Hope you enjoyed your summer! We have had some great times together since the “self isolation” rules were set in place. I’m looking forward to the kids back in school and a little nervous about it, all at the same time. The house is going to be quiet.

I thought I’d talk a bit about oral restricted tissues or “tongue ties”. I feel like we see this as an issue in about 75% of our home visits.  Unfortunately in Edmonton right now there are very few specially trained practitioners that do a FULL release (anterior and posterior).  It’s not only about the appearance but about the function of the tongue. There are tongue ties that aren’t visible to the eye but are present and cause problems.  There are also obvious tongue ties that anyone can see by looking but if the function of the tongue is normal there is no need to intervene.  

Tongue ties can be controversial.  Please note that an International Board Certified Lactation Consultant (IBCLC) can NOT diagnose a tongue tie! We can only assess oral function and refer to a healthcare professional. 

Mychelle and I have extensive training with assessing normal oral function and identifying tethered oral tissues.  One of the assessment tools we always use is the The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF).  We were trained to use the HATLFF by Dr. Hazelbaker herself! We do, however, use multiple assessment tools to do a complete oral exam at each visit.  

From personal experience, when my son was born 10 years ago I didn’t really know about tongue ties.  I had enough knowledge as a Labour and Delivery Registered Nurse to know what a good latch was and how to achieve various breastfeeding positions. Breastfeeding was something I knew I wanted to do but I had so much pain. Toe curling pain.  The pain was so bad I dreaded the next feed. I tried all the nipple creams available. At one point we thought it could be yeast. I don’t recall if anyone looked in his mouth.  I wish I had the knowledge that I do now! However I persevered, breastfeeding my son until he was 18 months old because I am stubborn and I wanted him to have breastmilk.  I would never wish that pain on anyone.  So how did I find out he has a tongue tie? His orthodontist recently said, “He has quite a tongue tie!!!!!” My mouth dropped.

What is a frenulum?

A frenulum is the membrane underneath the tongue connecting it to the bottom of the mouth.  

What is a tongue tie?

A tongue tie is when the frenulum is too short, which affects tongue movement.  A baby needs to be able to stick their tongue out and move it high enough to breastfeed effectively, otherwise it is almost impossible to breastfeed.  

Signs of a tongue tie

• Shallow latch

• Your nipples are painful

• Gassy baby/reflux

• You feel as though you aren’t making enough milk 

• Slow weight gain

• Frequent feeding

• Baby might latch well then slide off

• Short feeds that are tiring for them  

• Very long feeds in order to get enough milk

• Persistent, painful feeds often described as chomping, grinding

• After feeds your nipple may look flattened or lipstick-shaped

• Tongue may be heart-shaped or forked in appearance

• Baby can’t open wide to latch to the breast

• Clicking/smacking sound while breast or bottle feeding

• Cough or choke on the “letdown”

• Frustration at the breast if milk supply is low or if flow slows

It is so important to work with an IBCLC before and after treatment of a tongue tie. If you choose to have your baby diagnosed we will refer you to the most trusted and experienced professionals in the city. While you are awaiting your appointment, your number one priority is protecting your milk supply, We will give you advice on how to best do that.  Mychelle and I will teach oral exercises to be done before and after treatment and ensure you are prepared for the treatment day by reviewing the procedure.  After a tongue tie release, babies need to learn how to use their “new” tongues and often you are starting from the beginning with latch and positioning.  We will be there for you after the treatment to ensure latch, positioning and post care exercises are done correctly and also to teach suck training exercises.  

It is important to note that not all babies treated for tongue tie will breastfeed with ease!  Keep it in the back of your mind that it might not work and be prepared to explore other avenues if need be (we have suggestions for that too). If this is something you have been anxious about or have struggled with previous babies, you are not alone! Many other moms struggle with this “under discussed” issue and we have the information you need to support and assist you!

Melissa, RN, IBCLC

Guest Blog Article

By Dr. James Thomas, DDS, MS
Founder of the ​health:latch circle​ and the ​health:latch clinic

Dr. James Thomas, DDS, MS

Dear Moms,

We know how painful it can be, both physically and emotionally, if you and your baby are struggling with breastfeeding.

You may have heard about tongue tie and are wondering whether an oral restriction could be at the root of your breastfeeding challenges.

As a pediatric dentist who specializes in diagnosing and releasing oral restrictions in babies, I have had the honor of collaborating with amazing lactation consultants to support thousands of mothers and infants on their breastfeeding journeys.

This article will help you understand the basics of ​oral restrictions​ such as ​tongue tie​, how they can impact ​breastfeeding​, and ​what to do next​ if you suspect your baby could have an oral restriction.

What is an oral restriction?
Tongue tie is the common term for a medical condition called ​ankyloglossia​ that restricts the tongue’s range of motion. The most common types of oral restrictions are ​tongue tie, lip tie, and buccal tie. These conditions are conditions present at birth and impact the normal movement and function of the tongue and mouth​.

●  A ​tongue tie​ is when the band of tissue connecting the tongue to the bottom of the mouth is too short, too thick, or too tight, restricting the tongue’s normal range of motion.

●  A ​lip tie ​is when the tissue connecting the upper lip to the gum is too stiff or too thick, preventing the upper lip from moving freely.

●  A​ buccal tie ​refers to tissues that attach the inside of the cheeks to the gums, restricting normal movement.

How can an oral restriction affect breastfeeding?

Many oral restrictions are discovered and diagnosed due to difficulties with breastfeeding. An oral restriction can impair a baby’s ability to properly latch, suck, and swallow. If you are having issues such as mastitis, decreasing milk supply, or clogged ducts, or if your baby is having difficulty latching or losing weight, it is a great idea to check if your infant has an oral restriction.

What signs should I look for?

An oral restriction can hamper your baby’s ability to breastfeed, leading to important symptoms for both you and your baby.

You may notice that your baby is:

• acting irritable or fussy during or after feeding

• experiencing gassiness or frequently spitting up

• having difficulty creating a secure latch during nursing

• losing weight or having poor weight gain

• falling off the breast frequently during nursing

• frequent feedings without feeling “satisfied”

If you are nursing your baby, you may notice:

• breast pain

• plugged milk ducts (which can lead to mastitis)

• engorgement

•  cracked or blistered nipples

•  a feeling that your baby is chewing or biting on the breast

• recurrent thrush or infections

Of course, not all breastfeeding issues are related to an oral restriction. Your lactation consultant can help you find solutions to issues such as milk supply, positioning, shallow latch, inverted or flat nipples etc.

What does tongue tie look like in a baby?

When it comes to oral restrictions, there’s no “one size fits all” presentation. Oral restrictions are diverse in their appearance, which is why it is important to seek care from a healthcare professional who is knowledgeable about this condition.

How common is tongue tie?

It’s hard to say for sure because more research and better statistics are needed. Some research indicates that up to 10 percent of babies are born with an oral restriction and up to 25 percent of nursing infants can be affected by shallow latch caused by this condition. Many oral restrictions go undiagnosed even into adulthood, mainly because of the lack of education among healthcare professionals about this condition.

What is the treatment for an oral restriction?

Oral restrictions can be treated​ with a quick outpatient procedure to release the tie, sometimes referred to as a tongue tie surgery.

A release procedure known as ​frenectomy​ is usually done with a laser and may completely eliminate (“ablate”) the tissue restricting the tongue or lip. This differs from a ​frenotomy​, which is usually done with sterile scissors and involves “clipping” or “snipping” the tissue.

What types of healthcare professionals can help my tongue tied baby?

Lactation consultants are often the first to notice breastfeeding-related symptoms that could point to an oral restriction. Although they cannot diagnose, your lactation consultant can help you by referring you to a Proceduralist who can identify and treat the condition.

Proceduralists​ are trained and licensed to diagnose oral restrictions and perform the release procedure. They include dentists, doctors, naturopaths, nurse practitioners, and oral surgeons.

When is the best time to diagnose and treat an oral restriction?

As soon as possible! In the best of circumstances, a tongue tied baby can be diagnosed and treated shortly after birth. The longer we wait, the more problems can arise. For example, if a baby’s oral muscles are restricted and they compensate by using other muscles not intended for suck and swallow, the brain quickly memorizes these dysfunctional patterns. Thankfully, with the right support from healthcare professionals, after a release procedure babies can learn healthy suck and swallow patterns. Lactation consultants can provide critical support after a release procedure by helping you adjust your feeding plan and breastfeeding technique.

What causes oral restrictions?

As a fetus develops in the womb, tissue forms to anchor the tongue to the base of the mouth. Usually, this tissue dissolves naturally over time. At around the 12th week of pregnancy all that is left is a small, flexible tether. For reasons that have yet to be fully understood, in some fetuses, this tissue does not dissolve. These babies are born with an oral tether that is especially short, tight or thick.

Although much research is needed to better understand what causes oral restrictions, some evidence points to a genetic mutation known as MTHFR (​methylenetetrahydrofolate reductase)​.

Oral restrictions:

•  are conditions present at birth

•  appear to be hereditary

•  are common in babies who are born prematurely

• are common in babies who are born with other mid-line traits like “stork bite” birthmarks

What are the possible long-term effects of tongue tie?

Even small components (such as the tiny tether under your tongue) can affect the entire body over time. Oral restrictions can be indirectly related to a cascade of developmental issues in the mouth and even in the rest of the body.

If left untreated​, oral restrictions may affect your child’s:

• airway development

• breathing

• eating

• sleeping

• chewing

• tooth and jaw development

• oral hygiene

Much research needed to understand the long term effects of oral restrictions. Some specialists suspect that oral restrictions could play a role in serious, chronic conditions in adulthood such as sleep apnea, asthma and heart problems.

Trust your instincts

It is very common for parents to be dismissed, have their concerns be minimized, or told their baby is not tongue tied because their practitioner lacked specific training and experience in diagnosing oral restrictions.

At the ​health:latch circle​ ​we are advocates for parents and patients. We believe you know your body and your baby better than anyone. Listen to your gut and continue to ask questions until you are satisfied with the answers.

Next steps

As soon as you suspect that tongue tie is a possibility, or even better, if you just want a preventative evaluation - it's time to gather together resources and prepare for the decisions that you will have to make.

You need caring, kind, and knowledgeable professionals who can guide and advise you through the sometimes bumpy road of education, examination, diagnosis, treatment, and follow-up therapy.

Creating your circle of support

We created the health:latch circle as a place for parents like you to surround yourself with support and for providers to connect with parents.

The ​health:latch circle​ is a radically kind, community-based online platform that allows interested parents and professionals to learn together and connect to trusted professionals who are committed to helping families thrive.

Learn more about the health:latch circle and create your free parent account ​here.

Hoping all you mamas are doing okay and making it through life during a pandemic.

Just a little of an update on how my family has been doing. My daughter just had her 8th birthday and we opened our doors to another family that is close to us and has been pretty strict with the isolation guidelines. Boy, was that ever a fun day! I missed my friends so much. I’m looking forward to and hoping for more “freedom” in the coming days.  Looking forward to drinks on the patio, playground dates and camping together! I’m also counting down the days to no “school”! 16 days to go, in case you weren’t already counting! I have to say that my kids have managed pretty well at home. My son Jack is in grade 4 and he despises doing schoolwork and it is a chore for both of us to get it done.  But he loves being home and staying in his housecoat all day. He’s done lots of cooking with me, built a treehouse with my husband and earned money helping my mom with yard work. I'd say he’s learning lots of life skills. My middle daughter, Molly, is in grade 2 and loves learning and loves doing her schoolwork on the computer. It’s so cute listening to her read stories to her teacher and the conversations she has with her friends on Kids Messenger. She also enjoys being in her pyjamas all day! My youngest, Hannah, is in kindergarten so she’s already used to being home most days. She’s enjoying having her siblings home all the time and keeps herself busy playing/crafting all day.  We’ve kinda (100%) stopped doing the assigned activities from her teacher (sshhhh) and life is way easier. This mama is not creative and does not enjoy crafts!! She went to an amazing preschool that prepared her so well. She’s ready for grade 1! (and yes, I have the teachers approval). Of course they all miss their friends but they also understand that this “new normal” isn’t forever and we need to keep ourselves and everyone else safe.   

How are all of you? I would love to hear how you are all coping and the positives that are coming from being home. Our days are starting to warm up and often we get this question:

Does my breastfed baby need water? 

The simple answer is, a breastfed baby does not need extra water or fluids. No matter how warm it gets breast milk is food and drink. If the newborn baby is thirsty, continue to feed on demand. Research shows that even in extremely hot countries, breast milk alone is good for keeping a baby hydrated.  

• Breast milk is over 90% water

• Our bodies are so smart! In hot weather, our bodies make milk that has a higher water content

• Babies might fill up on water, which has no nutrients or calories

• Giving anything other than breastmilk can affect milk supply

• Water may interfere with breastfeeding, and can actually contribute to weight loss and jaundice.  

• Although very rare, if babies under the age of 1 drink too much water, it can lead to water intoxication which can lead to brain seizures.

So mama’s, drink lots of water!  It is normal for your baby to have lots of short feeds on a hot day. This is because breastmilk is higher in water at the start of a feed therefore thirst quenching. It is okay to start giving a little water around 6 months of age, when your baby starts sampling solids, but always offer breast milk first.

Enjoy June!

Melissa, RN, Lactation Consultant