What does THIS LITTLE BUGABOO…
Have in common with this little lady…
And this little dude?
They all have lip ties, of course. As we fly out this morning for Micah’s surgery I am thinking of these two sweet babes and others whose mama’s I have chatted with in the past few weeks. So many of you identified maxillary ties in your children after reading last weeks post . . . and sent me pics to prove it! Word is getting out, yet few lactation consultants, pediatricians or pediatric dentists know about it.
How is that possible? Are we all just jumping onto a fad diagnosis? I don’t think so. More mothers are breastfeeding today than the past few decades, so it makes sense that we are more likely to notice when something is “off” with a baby’s latch.
Also, some researchers believe we are seeing an increase in the MTHFR mutation, which is the gene responsible for converting folate into a useable form is essential for DNA synthesis and repair, neurotransmitter production, detoxification, and immune function. When the gene isn’t functioning optimally, it may reduce the amount of usable folate in the body. Since folate is necessary to prevent midline defects, this may be one of the reasons we’re seeing an increase.
If you suspect your child might be tied and are struggling with questions, I hope this info will clarify some things for you. And if you have a friend that is having trouble breastfeeding, please pass this info along!
Q: What are the symptoms and complications associated with a maxillary (lip) tie?
A: Baby’s Symptoms (Micah had all of these except poor weight gain. We never tried a paci or bottle)
- Difficulty latching on or falls off the breast easily
- Gumming our chewing the nipple while nursing
- Unable to hold a paci or bottle
- Gassy (babies with ties often swallow a lot of air because they cannot maintain suction properly)
- Poor weight gain
- Excessive drooling
- Baby is not able to fully drain breast
Mama’s Symptom (I had none of these except discomfort)
- Creased/flat/blanched nipple after feedings
- Cracked/blistered/bleeding nipples
- Discomfort while nursing
- Plugged ducts
Complications of Tongue and Lip Ties
- Babies may not be able to stimulate milk production through vigorous nursing, leading to low milk supply
- Painful nursing/early weaning because child gets too frustrated
- Improper tongue mobility may prevent babies from clearing milk from their mouth, causing tooth decay (especially in the front teeth)
- sleep apnea
- abnormal sleep patterns (Micah woke every two hours to feed at five months old because he was hugry ALL the time)
- Speech difficulties
- Gap between teeth/jaw issues
Q: How do I know if my baby has one?
A: Here is an excellent pictorial guide with the information needed to make an informal diagnosis.
Q:My husband’s little brother was tongue-tied. They were told in the hospital that the operation was going to be a big deal – expensive, scary, I don’t know what all. But the family lives kind of in the boonies, and there’s a country doctor down the road, and they took the baby to him (for a second opinion?) and he said, “Oh yeah. That’s easy.” And snipped it right then and there. Gabe’s been fine ever since, and now that relieving anticlimax is a family story. Of course, I’m telling this vaguely and third-hand, so I’d love to get the details on how it went for you and Micah.
A: A frenulectomy is a relatively simple procedure for newborns because the nerve endings haven’t fully formed and they’re easy to hold still. Because he was older, Micah had to endure more discomfort, bled more and was more difficult to keep still (putting a five month old under anesthesia has risks and costs about $3-5K. Daniel had just changed jobs and wasn’t eligible for insurance yet. The surgery couldn’t wait, so we had to keep him awake and swaddled through the procedure).
Maxillary ties are more difficult.
They can’t be snipped because it will just create scar tissue that is thicker and tougher than the original tie. Scissors and scalpels cannot usually go deep enough into the tissue to correct the problem. However, a laser can be used, which has the side benefit of increased healing time and minimal scar tissue. Unfortunately, few doctors have laser instruments, which is we we are going to New York to have it done.
Q: Is it ever okay to wait and see if they outgrow it? Or is it something that I need to have taken care of ASAP?
Dr. Kotlow, who is one of the most respected authorities on the subject, doesn’t advocate the “wait and see” approach. According to this article, he says “individuals who state most abnormal frenum attachments will resolve or go away by themselves are incorrect. The result is continued pain for moms and eventually infants giving up nursing. These frenum attachments may contribute to breastfeeding problems and should be evaluated for revision along with the lingual frenum revision for breastfeeding problems.”
I think my child has a lip tie. What now?
If it were me, I would email Dr. Kotlow a pic of my child’s mouth. He’s agreed to do a phone consult for many concerned parents, and he can talk you through options. If surgery is necessary there are only a couple places I know of to get it done. One is Dr. Kotlow’s office in Albany, New York. The other is Dr. Cole’s in Fort Worth, Texas.
Why are we going all the way to New York when Dr. Cole is in our own backyard? Good question.
When we found Micah’s tongue tie we were told he’d have to be sedated to have it clipped. The surgery, when performed on babies, is quick and easy. But as babies get older and stronger, they can move at the wrong time and healthy tissue could be damaged in the process. Fortunately, Dr. Biavotti, a Dallas ear/nose/throat specialist, agreed to do procedure without general anesthesia (he did a fabulous job, btw!).
Dr. Cole is one of the most respected holistic dentists in the nation. However, because he only recently began doing the procedure we felt that the best scenario would be to put Micah under to ensure a good outcome. But due to the risks of anesthesia we opted to go to Dr. Kotlow, who has lots of experience with wriggly babies and can perform the procedure with only a local anesthetic. On the flipside, we feel Dr. Cole is the best person to correct Katie’s maxillary tie (which we just discovered and believe is part of the cause of her tooth problems).
As more lactation consultants, pediatricians and pediatric dentist become aware of this problem the options will increase, but these are what I know of right now.