Nipple Pain & Slow Weight Gain – Undetected Tongue Tie?

Two of the most common reasons parents contact me for help have to do with severe nipple damage in the first days/weeks after birth and slow weight gain in their newborn.  Nipple pain and damage is caused by a shallow latch.  If the baby isn”t latched on deep enough then the nipple becomes trapped between the hard palate and the baby”s tongue.  Shallow latch can also cause the baby to not effectively drain the breast leading to low milk supply.

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Shallow latch can be from poor positioning, engorged breasts, or tongue ties.  Today I would like to talk a little about tongue ties.

 

During embryonic development the tongue and lower jaw start out as one.  Much like our webbed fingers and toes, as your fetus matures the cells between the tongue and the lower jaw mature and some die off, leaving the tongue as a separate muscle in the mouth.  In some infants this separation doesn”t happen completely and what we are left with is a tongue tie.

Normally, when a baby latches on to their parent to breastfeed, they open their mouth wide, stick their tongue out over their lower gum, and draw the nipple back into their mouth far enough so the nipple is about at the junction of the soft and hard palate.  If you run your tongue along the roof of your mouth you can feel where the bones in the roof of your mouth end and the soft tissue begin.

There is range of tongue ties that are classified based on where they are tied down and how much the movement of the tongue is restricted.  This system of classification was created by Dr. Elizabeth Coryllos.

One type of tongue tie that is commonly noticed is a classical or type I or type II tongue tie.  In this type of tongue tie the tongue will look heart shaped and is tied down behind the lower gum.  The baby will be unable to stick their tongue out of their mouth or past the gums.  This type of tongue tie is fairly obvious to notice and often healthcare providers will mention it at birth.

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Posterior tongue ties tend to be a bit trickier to spot.  In these tongues a small portion of the front of the tongue may not be tied down but a large part of the underside of the tongue may be stuck to the bottom of the mouth.  Sometimes people may mistakingly call these tongues short.  These babies might be able to stick the tip of their tongue out of their mouth when their mouths are partially closed, but when the baby opens wide (like they need to do for breastfeeding or crying) the tongue can”t move off of the bottom of their mouth.  Often only the edges of the tongue will lift when they are crying.

 

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Babies who are tongue tied often have difficulty breastfeeding effectively.  As with all aspects of breastfeeding every parent-baby pair is unique.  This is also true when it comes to tongue ties.  Sometimes tongue tied babies can breastfeed fine.  They don”t damage their parent’s nipples and they gain weight well.  Often though, that isn”t the case.

Typical symptoms in the lactating parent and baby that lead me to think to look at the baby’s mouth for a tongue tie:
žSevere nipple trauma within a few days of birth
žBaby refusing to latch
žBaby with noisy latch
—Smacking, clicking, breaking suction
—Baby feeding for extended periods of time (45 min – 1 hour)
—Baby not satisfied after feed
—Possibly baby not gaining weight well
Lactating parent notices their milk supply quickly disappearing
—Parent had difficulty getting comfortable latch with previous baby
If the lactating parent has a large milk supply, baby may gain fine for a few weeks or months, then the parent’s supply can crash from poor nipple stimulation.  The baby was drinking the initial let down, but wasn”t actually suckling enough to send the nerve signals to the brain to keep up milk supply.
If a baby is suspected of having a tongue tie a paediatrician or dentist experienced in releasing tongue ties can clip the tongue tie and release the tongue.  Many parents find that breastfeeding improves immensely once the tongue is released.  I find that the younger the baby is when the release happens, the quicker breastfeeding improves.  Babies also often benefit from body work after the tongue tie release.
A Cranial Sacral Therapist, Osteopath, or Chiropractor who specializes in babies can help loosen the tight muscles in the head, jaw, and neck allowing the baby to get full range of motion back.  Often the muscles are tight from being held in the wrong position by the tie, or by the position the baby was in when in utero, or from a difficult birth.
Here are some great resources to learn more about tongue ties:

 

 

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