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.

Today we are delighted to talk about breastfeeding, formula feeding and sleep. We all love our sleep, right!? Probably the hardest thing about becoming a new parent is losing sleep and having to function the next day….and this can go on for weeks, months or even years! It’s no surprise that parents are desperate to find ways to increase the amount of their little ones sleep.

Parents often ask us the question, “if I give my baby formula, will they sleep through the night?”. They get advice from their formula feeding friends, grandparents and other relatives that they should “give them formula; they’ll sleep longer.” And if you do a google search you can find plenty of people backing this belief up. This results in many sleep deprived, desperate parents prematurely giving up breastfeeding or night weaning altogether, just in the hope of more sleep. So is this advice accurate - does formula feeding mean more sleep? This article aims to give you the facts so that you can make an informed choice that is right for you and your family. 

Firstly, let’s look at what biologically normal  sleep looks like. All children, and adults, sleep in cycles, and as they enter the light phase at the end of each cycle they may partially or fully wake. So no-one actually ‘sleeps through the night’ ever! As adults if we have a need then we can attend to it ourselves - but if a baby is hungry or thirsty (or has any other need) then they will signal to an adult to help them. And so until a baby is able to sustain a full nights sleep without needing food, they will wake and signal to their parent. The point at which this is varies from child to child, but the evidence suggests that many babies need food at night up to 18 months old. And so if your child is waking up and feeding several times a night, whether via breast or bottle, they are behaving completely normally, and you are not creating bad habits by feeding them.

So next let’s look at whether giving formula will mean that babies will wake less.  Formula fed babies can often take larger volumes per feed than breastfed babies, and this milk also takes longer to digest than breast milk . For this reason, some formula-fed babies do sleep for slightly longer stretches than breastfed babies. However, research confirms that although breastfed babies wake more frequently, breastfeeding mothers actually get more overall sleep. This is because of a combination of factors. Firstly, breast milk is full or hormones that help a baby feel both satisfied and tired - it is basically mother nature’s amazing tool to get babies back to sleep quickly and easily. Secondly, making up bottles is a bigger job for the mother - they have to get out of bed, go downstairs, make the bottle etc. This means that it often takes longer, and wakes the mother and baby more, than breastfeeding, which, as we’ve said can be very quick and easy. 

Remember also that babies wake for more reasons than just hunger - feeling cold, needing a diaper change, needing a cuddle - so even if you are bottle feeding, it doesn’t not necessarily mean they will sleep longer as if they have another need they will still wake up. 

Here are some other interesting points about breastmilk and sleep:

* Tryptophan is in breast milk and helps develop a babies’ circadian rhythm. This will help your newborn learn day from night. 

* Breastfed infants have more Non-Rapid Eye Movement (NREM) sleep than formula fed infants. NREM sleep, known as lighter sleep, is thought to protect infants from Sudden Infant Death Syndrome (SIDS). 

* Night feeds, in the early weeks, are especially important to build milk supply. 

* In cultures where co-sleeping is the norm, babies feed lots at night. Sometimes up to 4 times per night; taking in almost half of their daily amount of milk.  

So, in the end, if your baby is breastfeeding and this is working for you then, adding a bottle of formula isn’t guaranteed to help her or you sleep any better, in fact it can sometimes make things harder. But ultimately the decision as to how to feed your baby is yours, and you should do what is right for your family given the facts. Never feel pressured into giving up breastfeeding before you are ready, instead work on establishing good, healthy sleep habits with your baby.

Melissa Alexander RN, IBCLC

Sarah Mabbutt | Baby Sleep Well Program

With having had 3 kids I can say that my experience breast feeding them was as different as they are. Before having kids I had a bit of an advantage, or so I thought, having had 2 older sisters with 6 kids between them and 4 years of labour and delivery experience as a nurse. I was encouraging and teaching new moms how to make this unique connection before I had gone through the steps myself.

I knew I wanted to give breastfeeding my all because it was what I knew the most about. I knew it had many benefits for my baby and hopefully me! I wanted the connection, the weight loss, the immunity for my baby and the lack of expense (vs formula feeding).

My first baby threw all my confidence out the window by coming early. Once he was born I was given a pump and told how to use it, clean it and encouraged to pump every 2-4 hours to bring my milk in and have a supply the nurses could use to feed my son through his naso-gastric tube. His blood sugars were low at birth so they needed him to start eating. His first feeds of formula he rejected making me strangely proud! My milk came in (and didn’t stop!) with all of my pumping and my son kept it down and increased feeds just as expected. I was given a nipple shield that I had never seen before, the next addition to my challenges! I had to learn how this big chunk of plastic was supposed to fit into my premies mouth (and function without choking him when it filled up!) while learning how and when to hold him, when to pump, when to go home and when be at the hospital…

The first lesson for me in motherhood was to keep my expectations very flexible!

I had not prepared for anything I was facing and had to use all the help I could get which was difficult to accept with my independent (controlling?) personality. As for the benefits I had hoped for, the “bond” was there from birth and it would have been regardless of what I fed him. His health was good though every “cold” was a cough or wheeze and I’ll never know if that might have been different if he had been full term. I did lose the weight and saved money without needing formula that first 8 (?) months. He did start to nurse without the shield after a few months and after that all ran smoothly but during those months I did a mix of previously pumped and frozen milk and the nipple shield.  I also pumped and brought a bottle to places that I thought would just be easier to keep my shirt on!

I felt protective of my new little love. I liked that when he cried I was the one with the answer. We went to some BBQs that summer and family events I intentionally did not bring a pumped bottle just so he would have to be with me. I felt like I missed out on so many tiny moments in those first few weeks that I wanted him in my arms as much as possible (see..control..).

Looking back on it all, and especially after having two more kids, I wish I could go back and tell myself “Just do what works for you!”. I spent so much time worrying if I was doing the right or best thing and I could have saved myself so much stress if I just relaxed and did what worked, what felt right.  Those were the most empowering actions that brought me so much pride. That and watching those babies chunk up from all that milk! 

After note- all my kids ate every 1.5-2 hrs. It was embarrassing that in one visit I had to feed…again. People would say “Didn’t you just feed him/her?” Sometimes I would leave early just to avoid the possible judgement.

Breastfeeding is a small action with a steep learning curve and a huge weight of expectation. Your mental health is as important as your baby’s physical health. What would that look like on a growth curve??! What percentile is your mental health in?

Lindy Akins

Helping you reach success on your breastfeeding journey

We are all about creating confident, happy mothers here at Little Nursing Company. If you want to learn more about breastfeeding and babies you’ve come to the right place.

Our hope is to empower women through education and support. We want to be your village! Your tribe! A place you can come to be encouraged and feel proud of yourself!

• Are you a grandmother looking to support the new mother/grandchild in your life;

• Are you are a new mother;

• Are you are an experienced mother;

• Are you the partner of a breastfeeding mother;

• Are you are a healthcare provider wanting to support your clients;

• Are you a best friend who bottle-fed your own babies and are unsure how to support your friend.

Whatever the case, I hope this blog keeps you informed so you can be the best support possible.

Mychelle and I feel the best chance of success is through education. I hope you enjoy what we post. Learn more Prenatal Breastfeeding Basics.

“I'm not telling you it's going to be easy - I'm telling you it's going to be worth it.” ― Art Williams

Melissa Alexander RN, IBCLC

We’re excited you’re here!