably* (or does she seem like she is struggling with the process at all?) You mentioned she gets gassy. Are there any other signs that she may be in some sort of discomfort during or after nursing?
      b) Consult with at least 3 International Board Certified Lactation Consultants (ones with extensive experience with tongue-tie). Perhaps even make an appointment with an Ear-Nose-Throat doctor, again, preferably one who has experience with tongue-tied babies & nursing mothers.
      c) Evaluate your own level of discomfort during and after nursing, rate it on a scale from 0 to 10 (10 being toe-curling, unbearable pain). Be honest with yourself.

      I do hope this helps a bit. Hugs to you…you sound like a wonderful, loving mom who is doing the absolute best she can despite some challenges. Do let me know how things go with you both. I wish you and your daughter well. (Feel free to email me offline, too mamasaymamaso AT gmail DOT com)

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  5. Kimberly Lorton says:

    I am a first time mom to an 8 week old little girl and we are having similar symptoms. She has been diagnosed with a posterior tie and after reading numerous places that a lip tie is likely as well I checked and it looks to me like she has a pretty significant upper lip tie as well. The first diagnosis was by a LC who I called after several people told me she was the loudest nurser they had ever heard, you can hear her clicks in the next room… The LC referred me to an MD in our area who specializes in ties – who again confirmed and wanted to clip her right then and there as she said her presentation was ‘classic’ for a posterior tie. Herein likes the problem, at least the problem for me… She is gaining weight like a ‘champ’ as you would say, and I am having little to no nipple pain. My only concerns have been her erratic behavior at the breast (thrashing around and releasing numerous times per feeding) as well as gas and significant episodes of spit up and drooling which I have also read are ‘classic’ signs that mirror reflux and could be alleviated by the procedure. My gut told me to get out of there and not have her clipped right then and there as the specialist would have liked – and I understand the procedure is quick and simple, but I am not convinced it is necessary! Also, it seems that the posterior tie is not as easily corrected and may require a second ‘cut’ Trying to do more research about later affects of leaving the ties in place, affects on facial growth, orthodontia, nutrition, milk supply, etc etc. Any good resources on that?

    On the other hand, if its so simple and could take care of future issues, why not?? Your thoughts??

    -Conflicted Mommy

  6. MamaSayMamaSo says:

    Kimberly,
    You are in the position I was in nearly 10 months ago. You’re asking many of the questions I asked myself over and over (and over) at that time: “Should we clip or not?” “If we clip, will it heal properly or need to be clipped again?” “Will she feel pain?” “What if the clipping doesn’t alleviate nursing problems?” OR… “If we don’t clip, will she have crooked teeth, digestive problems, speech problems, a weak jaw/chin, have TMJ, be overweight/underweight, have food sensory issues, food sensitivities, environmental allergies, sleep apnea, bad breath, cavities, behavioral issues…” etc., etc., ad nauseum, et cetera!

    It’s enough to send us concerned mommies screaming for the hills.

    I feel your pain. I *wish* I could give you some concrete answers and a simple “clip it!” or “don’t clip it!” answer. But alas, I’m not the tongue-tie expert. I am just one mom blogging about our experience with it, and I can only offer my thoughts from that perspective. Please take them as such.

    From what you describe, it sounds like your daughter is clearly struggling during the nursing process. This MAY be due to the tongue-tie and/or lip tie. Her TT may be inhibiting how effectively she can a) latch on and b) STAY latched on. If her TT is truly anchoring her tongue to the floor of her mouth, she may not physiologically be able to elevate her tongue enough to regulate the flow of milk, so she winds up gulping it (along with a lot of air) and has to pull off/latch on again and again to “manage” the flow. Does that make sense? If this is her situation, your milk supply *could* suffer if she is not adequately removing milk. Hard to tell if or when you might see a drop in supply. Supply usually regulates by the 3rd month, but could be later. Sometimes could even occur after 6 months, which is usually when solids are started. (Introduction of solids — any nourishment other than breast milk — is technically the start of weaning, and can affect how often/how long a baby nurses, which, in turn, can affect mother’s supply.)

    On the other hand, her behavior/symptoms are also in line with being unable to handle an “overactive” letdown. Lots of babies (TT or not) get overwhelmed by the initial, forceful letdown of mother’s milk. And they will do what you describe: flail around, pull off and latch on again and again, be extremely gassy, and spit up a lot. Have you observed your letdown *without* your daughter latched on? Does your milk projectile squirt across the room? (sort of exaggerating, but not really) She may just be having problems dealing with the firehose. :o ) Many babies who fall into this category learn to handle the fast flow as they grow older.

    I wanted to mention, if you do opt for the clipping to alleviate her nursing issues, you may want to consider it sooner than later. This is not to put undue pressure on you; just to educate you. The older the baby, the trickier the procedure becomes (strong, squirmy baby), necessitating use of general anesthesia. If you are seriously contemplating frenotomy/frenectomy, you might want to consider going to a trusted pediatric dentist as well as ENT (both highly experienced with releasing TT’s). A dentist, from what I’ve heard, uses a laser, which they promote as a cleaner cut that heals faster with less pain (it cauterizes the cut immediately).

    If you are convinced that your daughter can nurse comfortable and efficiently and are more concerned about later problems (speech, orthodontia, etc.), you can always opt to clip when she’s older, say 6 or 7, when the adult teeth start coming in.

    As for resources, I did *some* research in the beginning, mostly based on what resources my LC had given me. I’ve included some below. I read what I could and then, at some point, reached Information Overload, and just stopped. Perhaps you will find these resources helpful for your situation. If my memory serves, many articles I read were very pro-clipping. I had a hard time finding any information on NOT clipping, and anything good coming of NOT clipping. Hence, all my TT blog posts. Not very scientific, but some people find anecdotal accounts useful.

    Anyway, I hope you find some of what I’ve said here helpful. My daughter is now almost 1 year old and I stand by my decision not to have her TT clipped. BUT, I will always wonder if any “issues” she may have in the (near or far) future are due to her unresolved TT. That said, I’d probably have similar misgivings if we *did* opt to clip. In other words, if we did opt to clip, I’d be asking myself down the line, “Gee, I wonder if maybe she has food control issues/fear of doctors/funny lisp/whatever-odd-behavior BECAUSE of the clipping??” Know what I mean? It’s sort of a Damned if I do/Damned if I don’t warped mindset.

    Well, I’ve gone and written another novel. Please feel free to email me offline, or here, if you’re comfortable. I’m happy to continue the conversation, and be a sounding board.

    Hugs to you… you sound like a terrific mommy. Trust yourself. Trust your baby. You will know what to do.

    —-

    1. The webpage below is that of Catherine Watson Genna, one of the authors of the 2004 AAP article, “Congenital tongue-tie and its impact on breastfeeding.”
    http://www.cwgenna.com/quickhelp.html

    2. This is the website of Dr. Larry Kotlow, DDS, pediatric dentist in NY who is knowledgeable and experienced about tongue-ties from a dental perspective.
    http://kiddsteeth.com/articles.html

    Here is a Powerpoint presentation put together by Dr.Kotlow about tongue tie and breastfeeding:
    http://kiddsteeth.com/nursingbookaugfc2011.pdf

    3. This is the website of Carmen Fernando, an Australian speech therapist and author of the book, Tongue-Tie: From confusion to clarity.
    http://tonguetie.net/

    4. This website was inaugurated in 2010 by the International Association of Tongue-tie Professionals who all have their work with infants impacted by tongue-tie. It is up and running, but not finished, still under construction:
    http://tongue-tie.net/

    5. This blog is from a woman who breastfed four children with an upper lip,labial, frenum that caused difficulties breastfeeding. She presents research-based information, latch photos and helpful suggestions.
    http://thefunnyshapedwoman.blogspot.com/2011/03/introducing-maxillary-labial-frenulum.html

    6. The Academy of Breastfeeding Medicine, a professional subgroup of the American Academy of Pediatrics has a protocol regarding tongue-tie/ankyloglossia:
    http://www.bfmed.org/Resources/Protocols.aspx
    Scroll down to Protocol # 11, Neonatal Ankyloglossia
    The above protocol is being revised

  7. Crystal Burns says:

    Thank you for posting this! My 7 month old has the exact same issue and was just diagnosed. We are not having the procedure done and I have been worried, but now I do feel better after reading this. Alot of the issues have resolved since the early days, ie. clicking, but not all. I am still having pain and misshapen nipples, but it is bearable. I thought it was interesting that your daughter did not want to nurse side-lying on the right, my son has the same issue and I am wondering why? I am more hopeful now that the rest of the issues will also improve with time. Thank you so much!

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