The Lactation Nerd Blog
Evidence Based Info
for All Lactating People.
for All Lactating People.
Ouch! Breastfeeding hurts, and no matter what you do the pain just isn't going away. Your pediatrician says everything is fine, your lactation consultant said everything looked great, but something just isn't right. Why is this happening? Well, very often, there's a sneaky culprit that, YES, even your pediatrician and lactation consultant missed.
I'm talking about a tongue tie (sometimes lip tie, too). This sneaky breastfeeding problem is very often under-diagnosed, shrugged off, or missed altogether. Unless your lactation consultant or pediatrician has specialized training to recognize the specific markers of oral restriction related to tongue tie, you're likely to end up on google searching for answers yourself (hey, is that how you found us?). If your baby does have a tongue tie, you'll need supported through a revision and follow up care necessary to breastfeed successfully, without pain, milk supply issues, and/or weight gain issues that are commonly associated with ties.
So, what are the signs and symptoms of tongue tie? Nipple pain definitely isn't the only one (and sometimes it's not a symptom at all). There are quite a few different symptoms, and you could have some or even most of them. There are signs of a tongue tie you may be experiencing and others your baby may be experiencing. Let's take a look at some of the unexpected symptoms you probably don't know about!
Tongue tie symptoms you might experience include.....
Tongue tie symptoms your baby might experience include.....
Does any of this sound familiar? Are you checking any of these boxes? If you are, then there is a very real possibility that your baby has a tongue tie or an upper lip tie, and you're going to need some expert support. I'll talk you through how to get that support shortly, but first, let's talk a little more about these symptoms.
It can be difficult to find the right support for tongue ties. In our practice, we see families with this concern get turned away by their doctors all the time, for various reasons (and believe me when I say we advocate for those families like crazy until we find the support they need). The most common obstacles we see is a physician who isn't properly trained to diagnose a tie OR that they didn't see the point of revising a tie if the baby itself isn't having very obvious or "enough" issues.
But your baby is not the only one in this breastfeeding experience, right? You matter too! AND we fully understand how important breastfeeding is to you and your baby's lifelong health. Whether your doctor thinks your baby is having issues or not, you deserve to be heard, and your baby deserves a proper oral evaluation to help them get the diagnosis necessary to work through the issues stated above.
What if I don't have nipple pain? Does that mean my baby is not tongue tied?
The answer to that question is no, not necessarily. Sometimes we see some of the other symptoms with tongue tie and no nipple pain. The symptoms can vary.
You may be asking yourself, how can a baby with a tongue tie create either a low milk supply or cause mom to make too much milk? How could it possibly cause both? It seems counter intuitive, I know, but let me explain...
First, let me explain how milk supply works. The more milk you move, the more you make. The more your nipples are stimulated, the more you'll make. The opposite is also true.
If your baby is having a difficult time staying attached at the breast because of a tongue tie or upper lip tie, or if they get tired from all the extra hard work they have to do from not being able to move their tongue properly, then you're likely to experience a low milk supply because baby isn't able to move enough milk or even stay attached well at the breast. This means your breasts are not effectively being emptied (which tells your body to slow down milk production), and it also means they are not stimulating the nipple properly (effective nipple stimulation is crucial for milk production.) This is also usually why tongue tied babies may struggle with weight gain or prolonged Jaundice.
On the flip side of this, sometimes a baby will latch on just well enough to stay attached and suckle, BUT because they are tongue tied, their tongue is moving in a way that it is actually overstimulating your nipples, leading to an oversupply of breast milk. (CLICK HERE to read about oversupply, and why having too much milk is actually a bad thing.) When a baby is having difficulty with sucking properly, you may or may not have nipple pain, and you'll usually also hear "clicking" or "sucking" noises while nursing. This is NOT a normal part of breastfeeding. Those noises mean baby is losing suction at the breast and they are a sign something is off.
This lack of ability to stay attached properly and these "clicking" sounds are also contributing to gas, reflux, and colic symptoms. When your baby can't stay attached, they take in excess air which is really upsetting on their bellies. It's what can lead to colic, reflux, and all those gassy evenings. On top of it all, when your baby is fussier, they tend to want to come to the breast more which creates a snowball effect of even more discomfort and tummy pain (and more nipple pain for you too).
I could continue to soap box about the way tongue and lip ties affect breastfeeding, but I will stop here for now- unless you'd like an entire textbook. I'm mostly joking, but really there's a lot at play here.
What are the benefits of a tongue tie revision, and is it really necessary?
In short, almost every tongue and lip tie should be revised. Beyond breastfeeding issues, which is your current problem, your baby will have a lifelong impact from NOT being revised.
If the tongue is not allowed to rest naturally in the mouth, your baby's oral cavity will develop abnormally which will affect their entire ear, nose, and throat system. Typically we see babies develop issues from these abnormalities a little later in life, some starting as early as toddlerhood. Most common problems with leaving a tongue tie intact is speech impediments, dental issues and gaps in teeth that require expensive orthodontia, a high arch in baby's palate, sleep apnea, snoring, migraines, and a recessed chin.
The process of revision is typically very quick. Usually it is performed without anesthetic as an in office procedure. If you see an ENT, you're likely to have your baby's tongue "clipped" with scissors, or if you see a pediatric dentist, they are likely to use laser to perform the procedure. The procedure for revising a tongue tie is called a Frenectomy. What I always tell me clients, if they want to know what it will feel like, take your fingers and pinch the web (of frenulum) under your tongue or upper lip. There will be some pain, but it's very fast and minimal. Immediately afterwards, you'll be able to pick up your baby and see an immediate difference in how it feels. BUT the work doesn't stop there.
After your procedure you'll have some additional work to do, but it's short lived and will make a HUGE difference in the success of your procedure if you take the time to do it. One of the risks of the procedure is reattachment of the tissue as it heals. The after care exercises are meant to prevent reattachment and will help your baby learn how to suckle properly once they have full range of motion of their tongue. We have more information about after care procedures in our Members Only Vault, and of course, we share this with our private clients too.
So, you have this information, now what?
Here's your next step!
Download our Tongue Tie Symptom Checklist so you can share your symptoms with your doctor to get a referral to an ENT or Pediatric Dentist that specializes in tongue ties. If your doctor is on the fence about your symptoms, don't panic.
Sometimes finding a supportive provider is hard to find, and in our Private Virtual Breastfeeding Support Practice we advocate for families to help them seek appropriate support for this very real issue. Breastfeeding issues related to tongue and lip tie is our specialty, and we go above and beyond to support the families in our care and will advocate for you until you get the referral you need.
We provide extensive tongue tie related support, help with achieving proper diagnosis, and then work with you before and after revision to help you achieve the breastfeeding success you've been waiting for all this time.
Now it's time to hear from YOU!
Do you or your baby have any of these symptoms? Let us know in the comments below.
I'm Kelly! As far as credentials go I am a Certified Lactation Counselor (CLC), Certified Lactation Educator (CLE), HUG trained, breastfeeding counselor, a mother of 4 beautiful kids, and advocate for families. My personal experience with breastfeeding fueled my passion, and generated my mission. I founded Successful Breastfeeding because I saw a need for a better, more thorough, and individualized support for breastfeeding moms- especially working breastfeeding moms! I provide an approach to breastfeeding support that you won't find anywhere else! Breastfeeding is not one size fits all, and breastfeeding support should not be either!
Kelly Maher Carvell, CLC, CLE
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