Infant Ankyloglossia Tongue-Tie: What You Need to Know
What to Do If Your Infant Is Tongue-tied
Ankyloglossia, also known as "tongue-tie," is a congenital oral anomaly that may decrease the mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Ankyloglossia is when the frenulum on the bottom of the tongue is too short and tight.
Having two sons with Ankyloglossia, I can attest to the difficulties and challenges it causes for breastfeeding, speech, and eating certain foods if not addressed early. A tongue-tied infant can make breastfeeding extremely painful and may lead to the mother giving up, within a few hours to a few days.
Because of a Lactation Consultant, who spotted the issue with my fourth child, I promptly saw a dentist with Ankyloglossia experience. Within three days of birth, we were in the dental chair, snipping the tongue-tie. It was quick and easy, and I continued nursing that horrible pain. I nursed my son immediately following the procedure to help with bleeding and to soothe his discomfort. It was amazing how easily my son latched on and how much the pain was relieved. That was 23 years ago, so it's fantastic to see this be the recommended standard still today.
I introduce a dear friend, former co-worker, and one of the most phenomenal nurses I've had the pleasure to know and work with, Rebecca (Becky) Boyd, BSN, RN, IBCLC. The video at the end of this article is her presentation on Ankyloglossia at the Colorado State AWHONN Convention in April 2019. The best part is the personal story of Becky's patient, Kailin, who graciously permitted me to share her story.
A Mother's Journey With Three Tongue-Tied Infants (Shared With Permission)
My name is Kailin Hamilton, Registered Dietitian, IBCLC, and Chair of the Northern Colorado Breastfeeding Coalition. I worked for WIC as a dietitian and lactation consultant, before stepping down in 2017 when our third son was born. I wanted to stay home with our three boys who, at the time, were: Micah 6, Jude 3, and Luke 1. It’s an honor to share my breastfeeding and Ankylglossia journey with all of you.
Micah was born in 2013. At three days old, my nipples were cracked and bleeding. I bought “soothies” for relief between feedings. His latch looked good from the outside, but I couldn’t figure out why I was in pain. By day five, it was so painful my eyes filled with tears. Micah was jaundiced too, and his feedings took 45 minutes every 1-2 hours. I knew something was wrong, despite the positive exterior latch.
When he cried, I noticed his tongue was heart-shaped. I called the hospital and made an appointment with an IBCLC, Becky. (IBCLC stands for International Board of Lactation Consultant Examiners®). Little did I know the support I’d receive for years to come from this dear woman. She agreed Micah’s tongue should be assessed by his pediatrician. I felt hopeful we’d find relief.
The pediatrician looked at Micah’s tongue and said he indeed had a tongue-tie. He said it “wouldn’t have an effect on breastfeeding, and cutting the tongue would only be a cosmetic fix. He also said, “give it time, and it won’t feel difficult once my hormones calm down”. I’d just finished feeding Micah when he spit-up my blood! Through tears, my husband and I listened to our gut and had the doctor proceed to cut the tongue-tie. I was hoping it'd be smooth sailing from here.
After a week, I was still in pain and noticed a growing red area on my left breast. I made another appointment with Becky, and she agreed I had mastitis. I saw my doctor, and sure enough, both breasts were infected, and I started antibiotics. I felt like we were moving in the right direction, as the mastitis cleared up, but I was still in much pain when feeding.
My midwife prescribed Newman’s Nipple Cream. I started this cream and it provided incredible relief. But, after another week, I still wasn’t healing, and the pain was getting worse. My midwife said the damage was so bad, they’d use stitches if it were anywhere else on my body. She advised me to begin pumping and feeding Micah from a bottle.
For four weeks, I pumped every three hours around the clock. I got only what Micah needed and not a drop more, so I never got ahead. At week two of pumping and not healing, Becky called to say an ingredient in the Newman’s Nipple Cream may be preventing me from healing since the wounds were so intense. I stopped using the cream immediately.
Becky suggested Micah be assessed for a labial frenulum (upper lip) tie and sure enough, his upper frenulum was making it impossible for his upper lip to latch on properly. I was referred to an Ear, Nose, and Throat (ENT) specialist to have the frenulum assessed and potentially clipped. We visited two ENT specialists and the first said, “fixing the lip tie won’t help him breastfeed”. The second ENT specialist (in the same office) felt it would make a difference and proceeded to cut his upper lip frenulum.
Once my nipples healed, I stopped pumping and resumed breastfeeding. My nipples were finally better, but I experienced a different pain, since stopping the antibiotics for mastitis, assuming this was part of the healing process. I described the pain as feeling like fiberglass in my ducts when I’d nurse, and randomly when I wasn’t.
I consulted my favorite IBCLC, Becky, who agreed it was thrush. For months I tried everything to get rid of it. Vinegar was number one (everything that touched my breasts or Micah’s mouth got washed with vinegar), soap, bleach, grapefruit seed extract, Fluconazole, Nystatin, changing my diet, boiling pump parts, etc. It was exhausting. The thrush and pain went away when Micah was five months old.
We went on to breastfeed until Micah was two. It was an incredibly long journey and a steep learning curve for breastfeeding. I’m so thankful for the support we had to do this.
Since breastfeeding was so difficult with Micah, I felt apprehensive the second time with my son, Jude. Long story short, Jude’s birth was incredibly fast, we lived 30 minutes from the hospital, and we didn’t make it in time. Jude was born on the side of the road in our car!
Once we knew he was ok, I looked into his mouth while he was crying, and sure enough, he had that distinct heart-shaped tongue. We ended up at a hospital we didn’t plan on, and I worried the doctors wouldn’t see the value in assessing his tongue/lip--but we had an incredibly different experience!
Our doctor discharged us as soon as possible, with a referral to Dr. Scott Williams (a dentist in Greeley), who saw us on day two. Even then, breastfeeding had that familiar pain, and I started to get cracks. Using a laser, he took care of both his tongue and lip. Breastfeeding immediately felt better and with much less pain!
We still had a few minor bumps along the road, including returning a few weeks later when his tongue-tie healed back tightly, to laser his tongue again. Because we took care of his lip and tongue early and before it cascaded into other problems, we were able to breastfeed mostly without pain for 16 months.
When we learned we were pregnant with our third child, I prayed he wouldn’t have this same problem--but, he did. His tongue and lip were, by far, the tightest of all. Since I’d learned so much with our previous experiences, I immediately took him off the breast, hand expressed, and used a cup or syringe to finish his feedings.
We drove to Denver when Luke was only a few days old and saw Dr. Witkoff. He used a cold laser to cut both his lip and his tongue. It was by far our best experience with healing and my most uncomplicated breastfeeding journey. Luke and I had a long and happy time with breastfeeding.
I’m thankful to live where there’s access to knowledgeable professionals, like Becky and Dr. Witkoff. The biggest lesson I’ve learned in our breastfeeding journeys is an invaluable role support plays. I credit our breastfeeding success to the support I received and can never fully express my gratitude.
I highly recommend you watch this 23-minute video presentation below on "Infant Ankyloglossia", presented by Rebecca (Becky) Boyd, RN BSN, IBCLC. Becky is the lactation consultant who helped Kailin with all three of her babies as discussed in the story above.
Have You or Someone You Know Dealt With Infant Tongue-Tie?
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This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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© 2020 Debra Roberts