Tongue-tie and Breastfeeding

A tongue-tie (ankyloglossia) occurs when the connective tissue (frenum) under the tongue causes restriction in the tongue movement or function. It occurs in 2.8 – 10.7% babies, more often in boys and can be hereditary.

Anterior tongue-tie occurs when the frenum is attached at the front of the tongue, close to the tip. When the frenum is attached further back, or behind the mucosa, the term posterior tongue-tie is used. This term does not have consensus and the topic of posterior tongue tie (and lip tie) is a controversial one. Research is limited and opinions are divided.

Photo courtesy of Monica Hogan & David Todd

Signs & Symptoms

A baby with tongue-tie may not be able to poke the tongue out beyond the gum line / lips;  and /or may not be able to lift the tongue, or move it side to side. The tongue tip may look notched or heart shaped. This may interfere with correct attachment at the breast, leading to some of these problems:

Mother:

  • Nipple pain and damage
  • Low milk supply
  • Blocked ducts / mastitis
  • Early weaning
  • Frustration, disappointment and discouragement with breastfeeding

Infant:

  • Baby can’t latch or stay latched
  • Fussiness and frequent arching away from the breast
  • Clicking sound while feeding or spilling (poor suction)
  • Poor milk transfer – frequent small feeds or long inefficient feeds
  • Low weight gain
  • Chewing or chomping at the breast

How to treat:

Frenotomy is a minor surgical procedure performed using scissors. It is quick and the baby will often settle soon after. It can be performed without anaesthesia. Scissors are often used when the frenum is thin and anterior and unlikely to bleed much.

Laser frenectomy is an effective method for “posterior” tongue-tie / submucosal tongue-tie and lip tie that controls bleeding well. This is generally performed by a paediatric dentist or surgeon. Different lasers are used: water-lase is commonly used with infants.

Risks:

Infection is rare. Some babies may become fussy at the breast for a period of time afterwards. Bleeding is common – sucking/feeding straight after the procedure usually resolves this. There is a small risk of reattachment and scarring that may require a repeat procedure. Wound stretches and other oral exercises are often advised for this reason but may distress the baby and lead to oral aversion.

My approach as an IBCLC/bodyworker:

Sadly, I have seen many parents (and babies) whose breastfeeding journeys have been negatively affected due to missed tongue-ties. Babies with feeding challenges need to have an individualised, comprehensive feeding and oral function assessment. An IBCLC can rule out nipple infections and positioning and attachment issues which may potentially avoid surgery. Since becoming a craniosacral therapist, I further understand how cranial nerve compression and tension in the body can also cause similar symptoms to tongue tie. The tongue may be restricted, but not specifically due to the presence of a tight frenum. A couple of sessions of cranio/bodywork beforehand may address these issues and have a positive impact on breastfeeding. A procedure may be avoided or it may become clearer that a release is necessary. Cranio after the procedure can help to resolve any stress and to optimise function.

There is so much controversy, and limited research, around tongue ties, that it can be difficult for parents to know whether to go ahead with a procedure to release a tie – especially with posterior tongue-ties and lip ties. Where there is doubt about the presence of a tongue-tie, cranio is a gentle, less invasive approach than laser frenectomy. But ultimately, treating the tongue-tie can make all the difference to breastfeeding success.

Contact me for a lactation consultation, tongue-tie assessment or cranio pre or post tongue-tie release.

Top six reasons your baby would benefit from cranio.

Cranio is a holistic, gentle treatment that supports the nervous system to down-regulate, which triggers the body’s own self-healing mechanism.  Because it is so gentle, it is perfect to use with babies. Plus babies systems are so potent and ready to shift easily back to balance – some just need a little cranio support.

Because cranio is not well known, parents may not know the kinds of things that cranio is good at addressing. Here are the top six issues I see in my cranio/lactation practice:

1. Your baby had significant bruising around their head after birth

Some babies complete their birth journey looking pretty beat up!

Check out the squashed nose and facial asymmetry on this little bub, I had the pleasure to treat. He was not able to latch onto the breast without a shield and had issues transferring milk (before cranio).

And this little one had obviously been assisted to birth with a vacuum!

If after birth, your baby had significant bruising, forceps marks, chignon from vacuum extraction, a cephalohematoma or other abnormal head shape, it is a sign that baby has undergone some difficulty during birth and would benefit from cranio. Hospital staff are used to these kinds of injuries and often dismiss it, knowing that superficially these marks do disappear over the following weeks to months. But there can still be underlying physical and emotional tensions that are not yet integrated. These stress imprints remain in the tissues in obvious and less obvious ways. Babies may be very sensitive to touch on their head and may react strongly to clothes being pulled over their head. Other infant interventions like suctioning or fetal scalp monitors may also impact the tissues, in less obvious ways but may still be held in the system.

Cranio can find these holding patterns in the body and facilitate their system to gently release, leaving a sense of peace in the baby’s system.

2. Labour was very long or very fast

Babies have their own experience of birth, often linked to their mothers, but with their own unique pressures and stresses. If they have felt stuck for any reason or under a lot of pressure for a long amount of time this can influence their bodies, in particular the nervous system and the neck. They may have felt scared or panicked. If a prolonged labour ended up in emergency c-section then the baby may also feel disoriented, this can show as arching at the breast or pushing with the feet, the baby can feel stuck in the birth sequence of pushing from the uterine walls.

On the flip side, a fast birth may be a shock to the baby and can show up as activation in their nervous system.

Cranio acknowledges the birth experience and allows these physical and emotional tensions to release leading to happier well-adjusted babies.

3. You have been told your baby has a tongue tie

There is much controversy around tongue tie recently. Research is lacking around posterior tongue ties and lip ties, but that doesn’t mean they don’t exist. It helps to have bodywork before undergoing a tongue tie release. Cranio is a form of bodywork that can address other issues that may mimic the symptoms of tongue tie such as, cranial nerve dysfunction, tight fascia or general nervous system activation. If a couple of cranio treatments improves breastfeeding then the tongue tie procedure may be avoided; if it doesn’t, then the parent can feel confident that the procedure is necessary. It is also recommended to schedule a cranio treatment within a week of the tongue tie release, to optimise function and to reset the nervous system.

4. Your newborn has difficulty latching to the breast

Newborn babies have natural instincts to latch themselves to the breast after birth, if they can’t then there is usually a good reason for it. Often the mum feels like she is doing something wrong, but it is actually because the baby is in pain, tense, stressed or medicated from birth. Perhaps there is a tongue tie or tight jaw muscles? Cranial nerve function can be impeded due to compression of cranial bones which can affect tongue function and sensation. The earlier cranio treatment is given the better in these circumstances.

5. Your baby cries a lot

Babies cry to communicate and once that need is met usually stop crying. If your baby cries inconsolably or with a high pitch then they may need some cranio support. Some babies have musculoskeletal pain or discomfort from birth. Others have a strong need to tell their birth story through memory crying. I have successfully treated babies who have cried excessively since birth. Cranio provides deep listening as well as addressing any physical tensions and may help get to the root cause of their suffering.

6. Baby has a head preference/torticollis or breastfeeding is painful on one side

This gorgeous little guy needed a few cranio sessions for torticollis that was affecting latch at the breast and also causing him discomfort.

Babies with a stiff neck tend to have trouble with positioning and latch. Tight inutero environments and/or asynclitic positions during birth may impact the neck/shoulders and jaw and other parts of the body. This can cause breastfeeding difficulties which tend to be slow to resolve on their own. Cranio helps the body let go of these restrictions and then breastfeeding often becomes easier.

Birth is a formative experience. Its impact is imprinted in the tissues of the body and can influence the health and wellbeing of the person from infant to adulthood. Early cranio treatment can prevent future difficulties such as headaches, anxiety and more.

As the twig is bent, so grows the tree

Alexander Pope

Often an hour or so of skin to skin after birth helps the mum and baby to integrate the birth experience and let go of any held tensions; sometimes this doesn’t happen, sometimes it does – but bub needs more support.

Contact me to book your baby in for a treatment.

Photos used with parents permission*