Sunday, December 15, 2013

Diagnosing A Posterior Tongue Tie

My son was born 16 days early after my induction due to pre-eclampsia. While our breastfeeding relationship seemed to be off to a good start, two weeks later and I was in a world of pain! I honestly believed that if spy agencies used breastfeeding as a method of torture there would be no secrets left to tell! I kept calling Lactation Consultants until I found one that was able to see me right away – something needed to be done because there was no way bleeding, cracked nipples were normal! Our latch looked good so the LC took a closer look inside L's mouth. She immediately diagnosed him as having a bubble, or high, palate. L would not let her get a good look under his tongue but I had been told in the hospital he did not have a tongue tie so we didn’t think that was the issue.

Because he was a late pre-term he lacked buccal fat in his cheeks – so, along with the bubble palate, we thought we had found the issue. I began using a nipple shield and was told that in a few weeks, when the fat started growing in his cheeks, nursing would get better. From that point on our lives were dependent on that silly little piece of silicon. I couldn’t go anywhere without it – in fact, I got nervous if I didn’t have one immediately within arms reach.

Lucas was also eating pretty constantly – if he went more than 20 or 30 minutes without eating he’d start screaming. Each nursing session was also at least an hour. He was constantly falling asleep at the breast and I would have to pat his little bum to get him to keep eating. My life revolved around breastfeeding.  I didn’t mind it, but I had friends with babies only a few weeks older than L and that was NOT the breastfeeding relationship they had with their children. I tried to remind myself every baby was different, but something just didn’t seem right.  

Out of frustration, I finally called the pediatrician and they scheduled an appointment. They asked about my supply, thinking that may be the issue, but I was pumping 4-6 oz AFTER feeding him in the morning so that was ruled out; my son didn’t spit up so they ruled out reflux, the breast did calm him so they said it wasn’t true colic. After 20 minutes I was told I had a fussy baby and I was feeding him too much (He had gained 1.2lbs in about 2 and a half weeks – but remember he was eating constantly and attached to my breast about 16 hours per day). I was told to only feed him for 15-20 minutes per side and then wait at least 2 hours before feeding him again. The pediatrician said that the first few days would be rough but that my baby would “adjust.”

I hated that advice but I felt pressured into doing what the pediatrician told me to do. Those next few days were torture. I’m pretty sure there is video of my husband and I with the baby in the kitchen with the microwave fan on, the water running, us “shhh-shing” and squatting with our 8 week old. Those videos will certainly be used against us at some point in the future! After two days I knew this wasn’t really working and started to feed him more frequently again but not constantly. We began giving him bottles at night and he’d chug 5 or 6 oz if we let him. He made such funny noises when he’d take the bottle (another red flag we totally missed by the way!).

At the 9 week mark Lucas started losing weight. I had also began to have the most horrible pain in my breasts, which I eventually realized was blocked or plugged milk ducts. Literally every two or three days I’d be in the hot shower, massaging my breast and pumping like crazy. I even began taking Lecithin (which does help with plugged ducts in case you were wondering!).

Finally, after posting all of this on a Mommy Group board that I belong to one of the women suggested a posterior tongue tie. My mom, who is amazing and was doing her own research, came up with that same theory. Once we came up with this theory I started doing a ton of a research on the subject. Here is what I learned:

First, posterior tongue ties can be extremely difficult to diagnose. Because breastfeeding became less popular than bottle feeding many years ago a lot of pediatricians are not skilled at discovering anything other than the obvious “snake” tongue or “1 and 2″ tongue ties. **Oh, I should mention there are 4 “levels” of tongue ties.  The first two are very obvious and easy to see, the 3rd and 4th are considered posterior and make diagnosis difficult. 
If you look closely you can see the dip in L's tongue where it was connected
Second, tongue ties and lip ties are considered hereditary. My brother had a tongue tie that was clipped as a baby as well as a lip tie that was not corrected and my father’s brother still has a pretty significant lip tie.

Third, tongue ties, lip ties and bubble pallets are typically related – meaning if you have one, there is a good chance you have another.

And fourth, in order to breastfeed correctly, babies need full movement of their tongue – they need to create a seal around the nipple, preventing slippage, and proper drainage of the breast. A tongue tie prevents this – hence the pain, low weight gain and even plugged ducts you’ll see below.

So what are these tongue tie symptoms? I’ll highlight the ones we had in an effort to save you from reading too much!
  • Sore, damaged, cracked nipples that do not go away after the first few weeks of breastfeeding
  • Mis-shappen nipples after feeding (flat or pinched typically)
  • Frequent feeding
  • LONG nursing sessions – an hour or more at times!
  • Slow or no weight gain or excessive weight gain (quick explanation – because baby is eating all the time and constantly getting the high calorie foremilk they can gain weight excessively but if feedings are “limited” like was suggested to us they will not gain weight or begin to lose because they aren’t getting enough food)
  • Reflux
  • Hiccups
  • Fussy at breast
  • Tense and unable to relax when feeding – think clenched fists, tension in head/neck, etc.
  • Colic
  • Baby only takes short naps and never sleeps peacefully
  • Cannot maintain a seal on breast/bottle – a lot of leakage
  • Infrequent swallowing
  • Constant need to suck – at breast, on a bottle, paci, fingers, etc.
  • Mastitis or recurrent blocked milk ducts
  • Supply issues
  • Nursing blister on baby’s upper lip
  • Green stools
  • Unable to maintain a latch at breast
  • Noisy feedings – baby makes clicking or popping noises at breast and bottle, loud swallows, etc.
  • Excessive gas
  • Gagging
  • Weak or lazy suck
  • Baby falls asleep when feeding constantly
  • Snoring when sleeping
  • Scoop in the tongue
  • Unorganized suck/swallow pattern – doesn’t suck/swallow but rather you get suck, suck, suck, swallow, breathe.
  • Excessive drool (not related to teething)

Obviously we had a lot of things going on so I wanted to get into the pediatrician right away! I was pretty sure I had figured out our issue but I needed confirmation and a solution.

Was it a posterior tongue tie?  Finish reading our story here.

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