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Thread: Lip/tongue tie revision

  1. #1

    Default Lip/tongue tie revision

    My daughter is about 4 months old and I have just now discovered her lip and tongue tie. She has long feeding sessions (1-2 hours), gassy, fussy, constantly unlatching, cannot hold breast/bottle/paci in her mouth. My question is, is it worth revising at 4 months? How long will it take to relearn to latch? Do you think I should see an ent or pediatric dentist? It appears our insurance will cover ent (who uses scissors) but not dentist ( uses cold laser). Any advice or experiences would be appreciated!! Thanks in advance.

  2. #2
    Join Date
    Jun 2009
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    10,754

    Default Re: Lip/tongue tie revision

    Who diagnosed the tongue tie? Have you seen (or can you see) a board certified lactation consultant? (IBCLC)

    I would suggest, forget gassiness and fussiness. This could be caused by any number of things, or just be normal. Long feedings may or may not indicate an issue. Yes these show up on some lists of tongue tie symptoms, but overall it is just too grey an area to pin these things on tongue tie prior to treatment.

    In the infant, what problematic tongue tie causes, and revisions can help, is feeding issues. Feeding issues means baby is physically unable to nurse efficiently and/or, nursing is painful or injurious for mom. Of course there are other issues caused by tongue tie or lip tie, (Dental issues, speech) but these will not manifest until baby is older, if they ever do.

    So, I would suggest it is very important to have your baby assessed by an IBCLC to see if there are milk transfer issues when breastfeeding, or not, so that you can use this information when making your decision.

    An IBCLC will have the expertise to assess any bottle feeding issues as well and see if they might be caused by the ties, or have another explanation.

    My take on frenotomy is that if they are really needed, then they should be done no matter what the age. Yes there may be a learning curve for getting baby nursing efficiently, and this is also why you want an IBCLC helping you.

    On the other hand, if breastfeeding is going overall well already, and is something you plan to continue for some time, the fact that mouth surgery even minor may interrupt that or even possibly cause serous breastfeeding issues has to be part of the decision making process.

    As far as scissors vs. laser, I would suggest choose the practitioner with the most experience in treating ties specifically in breastfed infants due to breastfeeding problems, or who you feel most comfortable with, or is going to offer the most follow up assistance. No matter what the cost, use the person you have the most trust and confidence in. Also, if you have to pay out of pocket dentist may offer payment plan, discount etc.

    Here is a cautionary article about tongue ties and breastfeeding from a breastfeeding expert and lactation text book author: http://www.nancymohrbacher.com/blog/...e-and-lip-ties

    Good overall website on tongue tie: http://tonguetie.net/

    info on tongue tie and lip ties and breastfeeding: https://www.breastfeeding.asn.au/bf-...nfo/tongue-tie

    More: http://theleakyboob.com/2012/11/the-...and-treatment/

    http://www.kiddsteeth.com/dental-top...feeding_health
    Last edited by @llli*maddieb; July 15th, 2015 at 08:18 AM.

  3. #3

    Default Re: Lip/tongue tie revision

    Quote Originally Posted by @llli*maddieb View Post
    Who diagnosed the tongue tie? Have you seen (or can you see) a board certified lactation consultant? (IBCLC)

    I would suggest, forget gassiness and fussiness. This could be caused by any number of things, or just be normal. Long feedings may or may not indicate an issue. Yes these show up on some lists of tongue tie symptoms, but overall it is just too grey an area to pin these things on tongue tie prior to treatment.

    In the infant, what problematic tongue tie causes, and revisions can help, is feeding issues. Feeding issues means baby is physically unable to nurse efficiently and/or, nursing is painful or injurious for mom. Of course there are other issues caused by tongue tie or lip tie, (Dental issues, speech) but these will not manifest until baby is older, if they ever do.

    So, I would suggest it is very important to have your baby assessed by an IBCLC to see if there are milk transfer issues when breastfeeding, or not, so that you can use this information when making your decision.

    An IBCLC will have the expertise to assess any bottle feeding issues as well and see if they might be caused by the ties, or have another explanation.

    My take on frenotomy is that if they are really needed, then they should be done no matter what the age. Yes there may be a learning curve for getting baby nursing efficiently, and this is also why you want an IBCLC helping you.

    On the other hand, if breastfeeding is going overall well already, and is something you plan to continue for some time, the fact that mouth surgery even minor may interrupt that or even possibly cause serous breastfeeding issues has to be part of the decision making process.

    As far as scissors vs. laser, I would suggest choose the practitioner with the most experience in treating ties specifically in breastfed infants due to breastfeeding problems, or who you feel most comfortable with, or is going to offer the most follow up assistance. No matter what the cost, use the person you have the most trust and confidence in. Also, if you have to pay out of pocket dentist may offer payment plan, discount etc.

    Here is a cautionary article about tongue ties and breastfeeding from a breastfeeding expert and lactation text book author: http://www.nancymohrbacher.com/blog/...e-and-lip-ties

    Good overall website on tongue tie: http://tonguetie.net/

    info on tongue tie and lip ties and breastfeeding: https://www.breastfeeding.asn.au/bf-...nfo/tongue-tie

    More: http://theleakyboob.com/2012/11/the-...and-treatment/

    http://www.kiddsteeth.com/dental-top...feeding_health
    Thank you so much for these links. It was diagnosed by a lactation consultant. My baby cannot stay latched on the breast or bottle and cannot hold a paci in her mouth. She cannot stay latched deeply so I have a lot of nipple pain. She is transferring milk slowly (1oz in 10 min). If you have any other ideas for what is causing this I would love to hear them!

  4. #4
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    10,754

    Default Re: Lip/tongue tie revision

    How has the baby eaten for 4 months if baby has such severe eating issues?

    Trust me I am not saying your baby does not have tongue tie or it is not causing the problems you are seeing. It may well be, but I am sure you understand I cannot possibly make that call from here. I have to say I am a bit confused, as in your op you mentioned the very minor and non-conclusive "issues" of fussiness and gas, and neglected to say anything about the much more serious and telling issue of nipple pain still at 4 months along. My post was based on what you said in your op.

    Your questions was if it is "worth" getting the surgery at this age and I think I answered that the best I possibly can and offered links to information that is available to help you make that decision. It is not an easy one, I know, and the fact is that there are differences in opinion about tongue tie and lip ties and when treatment should be considered even among experts. If you and your baby are already under the care of a board certified lactation consultant, I really think they should be assisting you with this decision.

    Hopefully someone here will have personal experiences they can share.

  5. #5
    Join Date
    May 2015
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    36

    Default Re: Lip/tongue tie revision

    Hi, I have some recent experience with this, so I hope it helps you a bit.

    I just had my son's tongue and lip tie revised at almost 6 months old. For several months he was barely gaining weight, and had some periods of actual weight loss which was the biggest red flag for us. He was slipping off of the growth charts, and he actually wasn't even in the 0.1 percentile on the weight-to-length chart. Unfortunately, it took months for anybody to actually identify the problem. His pediatrician always thought the solution was for us to switch to formula and feed him solids to bolster his weight gain. I gladly would have done for his health, but he was unwilling (probably unable, really) to take a bottle or swallow solids, so this did not help whatsoever!

    His behaviour sounds slightly similar to what you are describing with the constant unlatching and fussiness, but he definitely never fed for 1-2 hours at a time. This isn't to say your baby doesn't have the ties--it could just be presenting differently than it did with my son. For us, the issue was getting him to stay on the breast for more than a minute or two, more than a few times per day. His ties turned out to be fairly significant, and nursing was uncomfortable and inefficient for him. I believe he was very frustrated and began to refuse the breast a lot of the time because feeding was a necessary, but unpleasant experience. We went through months of hell trying to make sure he stayed hydrated and nourished with these poor nursing habits (spoon-feeding, syringe feeding, etc. ), as he wouldn't/couldn't take a bottle. (I actually posted on here out of desperation at one point...you can read the whole long description of his issues here, before I knew about the tongue and lip tie : http://forums.llli.org/showthread.ph...ursing-anymore)

    Anyway, about two weeks ago I was at my wit's end so I finally ended up hiring an experienced IBCLC who spotted the problem. (I had actually hired one a couple months before, who mentioned a possible tongue tie, but unfortunately I couldn't get my son to nurse in front of her.) She did a very thorough physical exam of his mouth and even listened to his sucking and swallowing with a stethoscope during one of his short feeds. It was a pretty clear-cut case of tongue and lip tie. So, I HIGHLY recommend seeing an IBCLC as the posters above mentioned, if you haven't already. They should be able to tell you not only whether the ties are present, but also whether they are interfering with breastfeeding.

    We opted to get the surgery done right away after that. We took him to a pediatric dentist who was experienced in tongue/lip tie revision in babies (this is important, I think), and she agreed that the ties were there and severe enough to warrant surgery. She laser revised them in less than 10 minutes. It was NOT a fun experience for my son, or myself. I have to be honest that it was fairly traumatic to see him in so much pain. The dentist and IBCLC both agreed on the same after-care protocol as well, which involves "stretching" the site of the revision with your fingers several times/day after the surgery for several weeks. This is supposed to stop the ties from reforming. This is also not fun to do because it is uncomfortable for the baby, and you have to be prepared for that. If you can search on youtube for post-frenectomy tongue stretches to see what this involves. I will admit I haven't been as diligent with these stretches as I was supposed to be, because it is honestly very horrible and I don't like the strain it puts on my relationship with my baby.

    All that aside, the surgery made a HUGE difference almost immediately. After the initial healing period, my son's latch is so much better and he actually WANTS to breastfeed all the time! He has good 15-20 minute feeds, and I can actually hear him swallowing milk the entire time (before, it was about 7-8 sucks for every swallow). There has been a major increase in his wet diaper output, and he is already gaining significant weight--more in one week than he had been gaining in an entire month.

    So, for us it has been sort of a "magic bullet". We still have a long way to go to completely get rid of some oral aversion he has developed now that it's "time" to introduce solids (I think this is more caused by us trying to spoon-feed and get him to take bottles and solids all the time when he wasn't nursing well, so hopefully you don't have that problem). I would never recommend putting the baby through the trauma unless you're sure it is causing feeding problems, but I highly recommend looking into it and getting assessed if you think it might be an issue. Let me know if you have any more questions.
    Last edited by @llli*stepbelt; July 18th, 2015 at 03:18 PM.

  6. #6
    Join Date
    May 2015
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    36

    Default Re: Lip/tongue tie revision

    I also just want to note, in case it is relevant to you, that my son's issues weren't obvious to me until he was about 3 months old, and weight gain didn't become an obvious problem until a few weeks later. (It was basically a downward spiral after I wrote the post I linked you to) The IBCLC explained to me that this was likely because I had an oversupply when he was a newborn, so the milk was basically trickling out into his mouth on its own and he barely had to work for it. Once my supply regulated, he couldn't make the normal tongue movements or make a good enough seal necessary to extract milk the way a baby without the ties could. She said she sees lots of cases that go undiagnosed until the problems show up at 4,5, 6 months. It made sense to me, the way she explained it.

  7. #7

    Default Re: Lip/tongue tie revision

    Quote Originally Posted by @llli*stepbelt View Post
    I also just want to note, in case it is relevant to you, that my son's issues weren't obvious to me until he was about 3 months old, and weight gain didn't become an obvious problem until a few weeks later. (It was basically a downward spiral after I wrote the post I linked you to) The IBCLC explained to me that this was likely because I had an oversupply when he was a newborn, so the milk was basically trickling out into his mouth on its own and he barely had to work for it. Once my supply regulated, he couldn't make the normal tongue movements or make a good enough seal necessary to extract milk the way a baby without the ties could. She said she sees lots of cases that go undiagnosed until the problems show up at 4,5, 6 months. It made sense to me, the way she explained it.
    Thank you so much for sharing your experience! I'm sorry it was traumatic but glad to hear it helped.

    That does make sense about why the issue was more obvious after oversupply regulated around 3 months!

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