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.

I See You Formula, I See You

It happens to all of us to some extent I'm sure, that internal dialogue telling you that it might be a good idea to have some formula on hand, you know just in case. Perhaps that dialogue even extends to friends and family. A well-intended comment from a parent or grand-parent here or a coy suggestion layered with snark from a "friend" there, circling around. I know it did for me.

 You see, I knew early in my pregnancy that I was to be a single Mom. That I was "ok" with. What I was not "ok" with, however, was the insinuation that I couldn't be the type of parent I wanted to be or provide the best because of that title. I wear it with honor. So as the well-intended or snarky comments enveloped me the more determined I became. I had decided that I would breastfeed, come hell or high-water. After all, breast is best and my Harper was to have nothing but.

I hadn't once considered actually purchasing formula. I just knew that if I had that "stuff" in my house I'd give-in at 3 AM when I was struggling. For me personally, formula represented defeat in a can. Not just breastfeeding defeat, but parenting defeat. Then one day that "defeat" showed up in the mail. And then another can and another, until I had a stack in my closet staring back at me each time I put away more baby items. How did they find me? It was like some big inside joke between the formula companies and all the nay sayers (as it turns out this happens to most pregnant woman, but that's a different post altogether). For whatever reason I just kept it all.

When my daughter arrived the breastfeeding challenges began. It was the happiest moment of my life, but I immediately felt that voice encircling me again saying, "You can't do this, you'll never be able to do this. You won't succeed". I can remember it being around 4 AM in my hospital room trying to help Harper latch. She struggled with my flat nipples. I felt like my body was failing me. The nurse came in, took one look at my breasts and said, "Oh you've got flat nipples. We'll try a shield, but you may have to go to formula." Then she offered me a breast shield, but it just wasn't working. My mom rolled over from her hospital chair-turned-bed and suggested I just try giving her a little formula. I know, you're thinking how unsupportive that is. Honestly, those were the best words she could have ever said to me. They fueled me. I was angry that this wasn't going the way I'd imagined. I looked down at my little girl and said, "Don't worry. Mama knows you're just learning, so am I. We can do this. We will do this."

From then on it was breastfeeding jaundice, weaning from the shield, cracked and bleeding nipples, thrush, chronic plugged ducts, and mastitis that taunted me at every turn (which I plan to discuss in more detail in future posts). Those days. Were. Hard. With each hurdle I'd pass that closet and glare at those cans. Again those cans represented so much more than just a dry powder. They were my nemesis during that time and I just had to keep on keepin' on.  I'd say, "I see you formula, I see you. And it's not going to work." Then I'd apply my nipple butter like I was Katniss in The Hunger Games doctoring my wounds with salve. I like to think I was in a bit of a survival of the fittest game myself, only I call it The Hungry Games and we won.

We've since donated the cans to a local charity as we are almost 9 months strong in to this whole breastfeeding thing and I feel a great deal of support and confidence now. So "F" you formula, we won, and you still live in a can.

How do you feel about having formula in the house during the early days? Is it necessary?

WW: Pumpkin Spice Lacation Cookies

What better excuse to eat 3-4 cookies than they help with milk supply?

Go check out the recipe for Pumpkin Spice Lactation Cookies and report back! Would you eat them?

A Bad Latch

I did so much to prepare for the birth of my daughter.  Twenty four hours of Bradley classes (spread over eight Saturday nights), pain management practices, book after book.  During my time educating myself I read up on breastfeeding and even practiced with a doll at my classes. 

After basically the most awesome natural birth ever I brought my baby to my chest and she latched on with ease.  I grew this baby for nine months, I birthed her and of course I could feed her.  We spent the next twenty four hours wrapped in each others embrace in my hospital bed.  New York City hospitals are pro-breastfeeding and keep formula out of sight, but no one ever asked if I wanted to see a lactation consultant or got close enough to see her latch.  And I was too prideful to ask them.

Toward the end of my baby's first week of life I was in so much pain I declared breastfeeding harder than giving birth naturally.  And I meant that.  My nipples were cracked and bleeding and I was crying along with my baby.  Finally, late that Saturday night I called my Bradley teacher in tears.  I remember so clearly that she told me, "It's okay not to love every second of this."  She helped me find a lactation consultant who came over the next morning and not two seconds into her visit she diagnosed Adelaide as having a bad latch and showed me how to get her to latch correctly.

She also suggested I soak and rinse my nipples in warm salt water which helped tremendously in healing.  

That afternoon I put on my shoes and my coat, put my baby in the sling and walked proudly outside to meet my husband and in-laws who were picking up lunch.  My nipples still hurt like hell, but I knew from then on out that I could do it.

It's been just over nine months since my daughter was born.  I don't think there's any feeling in the world like knowing you made this tiny little human and your body alone is sustaining all of her needs. 

Now if only teaching her not to bite me with her shiny new teeth was as easy as teaching her to latch correctly.

4 Myths Busted

My adventure in breastfeeding started about three years ago when I started working as a night RN in the newborn nursery. There were no night shift lactation consultants at my hospital and most of the time, since company was gone for the day and things had settled down, night shift was the perfect time for first-time breastfeeding moms to ask for coaching. It was also the time that breastfeeding moms wanted to give up and get sleep. I took on the challenge, even though I had never breastfed, and instantly fell in love with lactation. During my journey of trying to conceive and pregnancy loss then finally my pregnancy with C, I was envious of all of the breastfeeding mothers. All I wanted to do was nurse my own baby and I prayed that all of the advice I gave new moms over the years was worth taking!

Working in the hospital with new moms during their first few days, I hear so many reasons why moms don't think they can nurse right away, exclusively, or at all. Here are some of the most common myths - busted.

I can't squeeze anything out so my baby isn't getting anything.

If only we could be so lucky! Most women aren't blessed with the ability to squirt milk across the room right after the cord is cut (and yes, I actually say that at the bedside because I'm awesome like that). It takes time and effort to establish supply.

Think of it as breast milk economics. Create the demand for a supply and generally it will come.

It can take 4-10 days to beef up milk supply to the point of feeling full or that milk has come in. Even after this period, it is normal to have highs and lows of production throughout the day, so don't be discouraged if you see colostrum dripping out during the first feeding and not the second or more commonly, morning and nighttime feedings.

Check out my next post for yummy recipes and ways to modify your diet to help increase supply!

My baby is in a low weight percentile so I need to supplement with formula to help him gain.

In the words of my son's pediatrician, someone has to be down there! Anywhere from the 1-99 percentiles is considered normal. If a baby is below the 1st percentile or starts dropping weight rapidly, that can be cause for concern, but some babies just gain slower than others and that's OK.

Exhibit A - My son's growth chart

He was consistently under the lowest little line but thanks to a great pediatrician, supportive family, and a hint of genetic stubbornness, we are now 9.5 months into our breastfeeding relationship without supplementing and he is now in the 31st percentile for weight and 69th for height. We are lucky to have a great pediatrician who told us that C would just follow his own curve and around 6 months he was expecting him to shoot up - that's exactly what happened.

Usually, as long as baby is having adequate wet diapers and not showing any signs of dehydration or other distress, even with slow weight gain, exclusive breast milk feeding is the way to go.

I have sensitive nipples. 

Oh yeah? Me, too!

Can it hurt a little in the beginning? Yes. Should it hurt the whole time? No.

If the latch is good, (which is a topic on the shelf for another day) it should not hurt for the entire duration of your breastfeeding relationship. A good way to initially check a latch is to assess if your baby is tugging or biting. It should feel like a strong tug so if it feels like a bite, break suction, start over and get the nipple deeper in the mouth until you feel a tug. This helps alleviate a lot of tenderness in the early days.

A question I get asked often by mothers experiencing tenderness is if it goes away. I'd love to tell you it does but the jury is still out. Does it go away or do we just toughen up and get used to it? 

Regardless, that wincing, piercing, OMG-why-am-I-doing-this feeling should subside in the first week or so. In the meantime, air out your nipples, wear gel pads, use lanolin cream, coconut or olive oil and ensure that your baby has a good latch.

My baby is hungry an hour after I nurse. There's no way he's getting enough.

The simple answer: You and your baby are designed to grow at the same rate. As long as you exclusively breastfeed, baby's tummy and your supply will grow together. In the first few days, when you just have colostrum -aka liquid gold- baby will probably want to eat small, frequent feedings and as milk gradually gets more calorie dense, there may be longer stretches between feedings.

Baby's tummy probably isn't going to be bigger than a marble on the day of birth and it will gradually increase in size.

As baby sucks more, mom will produce more, then baby's tummy will grow. If a bottle is introduced in these early days, baby will suck it down really fast and it is super easy so the tummy will expand faster than mom's supply can catch up.



What myths, wives' tales, or opinions did you have to combat in the early days of your breastfeeding relationship? Were you able to bust or overcome them?

Keep calm and nurse on, mamas. Til next time...