Advice - tongue tie & overactive letdown/oversupply

[bluebirdmama]

A little background: Silas is my 3rd baby. I breastfed the other two until they were 2.5 years old. I found it easy overall. No real problems aside from the occasional plugged duct. I do have overactive letdown/oversupply issues with the resulting problems (baby gasping for air, sucking air/making a clicking noise, choking on milk, and gas/reflux). These issues generally subside after about 6-8 weeks, especially as I block feed.

I've got the same thing going on again only worse. Silas also has minor tongue tie. Apparently the midwives mentioned it as something to watch the night he was born but I don't remember this. He can stick his tongue out over his gums and his tongue only makes a heart shape when he's yelling/crying hard. I didn't have a big problem with his latch (i.e. no cracked or bleeding nipples) and he's been gaining fine (he's up more than 4 Lbs since birth!).

However, his latch has always been what I would call narrow and pinchy. It doesn't HURT but it's not comfortable either. I have a very hard time getting him to open his mouth wide and none of my usual tricks work (rubbing the nipple from the nose down his face to his chin, or using a finger to pull his bottom jaw down). He really won't open his mouth. In fact, when he roots he either just moves his head side to side or bangs his face on my boob rather than opening his mouth at all. I really only get a great latch if he's been crying (which is a state I'd rather avoid, yk?) Because of this I still (at 7 weeks) have a hard time latching him in the dark or lying down. We still can't nurse side-lying because it's so hard to latch him and he has a hard time keeping his suction. He loses the nipple repeatedly and then slurps it back in (if he can) or starts banging his face around to look for it again.

I didn't even think of tongue tie until one day about 2 weeks ago when I noticed the frenulum when he was crying and it seemed more pronounced than my other kids' - and then I looked it up and learned that it could be the cause of him not opening his mouth. I brought it up with my midwife and she said that while he does have tongue tie, she thought that it's more a case of a lazy latch from the oversupply - he definitely does have that going on (holding the nipple and letting it drain in rather than sucking, just licking the nipple, milk pooling around his mouth) - and also that he may not open his mouth sometimes because he's fighting the drowning in milk thing (I know this from my previous babies biting down to stop the flow - but refusing to open their mouth when they're hungry?). Anyway, this seems a plausible explanation too.

She emailed me a couple of days later and said that she keeps thinking about it and that maybe we should see the specialist for a second opinion, just in case. So I see the specialist on Monday to see if we want to have the frenulum clipped.

I just can't determine if the problems are related to the tongue tie (and thus won't go away) or to the oversupply (and might lessen over time). I suspect it's the combo and I don't know if we should go ahead with having it clipped. I mean, he's gaining fine and I'm not in Pain. But I do find the situation disruptive and annoying, especially since he's still nursing every hour or two at night.

Any thoughts or experience with this?

TIA

[kitkat5505]

One of my twins had a mild tongue tie. He was still able to nurse but it wasn't really comfortable and hard to latch him. We had it clipped the day we left the hospital and it helped so much and he was happier too since he was able to eat better.

[nosce]

You sound like us. E has a pretty tight frenulum and I have an overactive letdown. I had a LOT of nipple cracking/bleeding when he was born and he had trouble latching. Even now, at 10 wks, his latch is just...weird. It feels like he's fumbling, shoving his tongue around awkwardly. He doesn't get that red crease on his face from nursing like my daughter did, and he really doesn't look like his lips are flanged open. And as you say, it's more flinging his head side to side or bashing his face at my breast than just opening wide. I'm not in PAIN either, but I'm not totally comfortable. He's gaining weight well so I'm not super worried, but I've heard a lot of testimony that non-clipped tight-frenulum kids end up having problems with solids when the time comes and with speech later on. I worry about that.

My midwife never said anything about it and neither did his pediatrician, so I'm going to get a second opinion. His frenulum extends all the way to the tip of his tongue and he can't get his tongue past his gums.

I think you're right that it's a combination of things, but I say that if you feel this would help your breastfeeding relationship/stamina as a mother, then go for it. It's a quick in office procedure and from what I've seen, babies cry more from being restrained/having their mouths pried open than from the actual clipping. If you're unable to nurse side lying than I would consider this hindering your breastfeeding. I'm so grateful that his latch/tongue tie hasn't affected my ability to nurse him while sleeping!

Hang in there, mama, and let me know what you find out.

[nosce]

Here's a shot of E's mouth, for comparison:

[Knittin Mama]

DDCC - We talked about this in my Bradley class, and although not always a cure all my teacher/LLL leader/doula (she's an amazing woman!) says that she has seen many BF'ing issues fixed with the clip of those tied tongues.  In agreement with what Nosce said it isn't even anything that requires pain meds for the wee one, just a simple snip and its done.  :) 

[smeep]

Allora has also been a bit of a mystery. Her latch has always been shallow, clicky more often that not, and it's also been painful for me. Ankylolabia (short upper frenulum aka "lip tie"), receded chin and high palate as we most recently discovered. I discovered the ankylolabia at 4 1/2 weeks and had it cut a week later. I'm now in very little pain (I think the other issues have made the healing slow but that the clamping upper lip was the main issue with pain). She does still click a whole lot and doesn't open her mouth wide enough but we are doing CranioSacral Therapy and it seems to be helping some. 

I decided to cut her upper frenulum because I figured that even if it made no difference, I had to try. Sure, she was gaining amazing (higher end of average) and I wouldn't consider weaning even for a second, but I still felt it was important for improving our nursing relationship. I don't regret it one bit.

If I were in your shoes, I would clip it. They're far, far, far less invasive than a circumcision and those are handed out like candy. And you also may want to look into CranioSacral Therapy. I happened across it whilst looking up a palatal obturator for someone else (before I learned she had a high palate) and come to find out there is quite a bit of success with it. http://www.llli.org/llleaderweb/lv/lvaugsep01p82.html

Good luck, mama!

ETA: We've been nursing laying down since the beginning (the extra sleep was worth the extra pain lol) but we no longer have to sit up with the light on to latch her on and that started after cutting her frenulum.