From a Mommy Dentist: the challenge of breastfeeding tongue-tied babies
Like many new moms, I thought breastfeeding would come naturally.
When my third baby, Ted, was born, I already had 2 years cumulative experience breastfeeding my other children. I planned to exclusively breastfed Ted for at least 12 months.
When Ted was just one day old in the hospital, I knew something was different with breastfeeding. I felt he was “chewing” instead of “sucking.” The lactation consultants worked with me on encouraging a deeper latch:
- I was told to use my finger to encourage him to stick his tongue out further. But he couldn’t stick his tongue out very far.
- I would wait for a wide opening before letting him latch. But he didn’t open very wide.
- I was told to use a nipple shield. But that made the pain even worse since he was still “chewing,” and the plastic was pinching me where I had open cuts.
- When his latch was shallow, I was told to break suction and try again to relatch. But the latch-on was the worst part and I didn’t want to restart the feeding. I just wanted to get it over with. The toe-curling pain brought me to tears and I dreaded the next feeding.
I had cracked and bleeding nipples. The lanolin and gel soothies weren’t helping enough. I attended the breastfeeding support group when he was 3 weeks old and discussed the pain with the lactation consultants. I was sitting near a sweet mom named Jessi. Jessi suggested Ted might have a tongue-tie, as she experienced it with her daughter and had it clipped by an ENT physician. The lactation consultants took a look at his tongue, but were not sure. At Ted’s 3-week well child appointment, his pediatrician was also not sure.
I made a phone call and the ENT could not see Ted until the next week.
The next night, I felt shooting pains in my chest in between feedings. With one arm clutched across my chest, and the other arm used to search Google, I read that it might be thrush- a yeast infection of the nipple and breast. I looked inside Ted’s mouth and saw small white patches in his cheeks. I went to the pediatrician’s night clinic to confirm the diagnosis of thrush. Then I drove to the pharmacy in tears, to get our prescriptions. The pain, the frustration, the thrush diagnosis—were pushing me over the edge. But I didn’t want to stop breastfeeding.
I called the ENT doctor’s office the next morning, and politely but desperately asked if there was any way they could see us sooner due to the severe pain I was having. They squeezed me in that day.
At our appointment, I explained to the ENT doctor how I knew Ted’s latch was drastically different than my first 2 babies. We discussed the procedure, I signed a consent form, and the nurses prepped the room for the frenotomy procedure. Three-week-old Baby Ted was placed onto the operating table, he was stabilized by a couple nurses, and the ENT clipped Ted’s lingual frenulum with a surgical scissors. Ted was immediately returned to me to breastfeed. His latch was instantly better: deeper and less painful. I was so relieved to have improvement. My cracked nipples healed over the next week.
It took some time until the thrush was completely managed, but the frenotomy saved our breastfeeding relationship and I exclusively breastfed Ted for 13 months.
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Fast forward to when my 4th child, Clara, was born. She latched on fairly well in the hospital and gained weight well. I thought we were in the clear.
However, a few months passed and the initial soreness from breastfeeding was not going away. Her latch was shallow, but not as bad as Ted’s. She popped on and off the breast frequently and was gassy. I had sore nipples and cracking again. I was dreading each feeding as her latch rubbed on the open cracks causing awful, toe-curling pain. I pumped several feedings (which also hurt) so my husband could bottle feed her and I could take a break from her poor latch. I tried different nursing positions, used prescription APNO (Jack Newman’s all purpose nipple ointment), and did everything I knew to improve her shallow latch. I also dealt with clogged ducts and developed mastitis, and was in the doctor’s office again, in tears.
I noticed Clara’s upper lip was often tucked in while nursing, and it did not flange. In our local private Facebook group for breastfeeding mothers, a mom named Tricia mentioned difficulties breastfeeding due to a lip tie. I had become aware of tongue-ties after my experience with Ted, but I was unsure how lip ties affected breastfeeding. I needed to find out more…
I learned that when a lip tie was present, a posterior tongue-tie was usually present. A medical practitioner may be familiar with anterior tongue ties, however, posterior tongue-ties are not as visible to the untrained eye. Clara also had a posterior tongue tie.
Lip and Tongue Tie Laser Revision
I engaged myself in learning about lip ties and tongue-ties as I had experienced so much of this myself with minimal local support. Let me emphasize, I really appreciate and respect my local lactation consultants and pediatricians. They are wonderful, smart people and help so many of us! They just were not (at that time) familiar enough with lip ties and posterior tongue-ties.
I learned there were both pediatric dentists and general dentists treating and releasing infant lip and tongue-ties with lasers. I was using a laser almost daily in our Dubuque, Iowa dental practice and had done many laser frenectomies on older children and adults. Dr. Mindy Hochgesang became my mentor and allowed me to observe the infant lip and tongue tie laser procedure. I also spent a day observing Dr. Fred Margolis, a pediatric laser dentist in Chicago. I attended a course by Dr. Larry Kotlow, another pediatric laser dentist who has been doing this procedure for many years and has many published articles on the topic. I participated in a tongue-tie workshop led by Dr. Alison Hazelbaker, PhD, IBLC. I soaked up as much information as I could from all of these experts.
As a passionate supporter of breastfeeding, this opened the door for me to “pay it forward.” It was mom-to-mom support that sent me on this journey. I could now give both mom-to-mom support and provider-to-mom support for breastfeeding dyads struggling with tongue and lip ties themselves.
My daughter Clara was my first infant patient. I revised her lip tie and posterior tongue-tie, we did post-frenotomy care, we both healed, and we achieved a great breastfeeding relationship.
Our dental office has helped many moms and babies improve their breastfeeding relationship when lip and tongue-ties are present. We have become passionate about helping identify lip ties and tongue-ties, treating them when needed, and providing ongoing support and resources for moms. In the Eastern Iowa and Tri-State area, we are lucky to have awesome lactation support in our local support groups and from our local International Board Certified Lactation Consultants (IBCLCs).
Dr. Kristen Berning provides support for breastfeeding moms who are dealing with lip and tongue ties. She uses a laser to perform lip and tongue tie revision, including posterior tongue ties. Her office is located at 4200 Asbury Road, Dubuque, IA 52002 and serves the Cedar Valley, Iowa City, Cedar Rapids & Dubuque, IA, Galena, IL and Madison, WI areas. To schedule a consultation or ask questions about laser lip and tongue tie revision with Dr. Kristen Berning please call 563-556-2711 or contact us online.