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Discussion Starter · #1 ·
My 7 week old has a grade 4 (or type 4? I'm reading conflicting definitions, his tie is very posterior) tongue tie. It was diagnosed over email by Catherine Watson-Genna and verified by a local dentist. He does clip and recommended that we clip this one, but I have a few questions.<br><br>
He is gaining weight very well. His input/output is good. I do not have any nipple damage (I did, but it's healed, and I think it was caused by one bad latch when we were all sick) I have an abundant supply.<br><br>
BUT...he is very gassy, semi-colicky (cutting dairy got rid of most of it, but not all, my food log doesn't show any other foods jumping out as other possible allergens) so I think it's an issue of getting too much air.<br><br>
He does break latch often, and makes a clicking sound.<br><br>
He is having trouble with bottles, and I go back to work on Monday <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> We are still experimenting with different nipples to find one he can latch on to better.<br><br>
He has not spaced his feedings out much yet, he still wants to nurse every 1-1.5 hours during the day.<br><br>
The dentist explained that he is having to suck harder than he should since he can't elevate the back of his tongue, which is causing the frequent latch breaks, the clicking, the gassiness, and he is tiring more quickly which causes him to feed more frequently. He also has a funky palate (not quite a bubble, but rather high, and somewhat terraced along the gum line, it looks like he has two gum lines almost, very odd). The dentist said that if we release his tongue and he sucks properly, he will use the correct muscles which may allow his palate to widen some on its own. Right now since he's using accessory muscles to suck, and sucking harder, his palate is narrow and will remain narrow.<br><br>
None of this is a major deal, he is thriving and healthy. This isn't a case of a baby with failure to thrive, or completely unable to latch, or me having such damage that I can't nurse. So what do I do???<br><br>
It's expensive to clip it (this dentist doesn't take insurance), because it's grade 4 it will be more painful...<br><br>
Clip, or wait?
 

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Getting all the info before clipping is so important. I'll add another anecdotal piece for you to consider.<br><br>
I was at a clinic where a 8 or 9 month old baby came in because he was not gaining well. Mother had ample milk for the first 4-5 months or so. Baby nursed well, but after about 6 months Mom noticed he was nursing more frequently, and at his well baby check up his family doctor found that he was not gaining weight as you would expect. Very pro-breastfeeding MD sent mother and baby to a clinic for evaluation. Grade 4 tongue-tie. Baby was just not able to transfer milk well - they though that Mom's ample milk supply and over active let down had saved baby in the first few months (all he had to do was open his mouth and the milk poured in!) but Mom's supply finally regulated and baby's anatomy prevented good milk transfer. Interestingly he seemed to have difficultly swallowing solids too.<br><br>
After clipping and several weeks of CST, and suck therapy by Mom, with some herbs and pumping to bring Mom's supply back, baby and Mom went on to do fine.<br><br>
Now - that's just one baby who went on to have issues several months later. Hopefully some other moms will chime in with other stories too.
 

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I tend towards clipping. So many possible complications of tongue tie as baby gets older too - speech issues, cavities, etc.<br><br>
Is it possible to seek someone who does take insurance to do the clip?
 

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Definitely clip...and the sooner the better. I don't have time to write my tale right now, but we didn't do DD's until 6 months and I REALLY wish it would have been sooner.<br><br>
If I don't come back to reply more in depth, please bump this up to remind me.
 

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Discussion Starter · #5 ·
I don't have long-term supply concerns because I have never lost my forceful let-down with my other children (even through pregnancy) I even kept it with my second son who has/had a cleft palate, severe lip tie, swallowing disorder, low muscle tone, etc from numerous birth defects. Breastfeeding him was torturous for so long but my supploy never dropped. Like patiogardener said, my body basically sprayed milk down his throat, he never worked for it. I also WOH, so I pump, and my body responds very well to a pump (I have had oversupply with my other two babies, despite the severe feeding issues my second son had), so I really am not worried about supply.<br><br>
Speech...I was under the impression that this kind of tie won't effect speech?? The dentist gave me another webpage to get information from, so I'll be researching it more this weekend.<br><br>
I definitely want to make sure we have all the information about all the pros/cons before I have him clipped. Right now I can't see any negatives (besides the money and the pain) but I'm also not fully convinced that we can't manage the issues it's causing and go on without it being clipped. If that makes sense. But I want to make sure I'm understanding everything that could happen down the road.<br><br>
Honestly, if it weren't for his funky palate I never would have sent pictures to Watson-Genna, she never would have pointed out his tongue, and I never would have taken him in to get it checked. And the only reason I noticed his palate was because my middle son has a complex clefting of his soft palate and a malformed hard palate, so I was specifically looking for signs of palate issues in this baby. My ped didn't think his palate was anything noteworthy, but I thought it was, so I sent pictures and here we are.
 

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<div style="font-style:italic;">Speech...I was under the impression that this kind of tie won't effect speech?? The dentist gave me another webpage to get information from, so I'll be researching it more this weekend.</div>
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I'd agree with you here on this one - unless you need the french rrrr or are starting to speak arabic!!<br><br>
Maybe look into an oesteopath, it's amazing what these guys can do sometimes, I'm working with a mother who has decided not to clip and we're working with an oesteopath and the differences are fantastic - I would look into that especially with his 'funky' palate - when you say that, what shape is it actually? I'd be interested to know. In some cases it can take a long time for the baby to adjust to the clip I know babies that have taken up to 9 months to get used to it, others just a few weeks so it's really for you to judge. I'd keep doing lots of research and see what you come up with. Also I know that there is patient confidentiality but you could maybe ask the dentist if there are one or two parents who wouldn't mind you contacting them to find out how it worked out for them - not sure if that would work but maybe worth a try.
 

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Discussion Starter · #7 ·
His palate looked like a bubble palate to me, no gradual slope, it just suddenly goes way up. It also looks very narrow from the inside of one gumline to the inside of the other. BUT, from the outside of one gumline to the outside of the other, it is a normal width. So is it his gumline that's funky?? I've asked two dentists, and shared pictures with Catherine Watson Genna. Genna described his palate as "terraced", like a landscape or something! I can upload pictures here to show you guys. Both dentists said that they think it's more of an optical illusion, that the overall height and width aren't hugely abnormal, but because it's not gradual, it looks odd. No one knows what's with the terracing, I've never seen anything like that. I'll be back with a link.
 

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Have you read Brian Palmer's thoughts on tongue-ties? If it would be useful I'll try to find a link for you. (He's an extremely pro-breastfeeding dentist, but I seem to recall his thoughts about tongue-tie go beyond breastfeeding.)<br><br>
ps. totally off topic, but congratulations on your new baby!
 

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Discussion Starter · #9 ·
<a href="http://www.facebook.com/photo.php?pid=3062726&l=f3b30ae1fd&id=634508169" target="_blank">http://www.facebook.com/photo.php?pi...d&id=634508169</a><br><br>
Here's pictures of his palate, and one picture shows that he can lift the front of his tongue.<br><br>
I have read Dr Palmer's information, but he doesn't (or at least didn't) have information about Grade 4 ties (I'll look again). The dentist gave me this webpage <a href="http://www.kiddsteeth.com" target="_blank">www.kiddsteeth.com</a>, said that Dr Kotlow has been publishing more research and is the one who classified the ties. I'm going through his page now.
 

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My $0.02 vote is for clipping.<br><br>
Do you mind mentioning the name of the dentist? One of my Tweeps is dealing with tongue-tie and she's in Dayton!
 

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Wow - I'd be surprised if a baby without a tongue tie could nurse effectively with a palate like this - not being rude at all, but I'm not sure even with a clip that it would help enormously - don't know what everyone else thinks. I would really go with getting an oesteopath on board who is pro-bf and has worked or is willing to work with this sort of thing, nursing will naturally flatten out the palate and with the help of someone as well - it may just help the situation. Good luck - I'll speak to a colleague of mine who may have some more information for you - do you mind me sharing photos? I obviously won't share until you post back.
 

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Discussion Starter · #12 ·
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<div style="font-style:italic;">Wow - I'd be surprised if a baby without a tongue tie could nurse effectively with a palate like this - not being rude at all, but I'm not sure even with a clip that it would help enormously - don't know what everyone else thinks. I would really go with getting an oesteopath on board who is pro-bf and has worked or is willing to work with this sort of thing, nursing will naturally flatten out the palate and with the help of someone as well - it may just help the situation. Good luck - I'll speak to a colleague of mine who may have some more information for you - do you mind me sharing photos? I obviously won't share until you post back.</div>
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Luckily for my younger two sons, I have mega-supply and nipples of steel, so despite their problems I've been able to breastfeed. And Gavin (youngest) is growing just fine despite his palate looking like that. But like you said, is it the slight posterior tongue tie causing the few problems he does have (gassiness, fussiness, frequent feeding) or is it his palate and no matter what his tongue looks like he'll be gassy and fussy? I just don't know. I guess the best course of action then would be to clip it and see...the only downside being the cost and the pain.<br><br>
You're welcome to share pictures with whomever, there are lots of pictures of both my younger two sons floating around various specialists because of their craniofacial area! My middle son has numerous craniofacial abnormalities, not just his palate, we thought all of them stemmed from his chromosomal deletion, but now to have another son with a funky palate (and we assume complete chromosomes since he has no other health issues, although we didn't test him) now I wonder how much of this is hereditary vs chromosomal.<br><br>
And I'm confused now about the classifications of tongue tie. The dentist called it Grade 4, but then the webpage he gave me has a very different description of Grade 4. Is it more correct to call it a posterior tie? Does anyone have any good links with short and long-term effects of posterior ties?
 

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Honestly, with the palate problems, I'd get him clipped. From the description, it sounds a LOT like the palate I have even now as an adult, and there are issues.<br><br>
Is his tie anterior or posterior? I have an anterior tie that was not clipped as a child because I got enough milk - and I suspect it's for the same reason your LOs got enough. But I was in speech therapy as a child to learn to pronounce my R, I spent years in braces, a year of which was spent trying to widen my palate, and even now (after clipping) it's been recommended that I have speech therapy to relearn how to swallow, more braces and surgery to widen my palate even further. I have TMJ, a cross bite, and a tongue thrust that is slowly pushing my lower teeth forward. Getting clipped as a baby and having my palate widened then would have likely resolved all of those issues.
 

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Discussion Starter · #14 ·
It's definitely posterior...very posterior. The dentist (who is the TT expert in this area) said that 2 years ago they never bothered with ties like this. I emailed Catherine Watson-Genna back and she said that they don't know yet what kind of effects this kind of tie has on anything. In theory clipping it could help flatten his palate some, but no one really knows because no one ever paid attention to these ties in the past.<br><br>
I'm almost positive that this tie won't effect his speech or swallowing, he has full movement of the front of his tongue, it's only the back. But who knows?<br><br>
I'm researching more and more...my thoughts right now are aside from the cost and the pain, there's no harm in clipping, I'm just not convinced yet that we'll gain much.
 

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I'm pm'ing you ....
 

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Actually, I decided not to pm you and to post this so that everyone who may need this information may find it useful - i'm sorry if this is long but found it easier to list in this way:<br><br>
So here goes I'm starting at the beginning,the palate is in fact shaped by the tongue; hence a tongue-tie tends to create a palate that is high, square-edged, bubble, wall at the back, etc, depending on where the tongue-tie is, therefore, when we see a high or unusual palate we should suspect immediately a tongue-tie! Tongue muscles are not allowing a full extention of tongue and are not creating a nice rounded palate - I'm guessing you know all this already but maybe useful to others.<br><br>
Clipping a tongue tie now will certainly help baby latch better, get less air, since babies who suffer from this sort of tongue tie can't hold the breast in tightly and let go often, swallowing air in the process. However what must be noted in this particular case is that gassiness is not caused by swallowing air, that air comes back up as burps! Gassiness is more likely caused by the high lactose intake, if you have a great letdown, your ds is not doing a great job of staying on the breast and getting the high calorie, high fat, hind-milk. This extra amount of lactose cannot be digested and goes directly into lower intestines before the lactose has broken it down into simpler sugars that can be absorbed, and ferments, creating the gas, greenish and sometimes explosive stools.<br><br>
Clipping the tie might also be important in preventing apné in adults, swallowing problems etc. - just found this out and IMO probably one of the really big reasons for doing the clip - it'd being interesting to find out if those who suffer from sleep apnea have this sort of undiagnosed tongue tie.<br><br>
Osteopathy will help, and even if clipped, osteopathy will speed up the baby being able to use better the tongue, which in turn helps stretch out the frenulum.<br><br>
Milk supply diminishing over the long run is a strong possibility at around 3 - 4 months. The baby is not doing his job and the let-down reflex diminishes... so baby starts getting less milk. Moms who have ample supplies and good let-downs don't always notice that their babies have any problem at all, unless they have already breastfed before - I see this time and time again. They might then see that baby is only getting the let-down milk and managing to gain weight on that. But the gassiness is a symptom of an unbalanced feed. Cutting down the (over)milk supply is only going to force you to pump and feed with a SNS! Better too much milk, and correct the suck. Breast compression is often necessary if the mom keeps baby on the empty side for a 2nd feed to get more fatty milk - see <a href="http://www.drjacknewman.com" target="_blank">www.drjacknewman.com</a> (video clips) click on breast compression with tongue clip (although not a grade 4)<br><br>
I hope that this has helped you - you find yourself in an uneasy position but maybe that this can aid you in your decision, please do not hesitate to ask more questions, this is something I am very interested in and am extremely happy to do more work on!
 

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^^^ AWESOME post. Thanks for taking the time. I lernt. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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Discussion Starter · #18 ·
I've previously read most of what you wrote, ewe, but what I can't find is whether all that applies to such a posterior tie.<br><br>
Palate shape...he can elevate his tongue normally in the front, and I know that the entire tongue shapes the palate, but surely a mild posterior tie didn't cause this much of a palate malformation??? And if so, why are narrow arched palates seemingly hereditary on my side of the family but tongue ties aren't? (at least obvious tongue ties aren't, my mom, myself, and my sister can all lift our tongues normally, how would I check for a posterior tie on myself??)<br><br>
Gavin definitely HAD a foremilk/hindmilk imbalance, but through block feeding I was able to correct it. The explosive green poop is gone, the only sign remaining is his gassiness. Cutting dairy helped a lot, but I'm wondering if his continued gassiness has to do with a nursing problem, or another food sensitivity??<br><br>
And supply is really not a concern...for me at least, although I definitely understand how it would become an issue for most women. The lactation consultant that has worked me since Connor was born (my second son, the one with all the craniofacial birth defects) is continually amazed at my seemingly-never-ending supply. It just never stops! (or at least hasn't with my other two) When I was 12 weeks pregnant, Connor was 2, and I was very sick with a sinus infection, I was still able to pump 4 ounces in a sitting. And I still felt let-down. Plus, with me working full time and pumping often, my supply stays nice and stable.<br><br>
SO...I'm back to wondering how much of a problem his tongue is causing, and whether clipping it would really be beneficial. Even if it is a fore/hind imbalance causing his gassiness, clipping the tongue only corrects the tongue, not the palate, so would anything change?? Same thing with my milk supply...if it's more the palate causing him to not extract the milk effectively, fixing the tongue won't help that short-term (because it's such a posterior tie).<br><br>
I can see long term benefits to hopefully encouraging the palate to widen/flatten on its own if we clip the tongue.<br><br>
UGGGHHHH!!<br><br>
More to think about. I'm still waiting on my insurance company to determine how much they'll reimburse if we do decide to clip it.<br><br>
Keep the info coming, not only is it fascinating, but I want to make an educated decision.
 

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I nursed two boys with severe G4 ties and never had them clipped. Supply was an issue with one of the children, but managable in practical ways (that child also had GERD and was a preemie). Children are now age 8 and 5. Dentists will always tell you to clip, but it is still your choice. No facial problems, no palate problems. Twice a year I am still pressured to have what amounts to invasive cosmetic surgery on them, and I refuse. They speak perfectly, breath normally and are beautiful. I do not belive that we need to change every little thing in order to fit what professionals believe may or may not happen. I also would not have surgery on a tight frenulum anywhere else on the child's body. All surgery hurts, potenitally causes damage and risks infection.<br><br>
If you have no supply issues and do not want to clip--do not. You watch supply as with any baby and nurse through. Nursing every 1.5 hrs is normal pattern for a 7 week old. My first TT baby gained well over a pound a week and was 25lbs at 7 months. The second was normal weight once his GERD resolved (22 months). I nursed then both to 2 years.<br><br>
If you would like to speak more, PM me. I do not normally post in this secion and will likely "Lose" this thread<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
Take care and goodluck with your baby and your choice.<br><br>
I personally see the TT as a variation of normal, and even quite unique.
 

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Clipping the tongue CAN help correct the palate. The palate is still maleable and, once the tongue begins functioning in its full range, it will reshape the palate. Also, a myofascial therapist can work with him to expand and flatten the palate, helping to alleviate the problem from both "ends."<br><br>
We're starting with a myofascial therapist soon for DD's palate. It's high and narrow. We're doing so to reduce the chance of any dental work needed in the future. Our family has great teeth/alignment/etc. and nobody has ever needed braces. DD's teeth, on the other hand, are quite tightly spaced. Palate work now is cheaper, drastically more comfortable and I'm willing to do anything that's minimally invasive to practically guarantee that she won't need orthodontics later.<br><br>
The clipping does have some pain, but it's really on the low end of the scale....I wouldn't really worry about it much. I'm not saying that lightly...I worry about every little pinch, owie and bump they get. But, the potential for improvement is SO great that it pains me to think it's skipped for fear of inflicting a little pain.<br><br>
Cost? Yeah, that has to be considered. Ours was $4800 for a <10 minute procedure and 15 minutes in the recovery room before being discharged. We're in dispute over the fees, though. Bleh. We'd have to pay about $1700 of that, but our insurance sucks really badly. At his age, though, my doc would have done it with local, which I would have preferred for DD. But, she was too big and strong to "fight with", so they used general. That drastically upped the cost.<br><br>
I firmly believe that the procedure is so quick, minor and has such potential for great improvement that it should be done MORE often. Far too many adults have issues stemming from ties that could have easily been fixed as babes. The saddest part is that they don't know what's causing it and it could STILL be fixed, but no one recommends that. Instead, they receive gastrointestinal drugs, sleep apnea treatments, etc. Both examples are very serious problems with side effects, cost, hassles, etc....all could have been avoided. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"><br><br>
Hugs, Mama. I know it stinks making medical decisions...even more so handing a babe over for any treatment.
 
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