Nursing Troubles: Could Baby Be Tongue-Tied?

New moms are well aware of the benefits of breastfeeding their newborns, but there are times when it can feel like an exercise in torture if Baby doesn’t latch correctly. That doesn’t necessarily mean you and your baby are doing it wrong. He might simply have ankyloglossia, or tongue-tie, in which the band of tissue that connects the tongue to the bottom of the mouth is too thick. That makes it hard to use the full range of motion needed to properly latch and suck, and that can make for painful, frustrating breastfeeding sessions.

There’s a procedure to help, called a frenectomy, that clips the tissue to free up the tongue. In the past, that might have meant operating rooms and anesthesia, according to Murray Dock, DDS, MSD, of Montgomery Pediatric Dentistry. But Dock and his associate Lisa Rudolph, DMD, MPH, have recently added a new service in his office that includes using a state-of-the-art laser to vaporize the tissue. “It allows for a very fine focus so that we can target the tissue more precisely,” he says, adding that other benefits include a fast procedure (some take as little as 20 – 30 seconds once the baby is ready), no anesthesia, very little pain or bleeding, a faster healing time, and less recurrence. “We’ve done about 50 so far,” he says, “and we’ve had amazing results.”

Dock requires a full evaluation before scheduling the procedure. Families first meet with his team, composed of a lactation consultant and an occupational therapist, in what they all refer to as the “triad of care.”

Jamee Diver, IBCLC, is the first point of contact for a family struggling with breastfeeding. She looks for symptoms like nipple pain or damage in Mom, colic or reflux in Baby, inability to latch or a shallow latch, “clicking” at the breast and more. “We’ll try things like position first,” she says, adding that if that doesn’t seem to help, a full oral evaluation is offered.

“A proper, full oral assessment is critical,” says occupational therapist Michelle Emanuel and the other leg of Dock’s triad. Emanuel looks at all aspects of oral motor skills, including tongue motion, head turning preferences and asymmetries in facial or jaw development.

“Is it really baby’s tongue that’s causing the problem, or is it jaw, posture, etc.?” says Emanuel, adding that the team’s goal is to “ferret out those issues first.”

If a frenectomy is appropriate, Dock schedules the procedure when everyone can attend, so that families have plenty of support before, during, and especially afterward, when the real work begins. Once the release of the restrictive tissue is complete, parents will have three to six weeks of habilitation sessions with Emanuel and Diver to help facilitate their baby’s tongue movement and strength. Emanuel also recommends parents see her at least once before the procedure so they’re familiar with the prescribed oral exercises and have a chance to practice on their baby when they’re not as worried about pulling on a sore tongue.

Although many babies show signs of improvement almost immediately, both Emanuel and Diver caution parents to be prepared for bouts of regression. “They might be fussy a few days after the release,” says Diver. “They’re using muscles they haven’t been using, so they may be a little sore.” But with patience, and a full support system like Dock’s triad, moms and babes will be well on their way to successful breastfeeding.