Breastfeeding 101: Lip Ties

Disclaimer: I am not a medical professional. This post is strictly to share our own experience and the resources and support we received. Nothing provided here should be construed as medical advice.

Does your baby have a lip tie and tongue tie? Not sure? I shared about our experience with tongue ties here. Please review that post as well. It’s very common for lip ties to be accompanied by tongue ties.

So in my post about tongue ties I reviewed just how difficult our breastfeeding relationship was. I was fortunate, to a certain extent, because my daughter’s lip and tongue ties were very noticeable. So I knew from hour 1 that something was up. This helped me a lot because when doctors and nurses told me there wasn’t anything to worry about and that her issues would not impact breastfeeding, despite my bloody nipples, her nursing blisters, and weeks of suffering and pain, I knew better.

It can be much more difficult to find help with certain tongue and lip ties because professionals will be less likely to even diagnose, let alone treat certain ties. Tip: If you are having difficulty nursing and there is pain, latch issues, bleeding, nursing blisters, mastitis, etc. seek help and don’t wait. Keep going through pediatricians and pediatric dentists and lactation consultants until you find someone that actually helps you. Sadly, it can be a race against time because poor latch and nursing issues can impact supply and baby’s weight. Both of these things can be remedied but the longer it takes the more complicated things get. So move quickly and don’t stop until the issues are resolved.

Our Experience

Like I said, Boba had a very obvious lip tie. The tissue was very thick and spread wide and reached almost to the bottom of her gums, where her teeth would be coming in, eventually. I believe she had a Class III or IV (see Dr. Kutlow’s slide below).

What’s the big deal??

Lip ties can be minimal and you may have even had a lip tie as a child and never even noticed. Some children’s lip ties are released through injuries (face planting on the sidewalk, etc.) and others have issues later on and require orthodontia due to major spacing of front teeth and crowding. Others have large issues with lip ties and tongue ties that require more consideration.

With Boba’s lip tie (and tongue tie), we had incredible difficulty breastfeeding. Due to how impacted and restricted her upper lip was, she was unable to flange her lip out to get a deep latch. Her latch was shallow and very painful for me, it also caused large nursing blisters on her lips that were painful for her.

lip blisters
Nursing blisters. Image posted with permission from Dr. Ghaheri, DDS, a pediatric dentist in Oregon.

Her shallow latch also caused nipple compression for me which led to pain and discomfort, numbness, cracking, blistering and vasospasms. I tried a lot of things to stretch her lip tie to allow for a deeper latch but that tissue was tight and continued to cause us issues.

Breastfeeding issues, so what?

Many people who face issues during breastfeeding without support or relief from knowledgable professionals stop breastfeeding. Other people don’t ever attempt to breastfeed and both are personal choices that I will not debate here. Either way there can still be issues if you chose not to breastfeed your child that has a lip tie.

Other possible problems caused by lip ties-

  • Front tooth spacing and crowding of teeth leading to dental issues and braces later on.
  • Tooth decay due to lip being held down on the teeth more closely. This can be caused by bottle rot (milk sitting on the teeth), difficulty with oral hygiene due to limited space and food or drink being held on the teeth for longer periods than most.

What if you do decide to breastfeed? What issues may you face?

Dr. Kotlow, DDS shares in his article about exposing the top myths in diagnosing and treating lip and tongue ties that nursing babies with lip ties and their mothers may experience…

  • Colic and acid reflux (excess air due to improper latch will present as colic and reflux)
  • Failure to thrive due to poor latch (prolonged weight loss)
  • Non-nutritional breastfeeding (without proper latch and suction, baby might nurse for shorter less productive periods. This may cause the baby to get very little fatty, nutritionally dense milk, hind milk, and only receive foremilk, which is more sugary and may cause gas, frothy acidic poops, weight loss, pain, etc.)
  • Crying and gagging
  • Sleep apnea
  • Mom may experience plugged ducts and mastitis due to improper latch and incomplete nursing

So what did we do?

The road was a difficult one and we got help relatively quickly. I had an amazing lactation consultant on speed dial! Our birthing instructor happened to be a very knowledgeable lactation consultant with personal experience with lip and tongue ties in her own children. We contacted her immediately when things seemed off and the pain started. She diagnosed the tongue and lip ties and gave us some options. Again, we were fortunate in some ways because Boba was a very determined nurser even though her latch was shallow she sucked with all her might and was actually gaining weight, despite our issues. This was good and bad. Good because weight loss and pediatricians and mommy guilt is a lethal combination and bad because her pediatrician and other medical professionals determined there was no problem and wrote us off. Um??! Can we say bloody nipples and horrible pain? A tiny baby with gas, bloat, frothy and painful poops, and reflux and colic? Miserable! So we kept at it.

We decided to find someone who would clip her tongue tie but that didn’t do much for our nursing relationship due to a few reasons. 1) she was very inexperienced and conservative in the amount she clipped and 2) we still had the lip tie that was very restrictive in allowing for a deep latch. Kate Cropp, our lactation consultant recommended laser revision of both her tongue and lip tie. We looked into and it’s not as easy as it sounds. First my husband and I had to discuss the procedure and decide if we wanted to go ahead with oral surgery. Again we really lucked out that we had Kate because she recommended a pediatric dentist in Dayton, OH that revised infants. See here’s the deal, most pediatric dentists don’t deal with lip and tongue ties and if they do they will side with most medical professionals and state that it doesn’t need revision. Many of them don’t even clip tongue ties. Then there are those who might clip ties but they don’t perform laser revisions. Then there are those who perform laser revisions but only on adults and older children. Shesh!! Exhausted yet? Cut right to the source and just search pediatric dentists who perform laser revisions on infants. Will they be close to home? Maybe not. We had to drive and fortunate for us, he works very close to where my husband grew up so we combined the trip to see family. Is it worth it? ABSOLUTELY!

Below are images of Boba’s revision. The whole procedure lasted less than 5 minutes. They swaddled her and placed goggles on her face. He checked her ties and classified them. He explained the procedure and I held her with the assistant while he swiped a few times under her tongue and under her lip. Done.

Did she cry? Yes…but mostly from being restrained and held down and from having the goggles on her face. The wonderful thing about the lasers they use, they are practically painless and cauterize on contact. This allows for minimal healing time and less pain. They didn’t even have to numb the area. She was done in less than 5 minutes and back in my arms. Then Dr. Notestine, DDS, took us back to a private conference room and checked her nursing latch. ***DEEP, DEEP SIGH OF RELIEF*** For the first time ever, she latched correctly! Her top lip flanged completely and her latch was deep and painless. I cried! It was such a relief that we were finally here, nursing without pain. Was the the end of it? No. But we were on our way.

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Boba swaddled
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Boba’s goggles
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This is a photo of Boba’s lip tie (her tongue tie was too difficult to photograph)
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Post Revision

What else did we have to do?

It takes a team and support to continue nursing without pain. It isn’t just about the revisions and nothing else. There were other steps we took and all together they made the difference.

  • We had Boba adjusted by a infant specialized chiropractor from the moment she came home from the hospital. This helped with positioning during nursing, latch, gas, pain, bloat, colic, etc.
  • We also took her to several craniosacral therapy appointments after her revision. This is a licensed massage therapist with specific training, she basically used feather-light touches that move the plates in Boba’s head and in her upper pallet. This helped soooo much! It helped create a better latch and give her more comfort. After these appointments, Boba was nursing longer and receiving more hind milk which relieved so many issues I listed above (gas, colic, frothy painful poop, etc.).
  • We also continued to see Kate a few times.
  • WE DID THE STRETCHES AND EXERCISES the dentist told us to do! This is so important. I belonged to a few Facebook groups and forums about lip and tongue ties and many of the complaints after revisions had to do with reattachment. Can it happen? YES! Don’t let it. Our dentist gave us specific instructions on how to prevent reattachment because the mouth heals REALLY quickly. We had to firmly swipe under her tongue and lip several times before every feeding. Was it great? No! She didn’t like it and I’m sure it wasn’t the most comfortable thing. Did she tolerate it? Yes! For mama milk she tolerated a lot of stuff.

What does a lip tie look like? How do you know if your child has one?

Obviously, diagnosis from a medical professional is the only true way to know for sure but below are some images to help you take a look.

Here is a really wonderful slide by Dr. Kotlow, DDS that shows classifications of varying lip ties. Dr. Kotlow has a pediatric dentistry office in Albany, NY and provides laser revisions on lip and tongue ties. He is well known and very respected for his contribution to breastfeeding health and infant ties.

Lip tie classifications

 

Breastfeeding 101: Tongue Ties

Disclosure- I am not a medial professional, a nurse, a lactation consultant, etc. I’m a mother who struggled with breastfeeding and tried everything in my power to make it work and I want to share what happened, what came up, and how I got the right help.

Tongue ties? Lip ties? Check out my other post about Lip Ties here.

Do you have breasts? A baby? Are you trying to breastfeed? Is it going smoothly without hiccups (pun intended)? Or have you hit a few snags? I know I did! I have breasts (in case you didn’t notice), I had a brand new, wrinkly newborn, and we were attempting to breastfeed– ok we were more than attempting– we were knee deep in trench-warfare-style breastfeeding and I had the bloody nipples to show for it. *I just love saying “bloody”, makes me feel british!

Our Experience

Anywho…it wasn’t going so hot and I’m sure some of you have been in the same boat. I don’t want to say I was fortunate, but in a way I was lucky to have a pretty clear idea of what the big issues were, my daughter was born with an adorable, heart-shaped tongue. When they handed her to me, I could see it clear as day. Her tongue was attached to the bottom of her mouth all the way down to the tip and when she cried the edges of her tongue would lift up and make a sweet little heart. I thought, Hmm…that’s not normal. What do we do about that? The doctors and nurses could see it clear as I could and they all seemed to think it wasn’t a problem. I had a sneaking suspicion they might be wrong. I mean…my mom is a speech and language pathologist and my dad is a periodontist. I knew that tongue would cause issues. I just didn’t think about breastfeeding.

Until we actually started nursing regularly. When you have a newborn that’s only a few days old they sleep a lot! Like all the time. So it took me a while to realize how hard this whole things was going to be. I should also note that Boba was born using 2 sets of forceps. She got mighty stuck and we had to transfer from the cozy home birth we planned to Vanderbilt to get that little bean out! So her head was super sore and I had a rather harsh nurse grabbing my daughter’s poor head and smooshing my sore, tender breasts into her mouth like a hamburger. Eventually I told her to hit the road because my baby was wailing so hard and I was about to join her. Have you been there mama? Shesh…sometimes those well meaning nurses and lactation consultants need some courses in bedside manner. New mamas and babies are sore, tired, kind of in shock, and very vulnerable. BE GENTLE DAMN IT! Ahem…

Obviously, I had wanted a quiet birth at home so I wanted out of the hospital as soon as they would release me. I think I was only in for less than 24 hours. Them: Pee diaper? Vitals? Ok…I guess we can let you go… Me: GREAT! See ya!

Then we were home. Mommy. Daddy. Baby. Grandma. All of us finally settling in with this new addition to our family. Then came the hard part. Healing. Breastfeeding. Pediatrician visits. Lactation Consultants. Chiropractors. Craniosacral therapists. Aye! It makes me tired just remembering it. No wonder I didn’t blog about this until I could have a healthy amount of distance from it. That time was tough and beautiful (brutiful, like I’ve said before). By the end of the first week home I had blisters, scabs, and a hungry baby! I was also fortunate that Boba was a very interested nurser. She was determined and sucked with her awkward latch as hard as she could. Yes, it caused major injury for me but at least she got some milk and it allowed my supply to come in and kept her from losing too much weight.

One thing I know I did right, I took an awesome birth class with an amazing lactation consultant/advanced practice nurse and home-birth-loving, mama of 4! She’s like the wonder woman for mommies. Her name, Kate Cropp, APRN, IBCLC, MSN and if you live near Nashville, TN- you have her on speed dial and you go to her! Like the day after your baby is born. I mean it. Do it. It will save you! Believe me. *Steps down off my soapbox.*

Notice how I took a birth class to prepare for several weeks for the labor and delivery but never took a breastfeeding course? Yeah. I read a book…which is more than some do but still I was NOT prepared! Take a class. Take a few breastfeeding classes and find a few good lactation consultants and have them ready and waiting for you. Best piece of advice all post.

I went to Kate right away, like a few days after Boba was born. Luckily I had already had Boba adjusted by an amazing Chiropractor that works magic with pregnant ladies (I had seen her throughout my pregnancy) and babies (she came to my house the day after we got home!!!). Her name, Dr. Kristen Walkerwicz, DC, FICPA, and she’s also incredible to have on speed dial. I truly believe that all babies (not just ones who have a difficult birth) need adjustments. It helps with sooooo many issues like gas, bloating, reflux, pain, nursing/latch issues, nursing positioning, sleep, etc! Mommies, you go too! It helps with EVERYTHING (too much to list, right??)!

Kate checked us out, helped me with positioning, made sure Boba was taking in milk by weighing her before and after feedings, and was a huge Mary Poppins-bag-of-info! Thank you, Universe, for women like her. She easily diagnosed Boba’s tongue tie and lip tie and recommended we try and revise it. We went to a pediatrician close by to have it clipped first. They numb it topically and clip to tissue using sterile scissors. The whole procedure is done in a regular pediatric office and lasts less than 5 minutes.

**BIG FAT NOTE: Ok…so we lucked out because we surrounded ourselves with very knowledgable people who were very familiar with tongue ties and lip ties but I’ve been on forums and I’ve heard horror stories. There are women who go to countless lactation consultants who tell them everything is fine, meanwhile they have cracked, bloody nipples and a newborn losing too much weight. This can be incredibly heart wrenching and infuriating. I’ve also heard of people going to pediatricians who basically verbally abuse women over this kind of stuff. I’ve even heard of rare cases were babies have been taken into protective custody over nursing issues and losing weight. I don’t say all this to frighten you but it can be hard to find helpful people and get the help you need QUICKLY. There is a timeline here because we all know our babies need to eat and gain weight, etc. So please, do everything you can to prepare and then don’t stop looking for helpful help until you find it.

We did have issues with many pediatricians who pushed us and told us she didn’t need a revision, that it wasn’t impacting the nursing. Um, really? I had horrible pain, vasospasms and blanching due to compression (painful restriction of blood flow to the nipple due to shallow and incorrect latch), blisters, bleeding, mastitis, plugged ducts, etc. But of course, they knew best. You can feel alone and scared. Keep looking and searching.

After Boba’s tongue tie was clipped we still had issues. To be fair, the pediatrician who did the clipping was very conservative during the procedure and I guess I’m glad she landed on the side of cautious rather than heavy handed but her tongue was not released enough to make much difference. Boba also had a pretty significant lip tie which she said we didn’t need to revise. I DID NOT STOP LOOKING! I knew in my heart that we needed more help and that we had to keep searching. Kate recommended a pediatric dentist in Dayton, OH that was the closest person to us that performed laser revisions on lip ties and tongue ties in babies. HARD TO FIND, let me tell you. We were 6 weeks into our nursing warfare and I was pumping full-time at this point and trying to nurse during the day with a nipple shield to protect further injury to me. Poor Boba was still battling with nursing blisters and we were both battling thrush infections (mouth and nipple) by intravenous antibiotics during delivery. To say I was close to giving up is an understatement. I was beaten, bruised, exhausted, and scared! I had never thought of surgery so early in Boba’s life and I worried that maybe it wasn’t the right decision. I worried that maybe I was pushing this too far and that maybe this was just a sign that we couldn’t nurse. I mean, we gave it a good go, right? Who could blame us for throwing in the towel at this point and turning to formula. If I hadn’t had my own conviction (I am serious stubborn, like Irish-stubborn) and the support of my husband, my mom, Kate, and an active forum of nursing mommies going through the same thing (search FB and online), I would have given up. After a few conversations, my husband and I decided to go forward with the laser revision.

BEST DECISION EVER! We went to Dr. Greg Notestine, DDS in Dayton, OH, the man Kate recommended to us. He got us in within the next week. We drove up there and had it done on the way home from staying with Daddy Bear’s family. Dr. Notestine was amazing. He explained all the issues we’d been having, checked her latch, explained the success of laser revision and what to expect. He explained how the laser works and that lasers are so successful because it’s near painless and cauterizes the wound on contact, easing recovery. They had us swaddle her in one of those velcro swaddles, they put these adorable pink baby goggles on her and I held her on the big patient chair while they swiped under her tongue a few times and under her lip with the laser. It was amazing! Did she cry? Yes! But seriously, I think she cried more from being swaddled, held down and having to wear those glasses than anything else. The whole procedure lasted under a few minutes and I had her out of the swaddle and in my arms immediately. She stopped crying as soon as I held her. Then Dr.Notestine took us into a private conference room where we had her latch on and….I can’t even express how overwhelming that moment was. For the first time, she was able to flange out her upper lip over my breast the way all the books showed a baby latching. She could lift her tongue in full-range of movement right after the procedure and nurse correctly and painlessly! I cried. Like a baby. Holding my baby. I can’t put into words how happy, tired, and overjoyed I was that we had arrived here. The place I knew existed. I pushed through and it worked out and I was just so relieved. Were we done? No. But it was the first BIG step towards lasting success.

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Boba swaddled
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Boba’s goggles
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This is a photo of Boba’s lip tie (her tongue tie was too difficult to photograph)
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Post Revision
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Boba sleeping on the way home after revision!

Next steps…

  • There were exercises we needed to do in order to keep her lip and tongue from reattaching. Many people revise tongue and lip ties and don’t do the exercises for fear of hurting the child or because they don’t believe it’s necessary. IT IS! You have to swipe under the tongue and lip several times a day before nursing, in a firm way, to prevent reattaching. Give baby tylenol is pain is significant. Boba seemed fine and was happy to nurse.
  • We had a few more chiro appointments to help ease her positioning issues and digestion.
  • We saw a craniosacral therapist, Mary Beth Crawford, LMT, here in Nashville, TN who helped tremendously once we had the revisions. I can’t recommend craniosacral enough. It sounds hooky and weird but it just works. She used feather-light touch to help position the plates in her head, the plates in her palette and it just helped so much.
  • We had to work out positioning because at this point I had an oversupply issue. Which doesn’t sound like an issue to most women who struggle with undersupply but it has it’s downsides. Boba literally couldn’t keep up with the let down and supply and would choke and gag if I held her in a cradle hold. We eventually found that side-lying nursing was our only option until she gained more control and got a little better at handling the flow. Try lying down and nursing in a Nordstrom bathroom! Thank God they have chase lounges in there!!
  • Like I said above, we also battled thrush for a few more months after the latch was perfected. So we still had some pain…but nothing compared to what we had before!

It seriously takes a team before and after revisions. It takes a team that you surround yourself with and you will still feel alone sometimes. Was it all worth it? Absolutely. Would I do it again? Do I have to?? Yes, if/when I have another and we were faced with the same issues, yes, I would do it all again. Except this time I know the most direct path to the same end result! I would make an appt with Kate for the day the baby is born, maybe the next day. I would have the baby adjusted by Kristen the day we get home. I would set an appt with Dr. Notestine for only a few days after birth and I would have craniosacral appts set up for directly after revision. DONE. Kinda. You get the idea.

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Boba and I nursing in Ohio!

 

Information About Tongue Ties

Tongue ties and lip ties are very common, more common than most would know. You may even have a tongue tie or lip tie and not know it. Do you have trouble licking ice cream cones? Can you roll your R’s like in Spanish words (perro)? Can you roll your tongue like a taco? Did you have speech issues as a child? Are your front teeth very far apart with tissue between? Did you require orthodontia as a kid? Can you french kiss? These can all be signs.

What to look for when nursing-

  • Lipstick nipple (the nipple will look like the end of a lipstick because of the tongue tied latch)
  • Split/cracked nipples
  • Blisters
  • Bleeding nipples
  • Baby might have puffy, blistered lips
  • Pain and discomfort with nursing (beyond the initial adjustment)
  • Baby is losing weight (note: newborns lose weight after birth, this is normal. It also takes time for milk to come in naturally, this is normal too! But you will know when something isn’t right- get help then- trust your instincts!)
  • A couple weeks in and your supply isn’t coming in or is very low
  • Obvious skin holding down your baby’s tongue
  • Large web like skin all across the back of baby’s tongue (posterior tongue tie) and most difficult to diagnose and under treated

lip blisters

Lip blisters (nursing blisters on baby) Image posted with Dr.Ghaheri‘s permission. He provides lip and tongue revisions in the Oregon area.

Here are some slides from Dr.Larry Kutlow, posted with his permission. He provides laser revisions of lip ties and tongue ties at his pediatric dentistry office in Albany, NY.

Tongue tie classificationspotential-problem-dari-tongue-tie

 


Make sure to keep an eye out for an ebook I’m writing about breastfeeding, my experience, common issues that come up and home remedies, and a long list of resources!