Tongue and Lip Tie - To clip or not?

[maryjane]

My daughter is 2 months old. At our 2 week pp visit with the m/w, she diagnosed a tongue tie. DD was/is gaining well (I have over-supply, all my kids have gained well), so at the time I didn't choose to pursue having her tongue clipped.

Now, 6 weeks later, nursing is still painful at times and her latch actually seems to be worsening. I really have to work on it every time, which makes for annoying middle-of-the-night feeds, to say the least. Additionally, I now know that she also has a lip tie, which seems quite severe. She can not flange her lips at.all. I try while she is nursing, and get nowhere. I'm sure this contributes to my pain as well. I have an appointment with a facial surgeon for next week, who will clip it with local, rather than general, anesthetic.

I'm starting to get cold feet, however. I watched a YouTube video, which has me so squeamish now. Also, after seeing how the m/w diagnosed DD (from her heart-shaped tongue), I realized that DS1 was/is also tongue-tied. I had pain pretty much the whole time I was nursing him (2 years), but always thought it was from thrush. (In fact, I think I have thrush again now with DD.) In any case, DS1 gained well and BF was not adversely affected (at least not for him). He did have articulation issues and was a late talker, but nothing hugely detrimental.

He wasn't, however, lip tied, and it seems that that is the most problematic issue for DD. She may also have a high palate, as she clicks a lot when nursing -- especially during letdown. So I can see how the issues are affecting her now, but what I don't know is how/if they will affect her later. The research seems to indicate dental problems, speech problems, and perhaps breathing problems when she gets older. But... the clipping looks so painful for the baby and I'm just not sure I want to put her through that.

I'm wondering if others have struggled with this decision -- and how you ended up making it? Thanks for your input!

[beatnikbean]

2 of my kids were tongue tied. My 2nd DS got his tongue clipped at around 6-7 weeks. I was having all kinds of BF issues. It wasn't that big of a deal. I was in the room with him and it was so fast and he stopped crying right after.

My DD (10mths now) got her tongue clipped the day after she was born. I noticed it immediately and asked the ped to do it in the hospital. It was much easier.

The few kids I know who didn't get their tongues clipped now have severe speech problems. That is a risk I was not willing to take.

[cyclamen]

My daughter had a posterior TT and a lip tie that were both clipped at 2.5 weeks. The decision to do it was scary - I was afraid of having someone in my baby's mouth with scissors, and since it is not a well known problem, I was also afraid that the doctor I took her to would turn out to be a crackpot. (She wasn't! She was incredibly kind and smart!) But nursing was soooo incredibly excruciating, even with a shield, and she could not take a bottle, so I felt it was the right decision.

Also, I found out at the appointment that I have a tongue tie too, and she probably inherited it from me. When I was 18, I had to have jaw surgery to correct my bite (none of my teeth met except my back two molars - I couldn't chew) and the orthodontist who did my braces beforehand told me it was my tongue that had caused alot of the problems, and that unless I could retrain my tongue, some of my bite problems would return. I really tried to retrain my tongue but it was impossible. I did not understand what he could have meant until I started reading about DD's tongue tie, and now I know why it was impossible for me to do. So now I am even more interested in making sure her tongue works right because I don't want her to have to go through the years of jaw pain, bite problems, chewing and swallowing problems I have had, if a five minute procedure now can prevent it. I also have a high palate, and the doctor who did the TT clipping explained that a high palate is linked with recurrent ear infections, which I also had as a (breastfed) baby. I am even thinking of getting mine snipped now, to make swallowing easier, because I swallow a lot of air all the time.

Cutting the TT was bloody! I held her body while she was swaddled and a nurse held her head. The snip itself wasn't too bad - it was fast. She seemed pissed having people up in her business, but I started crying with her when the doctor had to hold the gauze in her mouth for four minutes.

I wasn't able to pick her up and comfort her. She screamed the whole four minutes, and it was probably the most awful four minutes of my life so far, but she calmed down immediately after the doctor took her fingers out. I got to hold her, and then nurse her pretty soon after. If your baby's TT is thinner, or anterior, there probably won't be much blood, and may be no need for gauze, etc, so it might not be too bad.

She did want to sleep right on my body for the next week or so, and my mom thinks it is probably because she needed to be comforted after the trauma.

She has more tongue mobility now, but breastfeeding is still not going well. We are working on it though. I was supposed to massage the bottom of her tongue to keep it from healing back together. This may not be an issue for you (if it's anterior), but it was really hard for me to do because it made her angry, so after a while I didn't really massage it, and just made sure I could see the scab to know it wasn't growing back together. I think this may be why she still can't extend her tongue far enough. If I'd massaged it as it was healing, it might have stretched out more. So keep that in mind if they tell you to massage it - really try and do it.

I found that the best way to do it was to hook my index finger over the lower lip, instead of trying to lift the tongue up or push it toward the roof of her mouth - unfortuately I discovered this after she was all healed. So we are seeing a lactation consultant soon to see if she needs PT or if the snip has healed together more than it should have. I would also recommend trying to see an LC soon after the snip, to help with latch and things like that.

Well I hope some of that information was helpful for you. Good luck making your decision!

[obiandelismom]

My ds is 8 now with a pretty severe tongue tie, and I SO wish it had been diagnosed and dealt with when he was younger. Now his bite is just awful, and we're going to have to actually put him under to get it done. Not to mention the stitches! :

Hindsight is 20/20, but I really really regret not doing it sooner. Good luck!

[GoGoGirl]

My daughter had a posterior tongue tie. We got it clipped twice (after the first clipping, her tongue pulled back and exposed more tie that needed to be clipped). She was about 4 weeks old the first time, and 6 weeks old the second time.

I just watched that video, and really, for my daughter it was NOT that bad. She didn't shriek like that baby, it was more like a fussy cry. Did you have the PKU heel stick done? That was much MUCH worse for my daughter. (Just to put the pain aspect in perspective). We didn't swaddle her, I held her in my arms and my DH held her head. I sang her favorite lullaby during the procedure. The whole thing was MUCH faster than in the video; our doctor didn't fiddle around in DD's mouth as much as that doctor did. I was able to breastfeed DD right afterward, and she immediately stopped crying. She didn't seem to have any lasting effects in the next few days.

We didn't really struggle too much with the decision. DD was losing weight because she couldn't transfer milk effectively, so we knew we had to do it.

Good luck with your decision! And hugs, it's scary to consider doing something that you know will be painful for your baby.

[maryjane]

I also have a high palate, and the doctor who did the TT clipping explained that a high palate is linked with recurrent ear infections, which I also had as a (breastfed) baby.

Wow! I also have a high palate (just realized it through researching daughter's TT) and had ear infections CONSTANTLY.

Thank you all for weighing in and sharing your experiences. I finally was able to lift her upper lip and the tie is quite pronounced. As for the tongue tie, it is definitely posterior, so I am a bit worried about trauma. Wishing I had done it even sooner, but will go ahead and keep the appointment for next Tuesday. (Although every time I think of that video, I want to cancel the appointment!)

[MuslimMama]

We chose to clip DS tongue tie and it made a HUGE difference in his BF-ing. He was able to stay at the breast longer and did not swallow so much air.

[evinmom]

We didn't discover my DS's posterior tongue-tie until he was 2 years old. I really wished it had been diagnosed when he was a baby and I had found someone competent in identifying and clipping it. We had terrible latch issues that resulted him not coming to the breast until he was 9 months old. He also suffered from severe projectile reflux and oral sensitivities as a result of the tongue-tie. Tongue-tie can cause a lot of problems other than breastfeeding difficulties. The problems can range from texture sensitivities, reflux, jaw/teeth misalignment to speech problems. In a young baby I would highly suggest getting it clipped and clipped right. Sometimes the clip isn't done deep enough (more likely with posterior than classic tongue-tie) and problems persist. Best of luck!

[dewi]

That video is horrible.

When I've seen it done on clients baby's the mother holds the baby in her lap.

There is NO downside to getting TT clipped.

[Panserbjorne]

well, it is minor surgery so I wouldn't personally emphasize the "no" in the downsides. There is a lot of benefit, that is for sure. In fact this past weekend in the first international tongue tie summit there were some pretty amazing stories about adults that had been clipped and the healing that had brought. I am pretty pro clipping and have been for several years, but it's important to know that, as with anything there are risks. I just happen to believe that in 99.9% of cases the benefits outweigh the risks.

Honestly, it's pretty rare for it to be painful and traumatic for the babe. As a pp said, they get cranky about being held down, poked and prodded and they especially dislike having their mouths pried open. However they tend to nurse directly afterwards. The practice that I work in tends to recommend that moms use homeopathy and flower essences. This makes a big difference. In fact adding an additional remedy actually had the ped who routinely clips comment on the difference.

FWIW it was reinforced in the summit that it's very important to have the upper and lower done together as having the lower done without the upper will not allow the structure to normalize.

And on a final note I not only have experience with other moms-I chose to have my son's anterior and posterior ties clipped. One at just a few days old and the next months later. Totally worth it in my maternal opinion though I never had pain while nursing.

[georgia]

If it's only getting worse, I would personally go ahead, the younger the better...and I'm pretty laid back as far as interventions go. IMO, the benefits can be tremendous for both members of the nursing dyad.

Have you ever read any of Dr. Palmer's stuff?

http://www.brianpalmerdds.com/frenum.htm

Here are some other helpful articles:

http://www.kellymom.com/babyconcerns...tonguetie.html

http://www.llli.org/NB/NBMarApr96p41.html

http://www.llli.org/podcasts.html (TT: Catherine Watson Genna and Dr. Palmer)

[Panserbjorne]

Originally Posted by maryjane

Wow! I also have a high palate (just realized it through researching daughter's TT) and had ear infections CONSTANTLY.

LOL. When I first met Betty Coryllos it was during a seminar and one of the things she did was make everyone show her their tongue. She's an older woman and it was hilarious to have her going around peering into everyone's mouth. Interestingly enough though I have full ROM and am not TT'd, my palate is abysmal. AND I was breastfed exclusively. I too had constant ear infections as a kid. Just goes to show that the benefits to having it dealt with do extend past the nursing relationship.

Good luck mama. You'll do fine. It's a tough decision to make, and I fully acknowledge that. But as with so many things I have chosen to do I had to stay aligned with the fact that it was for the health of my child. That's what matters. Oh, and no more youtube for you! At least not until *after* it's done. LOL.

[georgia]

I agree, no more youtube

[2boyzmama]

My son's experience was different, but I see no one else here is talking about the lip tie aspect, so I thought I would chime in.

My son had FIVE lip ties, one THICK one in the middle, and two on each side (thinner, web-like). We noticed them right away at birth, but he also is a special needs baby, born with a genetic syndrome, so frankly we were distracted with MANY other things.

Breastfeeding him was nightmarish, for lots of reasons, but the lip tie was really a problem. He couldn't flare his lip at all, and I mean AT ALL. He also had no movement of his upper lip, when he would smile, it didn't move.

Finally at 10 months old, I showed his lip to the surgeon on his cleft palate team and the surgeon said he'd never seen anything like it. I even had pictures sent to Dr Palmer because he also said he had never seen anything like it. At 11 months old my son had lip repair surgery, and the frenulums were cut during that surgery. The side ones did not need suturing, the middle one did (it was a z-plasty, I think you can see pictures of that on Dr Palmer's webpage, in one of his slide shows).

For my son it was done under general anesthesia for several reasons...his age, his underlying medical issues (including a significant airway malformation) and because it was much more involved than a simple "snip". He had a lot of swelling, but I requested that he be brought to me before he fully woke up from the anesthesia, and I latched him on before he had a chance to realize that anything was different.

For the first few weeks I still had to flare his lip for him, he had developed a habit in his latch and had to be re-taught (remember, though, that he was 11 months old already). And two of the side ties grew back. He never regained full movement of his upper lip, but we've since discovered a neurological condition we didn't know about before, so that may be effecting his lip movement. He's been in speech therapy since just after that surgery (he's almost 2.5 years now) and we've been working hard on his oral motor awareness and strength.

DEFINITELY I would do it again in a heartbeat, even in the absence of everything else he had. It obviously effected his ability to latch, he woudln't have been able to suck a straw, his smile never would have been "normal", his speech issues probably would be worse, etc etc etc.

In the mean time, to help with weight gain, what I did was manual breast massage while he nursed, so that he didn't have to physically suck quite as much (I basically squirted the milk into his mouth for him). That might give your nipples a break, too.

If your daughter seems to be *really* disliking it when you take her to get it clipped, lots of crying, lots of stress, you can always ask for just a touch of versed. It's safe in very small doses like that, even on such a little one. And just a bit of sedative might be what you both need to get through it with less stress. LOTS of babies have surgeries or procedures very young and have various sedatives, hardly any would be needed for something like this, so really the safety factor is on your side here.

[maryjane]

Thank you all for sharing your experiences and advice. We have an appointment with Dr. Tanner, a facial (dental?) surgeon recommended by Dr. Palmer. I am super nervous, but DH is coming with me and we'll see what he recommends. Should I give her Motrin ahead of time?

Georgia -- not only have I read Dr. Tanner's stuff, I got to talk to him in on the phone. He is so nice!:

[Marnica]

You won'r regret it...DS had his clipped twice...1st one was not done enough....it was level 4 posterior tongue and lip.
Betty Corrylos clipped it a second time at 10 weeks old.

He cried and screamed for a few minutes and it made me cry, but he went right to the breast and quite frankly I thinnk it was worse for me than for him....It has made all the difference in the world!!

I would give pain relief after if needed, not before.

[AustGirl]

I'm currently trying to decide as well.

DS is putting on weight very well, but breastfeeding results in extremely painful nipples for me. It seems that unless we clip, I'll have to keep dealing with the pain. DS doesn't seem to be bothered at all by the TT.

If it will affect his speech/development later in life, then yes, I'll clip. But if the clip would only help out my sore nipples, is that a good enough reason to do it? I'm currently feeding him my EBM to avoid the pain...

[Panserbjorne]

If you want my opinion it's never just about the pain-though IMO that's a perfectly reasonable reason to clip. Nursing is about mom *and* baby-not just baby and not just mom. You were both designed to enjoy it and if you aren't it's going to alter the relationship. Now, is it going to cause irreparable damage? I doubt it. BUT can it affect the bonding, the flood of hormones, the content of the milk as a result and the way you interact even on a subconscious level? Perhaps. I believe that everyone deserves to enjoy nursing and if a simple procedure that is correcting a deviation from what is thought of as "normal" would allow that, then I'm all for it. Your baby is going to be happier if you are happier having them at the breast and not bracing yourself, resenting every feeding.

I can tell you as a mom that didn't have one of her kids clipped, in my experience it only gets worse. By the time my dd was 4 and her teeth were all angled in as a result of the tie nursing was excruciating. That little clip (had I known she was tied) would have made a world of difference and I wasted no time with my next.

Beyond the simple-nursing should feel good-point, the restriction in mobility affects the way the cranial bones mould and well as the development of endocrine and digestive system. It affects the way they suckle, it allows incorrect muscles to develop as a result of their brilliant compensatory abilities. It can affect the sinus cavities and dental arch. It can affect the way they breathe as well as their speech.

Now, none of these are technically life threatening and I'm certainly not trying to scare you! Dd wasn't clipped (and she has anterior and posterior lingual ties as well as a significant labial tie) and she's a bright, wonderful, lovely child. However if I had it to do over again, I would clip her no question. And, not that it matters but I am totally non-interventive in every other way-homebirth, no vax, no meds, no xrays etc. My point is simply that when you are asking, "if it's simply for my comfort and convenience..." that in my opinion the answer is no. If your child's structure is off, it's off and if it can be easily righted then it's something to look in to.

Clipping won't be for everyone. And though I'm pro clipping, there have been cases I've worked with that I didn't recommend it for specific reasons. It's a very personal choice. But that's my long-winded response FWIW!

[cyclamen]

Originally Posted by AustGirl

I'm currently trying to decide as well.

DS is putting on weight very well, but breastfeeding results in extremely painful nipples for me. It seems that unless we clip, I'll have to keep dealing with the pain. DS doesn't seem to be bothered at all by the TT.

If it will affect his speech/development later in life, then yes, I'll clip. But if the clip would only help out my sore nipples, is that a good enough reason to do it? I'm currently feeding him my EBM to avoid the pain...

Read the stuff by Brian Palmer - he does believe that it affects orofacial development. There's also a thread in Allergies about TT that suggests it affects digestion, but I don't know how much scientific study backs that up. That said, pain for the nursing mother IS one of the indications for revising a TT, even though a lot of people act like that isn't a good enough reason. I may sound horrible for saying this, but I think that it is a good enough reason. And so I sound less horrible, it's not only breastmilk that is important (which is not to disparage those who must or choose to pump and do bottles - from what I understand, it's tremedously hard work and my hat's off to you) - the act of nursing from a human breast has benefits of its own.

Which is to say, I think as mothers we are prone to endure all kinds of pain for the sake of our kids but that's not always the best thing to do. Particularly with bfing, I think that when we try to fix the things that cause us pain, we benefit our babies. I put off having myself checked for thrush because I thought I was the only one in pain. Then my LO got it really bad! If I had taken my pain more seriously, I could have spared her pain too.

[maryjane]

Thank you so much, Panserbjørne and cyclamen for what you wrote about the mother's pain. It felt so nice to read that. I think I was developing a bit of a martyr complex.

We did have her tongue tie clipped today. He said that it was much thicker than he typically sees, so he wasn't able to go as far back as he would have liked. (Referred to it as "muscle" and said he couldn't clip muscle without general anesthetic and stitches?). He said he clipped about a centimeter back. When I asked if the tie was anterior or posterior, he looked at me like I was an idiot -- his bedside manner was pretty awful, actually. I also asked if clipping only as much as he did would result in a measurable difference, or if we'd have to "redo" it at some point, and he said, "I wouldn't want to speculate." Hmph.

I do see an improvement already, but it's not as much as I was hoping for. You know how you are supposed to be able to see their little tongue working from the side if you gently peel back the lip. Well, I never could before. Nor, for that matter, could I peel the lip, no matter how gentle, b/c she would lose her latch. I also feel like she bringing my nipple in a bit deeper, although I'd hardly say that nursing her today was pain free. She definitely has more side-to-side mobility -- she was curling it to the left today, which she had never done before. But she still isn't sticking her tongue out much past her gum line. For those of you who had your babies clipped, was the improvement immediate, or did it take a few days for the tongue to fully extend?

As for the lip, which quite frankly was more concerning to me, he said that he wouldn't clip that without being in the hospital and wouldn't recommend doing it until she is older and needs orthodontics. He did say, "It's right there and really quick thick", but when I asked about it affecting her teeth (and other things I had read on Dr. Palmer's website) he said, "Well, it's hard to say because she doesn't have teeth yet."

I don't know that I would recommend him, as his professional demeanor toward me and my husband was really lousy. And this is the guy that Dr. Palmer recommended! I was also frustrated b/c he took a ton of money ($450!!!!) for an "out of network procedure" and it amounted to less than 4 minutes of work -- including the so-called consultation. If the problem was resolved, I wouldn't sweat the money, but I have this sinking suspicion she will need to be clipped again at a later date.

My ILs live in New Jersey, so I might try to get a consult with the doctor in New York that everyone raves about the next time we are out there visiting.