Upper lip tie - to snip or not?

[beckington]

Will try to make this brief...

DS is just over 5 months and weighs 11lbs. He's been gaining about 1-3 ounces a week on average. We've been trying trying trying to get his weigh up, but no luck. I'm on domperidone, blessed thistle, fenugreek - my supply seems fine now. I found out about a month ago I have celiac so we thought that might be contributing to low weight gain but a month of gluten free has seen no change. Now we've discovered ds has an upper lip tie. Went to the dentist today who confirmed the upper lip tie, but says no tongue tie. He doesn't recommend snipping it. He says the literature doesn't support that - that it hasn't been proven to be a problem with breastfeeding. It could become an issue in future with teeth but he said they'd deal with it then and that it's easier to snip in an older child than a wiggly baby! He said if we wanted it cut that a pediatric EMT would probably do it.

I, of course, have been doing heaps of reading online and while there may not be literature saying it impacts breastfeeding at lot of people would say that's just because there hasn't been research into that area since breastfeeding research isn't a big area. The dentist says he sees people with lip tie a lot, even one a day, and that he's not known it to be a problem - but how many of these people were breastfed?

We do have a fair amount of symptoms that could be explained by tongue or lip tie, including the poor weight gain. But I don't have pain, and that's usually a big sign. And the symptoms we do have could be explained by other things. Or not. Who knows?! His upper lip doesn't flange out when nursing and when I do it it often goes back in or the latch breaks. He pops on and off the breast a lot, but I thought that was because of unhappiness with the flow of milk. Also *sometimes* his upper lip DOES flange out on his own, so maybe it's not that big of a problem? I have always called him an inefficient or lazy nurser - maybe this is why?

I'm going to email Jack Newman (he has said he doesn't think upper lip flanging out is a big deal, I think) and go see our pedi tomorrow. I want to check his weight now because if he is doing worse (has dropped to about an ounce a week lately!) then I'm more inclined to do something. But my feeling is to leave it, I think. We are close to starting solids and there are risks, though small, to cutting. Maybe if we'd known what we know now months ago we would have done something, but at almost 5.5 months I wonder if it's worth it. Though I do really believe in breast milk being the main source of nutrition for the first year and letting the baby lead on solids, so if fixing his lip would increase his weight gain and mean we don't need to be so paranoid about solids then that would be a good thing too! Oh I dunno. Bah!

So confused.
 

Would you snip? Or have you been in a similar situation and snipped - was it worth it?

Thanks!

[Megan73]

I'm sorry you're struggling with slow weight gain. I know how tough it is.
I asked an LC about this very issue and she said it doesn't matter what position the upper lip is in and the reason the lower lip flanges is because the tongue comes over it, pushing it downwards.
What are you doing to increase your supply? How much dom are you taking? Some women are taking up to 160 mg now. Are you pumping with a hospital grade pump? A nursing and pumping vacation might help.
Are you considering supplementing with donor milk (if you can find it) or formula using a Lact-Aid or other at-the-breast device until your LO is ready for high-calorie solids like meat, Balkan yogurt, egg yolk etc.? Given that he IS gaining - albeit slowly - it would likely take only a small amount of supplement to get him gaining well in the meantime.

[PatioGardener]

i'm an "n of 1" but ds did gain better once his thick upper lip tie was cut.

[ShwarmaQueen]

I was given the same advice by a pediatric dentist, and didn't clip DS's. His lips never flanged out either. Then, when he started crawling he fell and ripped it on his own, but it didn't improve things for us. His lips still don't flang out now that he takes a bottle either.

[homemademom]

My ds also had his upper lip tie cut and it doesn't seem to have done much. Even now that he's latching and nursing, he curls it in.  Same thing when he takes a bottle.  I'm wondering though, with your problems, if you could get a second opinion on the posterior tongue tie.  No one thought my ds was tt'd either, but I think it's important to look at what the tongue can do functionally and not just how it looks.  This site was really helpful to me: http://www.cwgenna.com/quickhelp.html

[beckington]

Thanks for all the replies! There's just so much conflicting info out there it's so hard to sort through it all. Basically, snipping it might help, or it might not. Bah!

PatioGardener - how old was your ds when it was cut? Was it done with a local or under general? Did he have a tongue tie as well?

homemademom - thanks for the link! I've been looking there and trying to test ds with their ideas but whenever I put my finger near his mouth he just wants to suck on it! I do think a second opinion is a good idea. I have an appointment with our pedi tomorrow and will get him to look at it properly, but I don't think he'll have much luck diagnosing it. I'm going to ask for a referral to a pediatric ENT - they could cut the lip tie if we decide to do it and also give us a second opinion on the tongue tie. He does have really good movement of his tongue from what I can see though.

Oh what I would give for a simple answer to all this!

[homemademom]

Not PatioGardener, but I'll share my opinion anyway ;)  I definitely wouldn't do a possibly unnecessary procedure that requires general anesthesia on an infant. We had our ds's lip and tongue tie lasered by a pediatric dentist with specialty in tongue and laser surgery, no general anesthesia required (just a local). Ds was swaddled and my dh laid in the dental chair while holding him on his chest.  He wasn't too wiggly at all, but I suspect it has to do with a doctor's experience and comfort doing the procedure.

[beckington]

Yeah, general is a line we won't cross. I'm just not sure how they do it here locally. That's one thing to find out with a referral, I guess!

[beckington]

OK so had an appointment with our pedi yesterday who said his lip tie is normal (I think he meant common, as in he sees it a lot, because he wasn't disputing the fact that he had a lip tie) but also thinks he has a mild tongue tie! He personally doesn't think it would be affecting breastfeeding but I pushed him for a referral to an ENT so we will see what they think. I don't know if at 5 months it's worth doing anything about it?

This is frustrating because I mentioned the possibility of a tongue tie MONTHS ago to my GP, doula and lactation consultant and they all thought he didn't have one. Maybe he doesn't, but I will be mighty peeved off if he does and all the stress of the last few months could have been avoided. I wish we had known to look at the upper lip since that one was more obvious and would have gotten us to an ENT earlier. Oh well. I guess there's no point getting upset about it, but man oh man!!

[Ola_]

I believe my DD has what you are describing and we've been to Jack Newman's clinic in person - that's who pointed it out to us.  They did not indicate that it could be an issue with breastfeeding but they did also find her to be tongue tied and clipped that.  From what I recall they said that the lip attachment is usually pointed out and clipped by dentists if it causes teeth to grow in crooked, which is apparently a possibility.

Not sure if that helps you any but I wanted to share anyway.  Good luck!

[manshi1975]

I just got my 3.5 month DS's upper lip tie clipped last week because of latch and vey poor weight gain but I dont see much of a difference in the latch. We havent got anyone to diagnose a possible PTT and infact all peds were against interfering with the lip tie as well. I was against the idea of G.A and sedation so my dentist agreed to do  laser frenotomy while my partner and I held him tight for 10 mins. Was the most traumatic experience for me while poor baby wriggled and screamed. After all that he hasnt taken the breast much - and has taken more to the bottle than earlier. I feel pathetic for putting him through the pain and worse that it hasnt really helped so far.

[BubbaMama]

Both of my kids are lip tied and my youngest also has a posterior TT, class II (see my recent post).  He is 9 months and we have not clipped it as it's a new discovery - he's gained weight fine, other things tipped us off.  I do know that a posterior TT can be hard for some to diagnose so your LO could have one, if found I would lean towards getting it clipped, not just because of breastfeeding but all the other things TT affects (some say gut issues, food intolerance's, dental carries, etc).  The younger the baby the more likely you do not need any local.  But, since baby is 5 months old I would recommend doing CST immediately after the procedure and for some time after wards, it will help him to un-learn the bad habits.

As far as a lip tie, I would only snip that if you are having pain from him not flanging or if it starts to affect his teeth.  As I said, both my kids have it and it hasn't affected their teeth nor their nursing.  

[homemademom]

I've been thinking about this thread since I posted and I've noticed some things about my upper lip-curling baby. He doesn't do an assymetrical latch very well. He doesn't tilt his head back very easily when he nurses, which makes side-lying nursing in bed a lot more difficult. I think the flanged upper lip gives their head more range of motion without breaking suction, which would help with positioning and being able to breathe without the breast pressed into their face. His tendency is to tip his forehead down in an effort to stay latched and he clamps his jaw sometimes because of it (especially when trying to nurse in bed during the night).  Not to say that clipping would improve any of this, since we did it and he still curls his lip. I try to flip his little lip out when I think of it, but it's not something that comes naturally to him.

[PatioGardener]

Originally Posted by homemademom His tendency is to tip his forehead down in an effort to stay latched and he clamps his jaw sometimes because of it (especially when trying to nurse in bed during the night).

Wow! This was my guy before he had his snipped! I had even complained to a friend about it. I didn't even realize that he stopped doing it after.

[Acaatee]

I live in London, Ontario. Where can I get a lip tie and posterior tongue tie taken care of via laser, but without  GA?  I"m willing to travel to TO, but don't know which dentist or specialist would be the one to go to. Canyou recommend names?

[choochootwo]

beckington, 

I have a 22 month old son with a lip tie and a tongue tie and I just found out about it 2 months ago. We still nurse and it's not painful. I struggled in the beginning and thought it was normal. He fell on and off the breast, had colic/reflux. He now has early childhood tooth decay and some speech problems ( but not too bad ), all caused by the lip tie. I have to add his lip tie is not one that goes under the palate, but still caused problems. I've found a dentist in NY and we're going to have laser revision done, a painless or almost painless procedure, no sedation needed. His website has a wealth of information on lip and tongue tie www.kiddsteeth.com. Look under articles. There's a tongue tie support group on FB where you can post photos and get feedback from other moms and lactation consultants. 

If you have celiac, you may have weak tooth enamel yourself and be predisposed to cavities and can pass this bacteria to your baby. Look for white spots on your child's teeth as they get older. This is demineralization, early decay. Don't mess around with it. It acts very differently in primary teeth and spreads and erodes extremely fast. 

[Acaatee]

Hi,

I found someone willing to do it, without GA, on DD who will be 19 months next week.

Dr. Fayad in Ottawa, who specializes in it, has been doing it for years, and does I heard an average of 15 a month (something about getting referrals from midwives, and that there is more awareness over the last couple of years).  Anyhow, I'm seeing him with DD on the 18th to get the procedure done, God-willing.  (My first time in Ottawa and for a dental visit!  Long 8 hours from London, but that's ok!).

I'll let you know how it goes.  Then we have the follow up on the 27th to make sure everything's healing right.

It ws interested how they push for this procedure, saying the earlier the better, and that it has long term benefits.  Meanwhile, our dentist in London is saying to wait till she's 11 or 12 if it's creating a space between the two teeth.

We'll see.  May God grant us what's best...

[ArtScienceDoula]

What was the cost of this procedure?

I always noticed my son had a strange looking top lip (inside), but never knew a lip tie was a thing. I am considering lip tie laser surgery for my 19 month old because he is having difficulty speaking. His lip tie is very sensitive and I believe it is causing pain and delaying his speech. We are also nursing still and I have over-producing breasts, but it makes sense that he wasn't getting a good latch. I had a lot of pain, blanched nipples, squashed nipples, the whole bit. Also, he has never been able to hold in a pacifier or suck from a bottle.
 

[dot1]

Just had BOTH of my girls Class IV upper lip tie and Type II posterior tongue ties treated with laser by a dentist.  Age 5 and age 12 months.  Instantly the 5 year old girls speech was better (can now say "sh" sound due to ability to fully pucker her lips).  I had no idea how restricted her tongue was too.  None of it was obvious unless a proper assessment was done.

This dentist, Dr. Kotlow,  has an amazing resource where you can see visuals of how to assess.  www.kiddsteeth.com

Untreated lip ties can cause upper front tooth decay, gaps between teeth and gum recession.  They can cause speech issues.  For those who learn to compensate and articulate, they may have slower speech.  

In our case, with the baby it caused excess air intake due to poor seal...reflux and colic, gagging, choking.  She has since stopped spitting up.

Have you joined the Facebook Group https://www.facebook.com/groups/tonguetiebabies/ ?

It's an excellent resource.  Group is closed so you need to ask to join.  Once in, the support and advice is phenomenal!

One thing that the group emphasizes is the importance of seeking treatment from providers with a proven reputation for being breastfeeding friendly, and who use laser (so no general anaesthesia needed).  They have a list of recommended providers.  A botched job by an ENT who only dabbles or who treats only very severe cases of anterior tongue tie (the heart shape tongue) may end up requiring further revision.  So it's best to go to someone who can guarantee the best possible job.  In Canada it costs $525 or so....but most dental plans fully cover it (ours did).  

I dealt with months of reflux....and even had referral to allergist.  Reflux got worse after starting solids.  Turns out it was the tongue....and no one ever even bothered to look in her mouth!  

Beckington - can you update us on how things have gone?