Tongue Tie

[@llli*kln2]

For those of you that have read my original post ( http://forums.llli.org/showthread.ph...-Breastfeeding ), you know that I've been in a lot of pain while breastfeeding with a latch that looks good. I took a picture and compared it to pictures online of a good latch and I think my baby's latch looks even better than those!
She is now 6 weeks and the pain and nipple damage is still there, when I developed my first bloody blister earlier in the week I decided it was time to go back to the hospital where she was born to see the LC again. I saw a different one this time (by the way I noticed they are all IBCLC) and she felt around in her mouth and then observed me breastfeeding. She couldn't believe the sight of my nipples and that I was still able to let the baby latch on! The latch looked good, but I told her it was pinching and when we removed baby the top of the nipple was pulled out. She brought in another LC to get a second opinion. Both are thinking it's something to do with the baby's mouth and not how I'm bringing her to the breast. Granted I haven't mastered the holds and how to bring her to the breast yet, but I would think that by now we would have gotten a little better at it. Anyway, they both mentioned the possibility of posterior tongue tie, same thing that was mentioned here as well as at a LLL meeting. Initially I thought she just needed to grow a bit more for my large nipples, but after several people saying tongue tie is a possibility and reading more about it, I think this may be what's going on. I read the main signs of it and a lot are there. She falls asleep at the breast, wakes up still hungry, clicking noises, nipple damage, etc...
I also thought nipple confusion was another possibility so I asked the LC if that may be the problem and she doesn't think so. We moved her lip a little and can see her tongue over her gums while nursing, but I can feel her moving it back and forth sometimes, it's like sandpaper rubbing on my nipple. I don't know if she's treating my nipple like a bottle or if she is having issues related to tongue tie. Any thoughts on that?
I made an appointment to see an ENT that is well known for treating tongue tie in babies. In the meantime I wanted to see if anyone on here had personal experience dealing with tongue tie (posterior tongue tie in particular) and can give me some tips on how to deal with this. If she does have it, should I get it cut (he uses a laser)? I can see the benefits of it, yet I worry about her ending up with a tongue like Gene Simmons! I noticed that the frenulum goes all the way down to her gums on her upper lip, but she typically doesn't have a problem with flanging out her lips.
I hear that some people notice immediate relief after getting the tongue tie cut and others didn't notice a difference. As much as I don't want her to have this issue or have her tongue cut, I'm hoping this is the problem so we can fix it and have a positive experience breastfeeding.
I've been trying to tweak how I bring her to the breast these past few days and I have been able to get latches that feel better, but so far none have been completely pain free. There's always some level of tenderness, not to mention her tongue rubbing on the nipple... which is very uncomfortable. If she doesn't have it, I'm not sure what to do from here. I feel like I've explored all options at this point.

[@llli*lllmeg]

The book the womanly art of Breastfeeding (8th edition 2010) has an excellent discussion of tongue tie.

This study showed that a tongue release procedure does improve outcomes: http://www.pediatricsdigest.mobi/con...28/2/280.short

In my experience talking with moms, you are correct, a clip can sometimes help almost immediately, or it can take time for baby to learn to nurse with the new mobility so it still may hurt for a while but improves over time, or it sometimes does not seem to help at all. I think it makes a lot of sense to have a follow up appt with a lactation consultant to work on latch when dealing with the aftermath of a tongue tie clip, especially if a clip is coming ‘later.'

But if your baby has tt, and there is even a chance clipping will allow you to nurse comfortably, (and continue nursing at all) the risk benefit analysis seems to me to be weighted heavily in favor of clipping, which most breastfeeding experts agree has very little risk. (While formula feeding has many demonstrated health risks.) You should discuss your concerns with the ENT, but it is my understanding that clipping the tongue will allow NORMAL movement & extension of the tongue, and not cause freakish lengthening of the tongue. (and I am not calling GS a freak, I am sure he loves his tongue )

Meanwhile have you tried laid back positioning or other techniques to improve latch? Even if a clip is warranted, you will want to keep working on comfortable latch and positioning before and after clipping.

[@llli*mommal]

with LLLMeg. I think going to see the ENT and potentially having the tongue-tie released, if it's present, is a very good next move. There's a lot of potential gain for very little risk. And don't worry about your LO ending up like Gene Simmons, that won't happen. And even if it did, hey, Einstein had a long tongue, too! http://en.wikipedia.org/wiki/Albert_...opular_culture

Just one possibility that I think should be considered: some babies have short tongues and high palates but are not tongue-tied. My firstborn was this way, and it can cause extreme pain and trauma to the nipple, and the only thing that really fixes it is time. Baby's mouth grows and tongue grows and everything gets better. The fact that you've hung in there this long suggests that you are one tough mama, and if you have done it this long and already achieved some pain-free latches I think you are eventually going to get through this and gain a really good, pain-free nursing relationship with your LO. Tongue-tie or not.

[@llli*kln2]

Well I took her today and she did have a minor posterior tongue tie. Doctor said he could correct it if I wanted, but he doesn't believe it's causing any major issues. I decided to go ahead and have it corrected, I nursed right after with no change. I'm going back to see the lactation consultant this week to continue working on her latch. I noticed today that when I did get a deep latch (after MANY attempts) she coughed and pulled back immediately, it must have triggered her gag reflex.
I do laid back sometimes and cross cradle the rest of the time. With laid back she will be tummy to tummy with me, but turns her head completely to the side to nurse. She doesn't look very comfortable, but doesn't seem to complain. I've been told baby needs to have ears, shoulders, and hips in line, so do you think it's an issue for her to have her head to the side during laid back?
It's just so frustrating because I will let her nurse for a good 45 minutes sometimes and she never seems satisfied. I know it's because the latch isn't good, but I get so worn out constantly trying to fill her tummy. Not to mention I get sore to point where I have to call it a day and give her breast milk in a bottle. When I go back to work in a few weeks I'm not going to have enough time in the day to work on this, I really need to have breastfeeding worked out by then or I may have to stop.

[@llli*allmykids]

This thread is really helping me because Im experiencing the exact same problems. My daughter is now 2 months old and I have never been able to nurse successfully. I have seen 2 lactation consultants and one said she thought there may be a tongue tie from her symptoms. I didn't opt to go to the ENT only because I felt if it were a minor issue I didn't want to put her through the pain. I've settled to pumping right now and feed her via bottle but I really want to be able to nurse. I am trying to keep my milk supply up until then but it's wearing me down. I nurse, top her off with a bottle and still empty by pumping so I feel like I'm doing double duty right now. I've been called obsessed at this point but I know this is my last child (I have nursed my 2 others) and want to relish the experience. I'm attending my first LLL group meeting tomorrow and hopefully will meet others who have overcome the same challenges to give me hope! I have noticed she seems to latch ok, sometimes, but isn't successfully transferring milk to be satisfied. I won't try more than 15 min or so because she fights( kicking legs and arms and flaring back her head) and I don't want to traumatized her and give her a complex about it so I give up and give her a bottle. In the beginning her not transferring made my supply decrease so I was on domperidone for about 2 weeks.... I seem to have experienced it all. My nipples are no longer sore so I know her latch is at best ok, and I can tell her tongue is getting longer, she actually stuck it out the other day and before it wouldn't go pass her gums. I'm just curious how will I know when she's got it?

[@llli*aprilsmagic]

allmykids, it might be better to start your own thread so it won't get lost here

I would stop using bottles and feed in any other way. You are risking baby developing nipple preference. Then she won't nurse even if she can.

You will know if her wets and poops are OK despite not supplementing.

[@llli*lllmeg]

I've been told baby needs to have ears, shoulders, and hips in line, so do you think it's an issue for her to have her head to the side during laid back?

For some babies, having everything in line promotes the best latch. But if NOT having everything in line works best for you & your baby, then it is fine. I strongly believe that it is counterproductive to think about positioning and latch tips as "rules" rather than simply guidelines to get you started and to help you correct things IF there are issues.

The biological nurturing (laid back) research done by Suzanne Colson shows that many of the 'rules' about positioning and latch that were taught for years (and still are taught) are actually counterproductive for a comfortable latch, or, if helpful, not helpful all the time for all mom/baby pairs. I attended a lecture by Suzanne Colson, and she said that her research showed that some babies even nurse just fine & does not hurt mom with a shallow latch (nipple nursing.) She also pointed out that struggling to get a big 'gape" and working towards an asymmetric latch was not necessary when doing laid back. I am not saying to not pay attention to getting a deep or asymmetric latch if that is working well for you, I am just saying the research is starting to show that how a baby and mom nurse 'best' is very, very individual.

It's just so frustrating because I will let her nurse for a good 45 minutes sometimes and she never seems satisfied. I know it's because the latch isn't good, but I get so worn out constantly trying to fill her tummy.

many babies act hungry and fussy post feeding and it has nothing to do with not having gotten enough. The simplest way to tell if a baby is getting enough from nursing is from output and weight gain. YES, nipple pain can indicate a milk transfer issue but you can also have a painful latch yet baby gets plenty.

have you tried breast compressions? Sometimes helps when nursing sessions are very long. http://www.nbci.ca/index.php?option=...tion&Itemid=17

[@llli*kln2]

I have been doing breast compressions. I feel empty when she's done, but I still fear losing my supply because she's not nursing correctly. I can't go by output and weight gain yet as she was getting most of her breast milk by bottle.
I went back to see the LC's at the hospital and they observed her again and said that the latch looks perfect. There was still some pain and there was a slight crease in the nipple when she was done. They said there's really nothing more that they can do and referred me to an OT. They agree something is going on with how she uses her tongue, but it's out of their area of expertise. I asked if I should continue to pump after feeding her because I don't want my supply to drop due to her shallow latch and one of them said "That's not a shallow latch!", but when I pull her off the nipple is literally right past her gums... it's not near the soft palate. So technically, isn't that a shallow latch even if it looks like a deep latch on the outside?
I also decided to not use bottles right now because personally I feel like she's treating my nipple like it's a bottle, even though the LC's are telling me that's not the case. I gave her extra milk with a cup and eye dropper. She cried the whole time with the eye dropper. ::: I'm just trying whatever I can. If anyone has anymore suggestions at all, I'm all ears! Thanks again!

[@llli*aprilsmagic]

She probably was crying because she wanted to suck, so give her some milk in the dropper, then put her to the breast so she associates the breast with comfort and sucking and warm feelings, and keep working on it while you explore with the OT.