Breastfeeding Troubles and Posterior Tongue Tie: A Sneaky Culprit

I gave birth to my second daughter, Olive, at home in January 2012.  It was a beautiful, quick birth, that rocked my very core.  My husband caught her, and laid our 7lb 5oz blonde beauty on my chest.  Immediately after I delivered the placenta, I got myself situated in bed and offered her my breast.  I held my breath…preparing for a struggle, as I had with her sister.  I held her to my breast, gave her perfect button nose a tickle with my nipple, and instinctively, she opened wide and started vigorously suckling with such enthusiasm that my husband and I looked at each other and chuckled out of pure relief.

From that point forward, Olive never refused the breast.  Quite the contrary, actually.  She nursed frequently, sometimes every 30 minutes or so.  Many times she would nurse through my first letdown, then she would either fall asleep, or start to fuss.  When she would fuss, I would try everything.

She must be still hungry.  She’s only nursed 3 minutes. 

I’d offer the other side.  She would latch on, suck a few times, then fuss some more.

Maybe she is overtired?

Am I eating something she is sensitive to?


I’d try different positions.  Walking and nursing.  Rocking and nursing.  Nursing in the dark.  Nursing outside.

I’ll give it time.  She is still learning.

Amidst this constant struggle, Olive was thriving.  Very well, actually.  She was climbing the charts fast, and turning into quite the adorable little chunk.  Her frequent nursing sessions created a pretty substantial oversupply issue.  My letdowns were extremely painful, so painful that I developed a bit of nursing aversion.  On top of the painful letdowns, my nipples were in bad shape.  Bruised and bloodied.  Cracked and misshapen.

Time.  We just need to give it time…it has to get better from here.

She would pop and click.  Her latch was shallow, and she would always tuck her bottom lip up over her gums.  No matter how many times I would unlatch and try again, she would end up suckling strictly on my nipple.  The pain from this was exhausting, many times unbearable.

When Olive was two weeks old, the cracking and bleeding had subsided, but the pain was still very intense.  I did hours of research, talked with my midwife,  and chatted with other breastfeeding moms in online forums.

Thrush, perhaps? 

I was prescribed Nystatin and a high dose Diflucan which I was to take for two weeks.  I tried gentian violet.  Vinegar rinses.  I ate pounds of yogurt and fermented foods.  I took high quality probiotics.  I boiled bras and bed sheets.  I cut out all sugar from my diet.  Through all of this, Olive never once showed any signs of having thrush herself,  though I consistently treated her for it with natural remedies.

Fast forward.  Olive is 3 months old and I can count on one hand how many pain-free nursing sessions we have had.  I was obsessed with killing the thrush.  It was all consuming, and I desperately wanted to sit down with my baby and nurse her, both of us relaxed and happy.

Something is wrong.  This isn’t normal.  It shouldn’t hurt like this. 

I took her to several lactation consultants to have her latch analyzed.

Yes, she has a shallow latch.  Yes, she pops and clicks when nursing, but that is probably due to your oversupply.  Her latch will get better as her mouth grows.  She is thriving.  She is fine.

I did 8 hour block feeds for days on end to get the oversupply under control.  I never pumped.  I wouldn’t even let the water beat on my breasts in the shower for fear of stimulating them too much.  The supply would be manageable for a few days, then it would shoot right back up again.  Olive was still nursing hourly, or even every 30 minutes at this point.  Day and night.

I was skimming through some comments on a breastfeeding page on Facebook.  Someone was describing the same nipple pain, and the same nursing behavior in their 3 week old baby. Posterior tongue tie.  I spent hours researching and skimming forums on anything and everything about posterior tongue tie. There are four degrees of tongue ties, each degree is an increase in severity based on both form and function.  The first and second degree “classic” ties are the most obvious.  They can be seen immediately when the baby opens their mouth.  The tip of their tongue is pulled into a heart shape, and is attached to the floor of the mouth by the frenulum, a mid-line membrane.  The third degree is also visible, more so when the baby is crying, as the tip of the tongue is not tied to the floor of the mouth, the middle is.

Fourth degree tongue tie is the rarest, and the most difficult to diagnose.  Known as the “hidden tie” or “posterior tie,” the tongue is rooted to the back of the mouth, and the frenulum is hidden in the muscle at the back of the throat.  Since they cannot be seen, they are diagnosed by expert palpation and manipulation of the bottom of the baby’s mouth.

Olive had been checked for tongue tie several times already, by both lactation consultants and her pediatrician. Yet, all of our symptoms matched the symptoms of posterior tongue tie.  Frequent, short nursing sessions (some tongue-tied babies are the opposite and have quite lengthy sessions), nipple trauma, feeling as if she was “flicking” the nipple over and over again while nursing, popping and clicking sounds, frustration at the breast…the list goes on.

I came across a pediatric dentist (and breastfeeding advocate), Dr. Lawrence A. Kotlow, who specializes in treating posterior tongue tie during my online research.  Exhausted and feeling a bit hopeless, I emailed him.  I spilled my entire nursing saga and attached pictures of the inside of Olive’s mouth and pictures of her nursing.  He emailed me back within the hour and said, “Mother’s instinct is never wrong.  Posterior tongue tie.”  He attached the name and number of one of two doctors in my state who are familiar with this tricky tie.

I called her immediately, and she fit Olive in at 9 a.m. the next morning.  She watched her nurse.  Listened to her nurse.  Listened to my story.  She watched her cry, watched her smile.  She then looked under Olive’s tongue and officially diagnosed her with a pretty severe case of posterior tongue tie.  Olive was three and a half months old.

Her frenulum was clipped and she was put immediately on the breast.  It felt like I was nursing a completely different baby.  No pain.  No clicking.  Instantly.  I looked up at the doctor, and I had no words.  Just warm tears streaming down my face in pure relief.


This is what it should feel like. 

Each day after the procedure was better and better.  Olive gradually started nursing longer at a time, and going longer between feedings.  My supply leveled out and she stopped fussing at the breast altogether.  I had zero pain while nursing.  Zero.  The struggles and worry of the previous three and a half months melted away with each successful nursing session.  I started to actually enjoy nursing my baby.  I felt like I could finally take a deep breath.

And now?  Now I can sit down with my sweet baby and just nurse her.  Relaxed.  Happy.  Relieved.


photo credit:  Katrina Amburgey Photography,


About Lindsay Karns

Lindsay Karns is a work-at-home mother to two daughters, Lula and Olive. She is a writer, massage therapist, wine and food lover, activist, and passionate about all things attachment parenting. Author of This Woman’s Work, she started her blog when she found out she was pregnant with her 2nd child, and wanted to chronicle her journey through her natural pregnancy and home birth. Over time, it has evolved into much, much more.

Lindsay runs Traditions Wellness Center with her mother, where she practices massage therapy.

When Lindsay isn’t busy writing or treating her clients, you will find her stuffing cloth diapers, cleaning up after Hurricane Toddler, and trying out new vegan recipes.

6 thoughts on “Breastfeeding Troubles and Posterior Tongue Tie: A Sneaky Culprit”

  1. Just went through this, though thankfully at 3 weeks, not 3 months. It is sneaky. It was only because of a knowledgeable friend and a good referral that I had any idea what the heck was going on, and even then, ours was compounded by a top lip tie as well. So that is what we saw first.

    Glad you got help. We’re still clicking over here (been about 2 weeks since the clip) but we get better with every nursing session.

  2. This is almost exactly my story. Dr. Kotlow even released my son’s lip tie and posterior tongue tie. However, for my son, three-months-old was a bit late for the revisions. He never completely adjusted his latch, though it got much better over time. He’s just turned 1 and we nurse just about pain free. It’s not the “perfect” latch his two older sisters had – but it’s his variation of perfect and I’m very very happy with the latch and all the progress we’ve made. Thanks for sharing your story. Inspiring!

  3. I cannot believe how similar our experiences were, right down to the war on thrush. Thrush may have played a part and not just been a misdiagnosis as persistent yeast troubles can be the result of the damaged nipples.

    I took us much longer to get my daughter’s clipped and 16 health care professionals missed it but the difference was amazing, even at 2 and a half. We went on to have a few months of trouble free nursing before weaning.

    Thanks for sharing your story.

  4. Wow. Congratulations for sticking with breastfeeding. It must have been very difficult.

    My daughter and I had all kinds of problems with breastfeeding in the early months. Small mouth, big boobs. She was very sleepy and would fall asleep after a few minutes (but not before she squirmed continuously first).

    Had a terrible time getting a good latch and just as challenging a time keeping it. Positioning was hard too. Baby wasn’t gaining weight as well as she should have been. So stressful and worrisome.

    After about 5 weeks, my midwife referred me to a pediatrician because she suspected baby may be tongue tied. The pediatrician found that she was indeed “moderately” tongue tied. Luckily it was the little band of skin right at the front so it was easy to fix.

    The whole thing took a couple of minutes and baby seemed more bothered by the pediatrician getting his fingers positioned in her mouth than the actual snip. I put her on the breast immediately afterwards and, like the original poster, it was like nursing a different baby. She went on relatively easy and quick and had a much stronger suck. She kept the same latch until she fell asleep after about 5 minutes.

    We continued to work through the rest of our issues (I think time was the most effective solution for many of our problems) but from that moment on, she got a good latch and kept it much, much better. Thank goodness for our midwife. 🙂

  5. We had a similar experience. Breastfeeding was so painful for me, I had bruises on my nipples after the very first time our daughter nursed and it just got worse from there. She was practically chewing the milk out of me. She had two clips anterior and posterior at 3 weeks and 5 weeks, respectively. I wish we done it sooner, because even though we went through exercises to help her suck she still isn’t the best nurser. I think she got set in her way and by then it was too late. But we are going strong still breastfeeding at 13 months now, though I can still remember very vividly all the pain and tears and hopes for a normal breastfeeding experience.

Leave a Reply

Your email address will not be published. Required fields are marked *