Signs and Symptoms of tongue and/or lip tie

Every week I work with one or more of the "Preferred Providers" in Utah, teaching, helping, and supporting breastfeeding mothers and their babies after a frenectomy. It's very fulfilling to me because  am not restricted from being honest with parents about the signs and symptoms of tethered oral tissues...even saying the words "tongue-tied" (of all the crazy things to say!!) Every single week I hear a similar story, 

"I saw 2 lactation consultants, and neither of them looked for or talked to me about a tongue. I even asked the doctor to look at the baby for a tongue tie, and he said the baby didn't have one."  

Needless to say, after a few days, weeks, or even months of horrific pain while latching. Macerated, red, blistered bruised, bloody nipples....OR mom's nipples might be okay, but the baby is not gaining weight as expected. Some babies are even severely underweight, despite hour long feedings. Well, guess what? When the professionally trained pediatric dentist examines the infant properly, there is a tie! You can easily see the confusion, hurt, anger, and frustration when these mothers realize that their hospital IBCLC or their pediatrician doesn't necessarily know how to properly assess for a tongue tie, nor does he feel comfortable treating it! (Read my previous blog post to get a glimpse at what pediatricians know about breastfeeding, from a real, practicing pediatrician! 

Lactivistactivist.blogspot.com/2018/04/pediatricians-and-breastfeedingby.html This is a very, very interesting read, I must say!

Listed below are some signs and symptoms listed below may indicate baby needs further evaluation by a Licensed Independent Practitioner specializing in ankyloglossia diagnosis and treatment if found necessary.  The number of symptoms doesn’t necessarily indicate severity.  Some babies even with a severe restriction may display just a few symptoms, others a lot; it depends upon numerous factors.  Something that seems very common with tongue-tie is the variation of feeds ie some feeds will be much better than others, it can be very up and down.  

 

• Excessive weight loss or slow weight gain, as shown in pictures above. (Keep in mind, this may not occur if topping off with formula)
• Persistent very sore or damaged/blistered nipples – However it’s important to note that there may be no nipple pain/trauma
• Compressed nipples (change in shape, pinched flattened look when the baby comes off) and/or blanching after feeding. The nipple should appear normally round after baby comes off the breast. May also note fluid/milk or blood blisters noted on the nipple tip.
• Difficulty establishing breastfeeding or baby refuses to latch.
• Excessive sucking need – baby wants to feed or suck very frequently/constantly.
• Baby only swallows infrequently or swallows well for initial “milk ejection” (letdown), but then swallows become less frequent/sporadic, (should be 1-2 sucks per swallow.)  In young babies this may result in falling asleep quickly at the breast because they only get milk when it “lets down” into their mouth. Otherwise, they are unable to remove milk well.
• Cannot maintain a seal at the breast/bottle, often has gaps at corners of the mouth which milk may spill out from.
• Baby falls asleep quickly at the breast, and then wakes hungry as soon as breast/bottle is removed.
• Baby doesn’t seem satisfied after a breastfeed
• Very frequent feeds, or prolonged feeding times (taking one hour or more per each feeding)
• Fussing at the breast shortly into a feed or takes very short, fast feeds, baby may pull away and cry, arch back – bobbing on and off.
• Parents may comment they can hear air being gulped, milk hitting the tummy or baby is a very “noisy feeder” with loud swallow sounds.
• Low milk supply
• Mastitis/blocked ducts
• Gagging, Reflux, colic, excessive gas, frequent hiccups
• Baby rarely/never settles into a deep restful sleep – some “catnap” and are described as very poor sleepers
• Sucking blister on baby’s upper lip
• Latch trouble or slipping down the nipple when feeding, losing latch
• Clicking sound when feeding.  The baby may pop on and off.
• Disorganized suck/swallow pattern – may result in coughing/spluttering/gagging and give an appearance of oversupply.  Bottle-feeding moms may note this happens even with the slowest flow nipple
• Weak suck/poor sucking reflex
• Oral aversion/ increased sensitivity – frequently refuses breast and/or bottles and/or spoons.  May gag frequently
• If breastfeeding may refuse bottles/cups
• Tongue tremor while feeding
• Noisy breathing/snoring sounds when sleeping
• Opens mouth to attach but doesn’t. Baby shakes head or bobs on and off before becoming frustrated
• Small mouth gape
• Gape is wider horizontally than it is vertically when crying.
• Unable to protrude tongue (some with tongue tie can, protrusion does not rule out tongue tie as the image at the top of the page highlights)
• Excessive drooling/bubbles at the mouth
• Displays stressed body language when feeding – hands up near face, fingers splayed.
• Breastfeeding requires “advanced” techniques such as nipple flipping or pinpoint accurate asymmetric positioning which mom struggles to replicate at each feed when not assisted.  Mom may feel a need to support the breast from the side to keep in baby’s mouth or he/she slips off (due to ineffective seal)
• — Restricted tongue elevation when crying.      
  

“Spooning” of tongue sometimes seen with tongue tie
Image cwgenna.com