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lip tie? *updated again!*

Posted by on Jan. 15, 2012 at 1:03 PM
  • 22 Replies
My son has a possible lip tie that I really didn't see as a big deal until his teeth have started coming in, now I'm wondering if its the reason why my son has had a tough time gaining weight. He's 17 mos old and maybe 19 lbs. He's meets all his developmental milestones early, so I stopped worrying. Anyone else deal with a lip tie?

*update*
Surgery went well. He did not have a tounge tie, thankfully. He had to have 4 teeth pulled. He is recovering from the anesthesia quickly. I am hopeful that fixing the lip tie will resolve his weight issues
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by on Jan. 15, 2012 at 1:03 PM
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lundaylove
by on Jan. 15, 2012 at 1:38 PM
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it definitely could be a contributing factor!  my daughter was only 11wks when she got her lip tie clipped and while she had gained the normal amount for an infant before the clipping afterwards she gained a ton. my sisters son has a lip tie and she refuses to get it clipped and he is a TINY lil guy (my 6mo is almost bigger than he is) yet she thinks its fine. I think if his lip was clipped it would benefit but she wont go for it......

slvrbtrfly
by on Jan. 15, 2012 at 1:42 PM
Did your doc check for lip tie, or did you notice it on your own?


Quoting lundaylove:

it definitely could be a contributing factor!  my daughter was only 11wks when she got her lip tie clipped and while she had gained the normal amount for an infant before the clipping afterwards she gained a ton. my sisters son has a lip tie and she refuses to get it clipped and he is a TINY lil guy (my 6mo is almost bigger than he is) yet she thinks its fine. I think if his lip was clipped it would benefit but she wont go for it......


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lundaylove
by on Jan. 15, 2012 at 1:52 PM

my daughter has never gone to the doctor so i noticed myself plus we had latching issues and such too. 

Quoting slvrbtrfly:

Did your doc check for lip tie, or did you notice it on your own?


Quoting lundaylove:

it definitely could be a contributing factor!  my daughter was only 11wks when she got her lip tie clipped and while she had gained the normal amount for an infant before the clipping afterwards she gained a ton. my sisters son has a lip tie and she refuses to get it clipped and he is a TINY lil guy (my 6mo is almost bigger than he is) yet she thinks its fine. I think if his lip was clipped it would benefit but she wont go for it......



maggiemom2000
by on Jan. 15, 2012 at 2:48 PM
1 mom liked this

A child who has a lip tie has about an 80-90% chance of having a posterior tongue tie. This is often overlooked and can be a cuase of low wegiht gain, and can lead to other difficulties as well:

Dr. Kotlow shows how to examine an infant for a posterior tongue tie

http://www.youtube.com/watch?v=5opSbXvL7yQ&sns=fb

Tight Frenulum Can Cause Painful Breastfeeding and Poor Weight Gain 

Nov 15, 2008 Christy Swift 


Painful Nursing Can Indicate Tongue-tie - Mark Swift

Poor latch, sore nipples, and slow infant growth may be caused by tongue-tie (ankyloglossia). Posterior tongue-tie can be especially difficult to diagnose. During the decades where bottle-feeding was the norm, medical professionals fell away from diagnosing and treating tongue-tie, a common and easily-remedied breastfeeding problem. As a result, today’s breastfeeding moms may have trouble finding a doctor who can recognize and treat the problem. However, left untreated, tongue-tie can not only destroy the breastfeeding relationship, but may cause additional health problems as the baby grows.

What is Tongue-tie?

Tongue tie is a congenital malformation where the membrane attaching the tongue to the bottom of the mouth (the frenulum) is too tight and restricts proper movement of the tongue. The abnormally tight frenulum does not allow the baby’s tongue to move properly during breastfeeding, and can cause pain and nipple damage. If the baby is not able to extract enough milk, he may go hungry and be at risk for poor weight gain and dehydration.

Types of Tongue-tie

  • Classic Tongue-tie. This is diagnosed when the frenulum is attached to the tip of the tongue or 2-4mm behind it. Many midwives, doctors and lactation consultants can easily spot this type of frenulum restriction. It may create a heart shape or notch in the tip of the tongue as the baby tries to lift or extend it. The tongue may also appear to roll forward.
  • Posterior Tongue-tie. With posterior tongue-tie, the frenulum is tightly attached between the mid-tongue and the middle of the floor of the mouth or is attached at the base of the tongue and is very thick, shiny and inelastic. This type of restriction is more difficult to spot as the tip of the tongue does lift, but not as much as it should.

How Does Tongue-tie Affect Breastfeeding?

Restriction of the tongue makes breastfeeding painful and can result in the baby not getting enough to eat. In their new book, The Breastfeeding Mother’s Guide to Making More Milk [McGraw-Hill, 2008], International Board-Certified Lactation Consultants Diana West and Lisa Marasco explain why:

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“A baby's ability to draw milk from the breast depends on his ability to move his tongue freely. In order to grasp an adequate amount of breast for latching deeply, his tongue must comfortably extend past his lower lip. To stabilize the breast, the sides of the tongue need to be able cup it. Finally, the tip of the tongue needs to be able to lift higher than halfway when the mouth is open, while the back of the tongue needs to lift and then drop to create the vacuum that pulls out milk.” [permission granted by Diana West, 2008]

If the baby is not successfully emptying the breast and triggering the supply-and-demand function that sustains breastfeeding, the mother’s milk supply can suffer as well. Low milk supply combined with latch problems associated with tongue-tie can cause a mother to lose confidence in her ability to breastfeed and to ultimately quit.

Symptoms of Tongue-tie

How can a struggling breastfeeding mother know if her baby is tongue-tied? In their book, West and Marasco list a number of clues, including:

Read on 

  • latch trouble
  • sucking blisters on the lips
  • chronic sore nipples
  • "clicking" or "popping" sounds during breastfeeding
  • a persistently abraded nipple
  • flattened nipple when baby unlatches
  • baby tires at breast, then awakens soon, hungry again
  • consistent, long, “marathon” feedings
  • tongue tremor

Treatment for Tongue-tie

If a breastfeeding mom thinks her baby might have tongue-tie, she should see a medical professional as soon as possible to have it diagnosed. Treatment for tongue-tie is usually a simple snipping of the frenulum, called frenotomy. Because the frenulum tissue has few nerve endings and blood vessels, the procedure does not usually cause the baby much pain or bleeding. Nursing right after the procedure is often enough to comfort a baby after frenotomy.

How to Diagnose Tongue-tie

Unfortunately, if a baby has posterior tongue-tie, even a medical professional may not be able to properly diagnose it. West and Marasco suggest, “In discussing the possibility of tongue-tie with your baby's doctor, it may be helpful to refer him or her to Supporting Sucking Skills in Breastfeeding Infants by Catherine Watson Genna, BS, IBCLC [Jones & Bartlett Publishers, 2007], for detailed tongue-tie diagnostic criteria and treatment information.”

In their book, West and Marasco also describe the Murphy Maneuver, which involves running a finger along the underside of the baby’s tongue to assess possible frenulum restriction. West also provides a list of care providers familiar with tongue-tie on her website.

Other Tongue-tie Complications

Even if a mother is bottle-feeding, she should still have her child’s tongue-tie treated. Unclipped tongue-tie can lead to several health problems in childhood and adulthood such as reflux, speech impediments, snoring, sleep apnea, dental problems and indigestion. While tongue-tied babies can often bottle-feed without issue, some will still be unable to feed effectively without a frenotomy.

Mothers who are having trouble breastfeeding should consult a midwife or lactation consultant about the possibility of tongue-tie. Treatment is usually quick and relatively painless, and catching the problem early can save the breastfeeding couple days, weeks or even months of painful nursing, poor weight gain, unhappiness, and eventually low milk supply and early weaning.



Read more at Suite101: Diagnosing Tongue-Tie in a Breastfed Baby: Tight Frenulum Can Cause Painful Breastfeeding and Poor Weight Gain http://www.suite101.com/content/diagnosing-tonguetie-in-a-breastfed-baby-a78730#ixzz1G7Wi5SSX


maggiemom2000
by on Jan. 15, 2012 at 2:49 PM

The best lip tie info:

http://thefunnyshapedwoman.blogspot.com/2011/03/introducing-maxillary-labial-frenulum.html

Introducing... the maxillary labial frenulum

Thoughts on breastfeeding with an upper labial tie


If your baby is struggling to latch properly and it's all a bit of a mystery, it might be worth checking for an upper labial tie.


Currently, there isn't much information about upper labial ties and breastfeeding, so I have done my best to piece together the research I have found in the hope that someone will find it useful. Some of the information I have included is from my own experience of feeding my own 4 children, all of whom have upper labial ties.

What is an upper labial tie?


Inside your mouth, there is a small fold of tissue which runs between your upper lip and gum (you can feel it with your tongue). This is called the maxillary labial frenulum (or frenum).  Most people have no significant frenulum attachment (1), but sometimes this frenulum attaches further down the gum, or runs between the front teeth and attaches behind them, causing restricted movement of the upper lip. It's similar to tongue tie, but involving the upper lip and gum instead. An upper labial tie can occur on its own or in conjunction with a tongue tie (2). It's also possible to have a lower labial tie (involving the bottom lip and gum).


The quickest and easiest way to find out whether a baby has an upper labial tie is to lift up his upper lip and have a look!

Most babies will have no significant frenulum attachment(1).
image reproduced with kind permission from Dr. Lawrence Kotlow DDS, PC

Some babies will have a maxillary frenulum which attaches into the gum above the front teeth. This is not normally a problem, as there should still be enough upper lip mobility in order to achieve a good latch.
images reproduced with kind permission from Dr. Lawrence Kotlow DDS, PC


In some babies, the maxillary frenulum attaches just in front of the anterior papilla (that's the small bump of tissue on the upper gum just behind the area where the upper front teeth grow) (2). 
images reproduced with kind permission from Dr. Lawrence Kotlow DDS, PC


Some babies (mine included) will have a maxillary frenulum which attaches into the papilla (the small bump of tissue just behind the area where the upper front teeth grow) and extends into the hard palate behind the front teeth (2).
images reproduced with kind permission from Dr. Lawrence Kotlow DDS, PC  


"It is very important to understand - the tightness of the frenulum can vary, and the degree of tightness can make a major difference as to any consequences."(3)


My children's dentist, Dr Chris Caldwell, has the following tip: if your baby has an upper labial tie, lift up his upper lip, stretching the frenulum. If the papilla blanches when you do this, the upper labial tie is likely to be a significant problem.


Healthcare professionals working with breastfeeding mothers and babies tell me upper labial ties are uncommon (is this simply because we aren't checking for them?). My children's dentist disagrees: they're fairly common, though they're not usually severe enough to cause major problems.



How might an upper labial tie affect breastfeeding?


Because an upper labial tie restricts movement of the upper lip, it may be difficult for the baby to latch effectively to the breast (3,4). Once latched onto the breast, the baby's upper lip may be tucked inwards, resulting in a shallow latch (5). The baby may be a 'clicky' feeder who takes in a lot of air during a feed. Breastfeeding may be painful for the mother. An older baby's upper teeth may dig into the breast during a feed, causing indentations or damage. Some babies will be able to breastfeed with an upper labial tie; others will have difficulty. The ability to breastfeed effectively depends on a range of other factors also affecting the mother (eg. breast anatomy, milk supply) and the baby (eg. oral anatomy), all of which may create further obstacles or make breastfeeding easier.



Ideas for improving the latch of a baby with an upper labial tie


If your baby has an upper labial tie and you are struggling with breastfeeding, seek help from a qualified breastfeeding specialist (such as a breastfeeding counsellor or lactation consultant).


The first step is to work on optimising the baby's latch in order to improve milk transfer: for some babies, this may be all that is needed to breastfeed successfully. In the hope that someone somewhere will find this information useful, I am sharing ways of overcoming an upper labial tie which worked for me and my babies:


A baby with an upper labial tie needs to be encouraged to accept the breast more deeply in his mouth. After much experimenting with more traditionally-taught breastfeeding holds (such as the cross-cradle hold), I initially found a variation of a technique called "exaggerated attachment" (adapted from 6) yielded some success:
  1. Cup your breast underneath with your hand (if you're using your right hand, your right hand cups your right breast).
  2. Use your thumb to tilt your nipple back so it points away from the baby's nose. This makes the breast under the nipple bulge forwards.
  3. When the baby gapes, his bottom lip and chin should come into contact with the breast first.
  4. Using your thumb, quickly roll your nipple forward into the roof of the baby's mouth.
  5. Then, as you take your thumb away, lift your thumb to catch the baby's upper lip and gently flick it outwards.
I've done my best to demonstrate this latching technique below (please excuse the change of holds part way through - it's hard to get good clear photos of a baby latching on!).









Although this technique helped my baby to stay on the breast, we still experienced slow weight gain, which improved after we learnt breast compressions.




Using a 'laid-back' or 'biological nurturing' position marked a major breastfeeding breakthrough for us. Catherine Watson Genna BS IBCLC suggests that "increasing head extension will allow the infant to grasp the breast sufficiently"(4) - I have noticed that this is naturally encouraged through self-attachment to the breast in a biological nurturing position. Biological nurturing, coupled with very frequent, on-demand feeds resulted in successful breastfeeding for us, despite an almost embarrassingly imperfect latch. And, as my baby grew bigger, his ability to latch vastly improved.



What if I'm considering having my baby's upper labial tie divided?


Because of the way the human face develops in the womb, an upper labial tie can occur on its own, or in conjunction with a posterior tongue tie. If your baby has an upper labial tie and you are debating whether it is the cause of any breastfeeding problems, it is worth getting someone to check for tongue tie. In some cases, dividing the tongue tie may resolve the feeding issues.



In the UK, it's not easy to find a practitioner who will divide a baby's upper labial tie. People who may be able to help you find a practitioner with the skills to divide a baby's upper labial tie include:
  • a Lactation Consultant (IBCLC)
  • the Infant Feeding Coordinator at your hospital
  • a paediatric dentist
  • a university dental school
It is worth considering that the procedure involved in dividing an upper labial tie is different to tongue tie division, and may require general anaesthetic. This really does depend on the skills of the practitioner carrying out the procedure: some will prefer to use a laser for the division; others may be more confident using a scalpel. Further information about the division of upper labial ties can be found here: 


Dr. Lawrence A Kotlow DDS PC - articles
Dr. Brian Palmer DDS - Frenum Presentation
Dr. Brian Palmer DDS - Breastfeeding and Frenulums
please note: these are non-UK links


The decision to divide an upper labial tie is an individual one, based on evaluating the severity of the tie, whether it is impacting on breastfeeding, and whether it is possible to find a practitioner who will divide the tie.




What is the evidence suggesting that lip tie division is of any benefit to breastfeeding?


In addition to the websites above, I have found just one journal article suggesting that the division of an upper labial tie might benefit breastfeeding. It is a case report of one baby whose latching difficulties remained unresolved after a tongue tie division, but was able to breastfeed successfully after an upper labial tie division.


The rest of the evidence is anecdotal:
Spanjer, P (2000) What a difference a day makes, La Leche League
(2009) Lip tie clipping, Heidiopolis
(2009) Breastfeeding update... A nurse who knits (unsure whether lip tie clipping was helpful)
(2011) The trouble with frenulums and The last snip, Becoming Daizee (not yet clear whether lip tie division was successful)
(2011) Tongue Tie Q&A and Micah's First Perfect Latch, the mommypotamus


The lack of documented supporting evidence is likely a result of lack of funding to undertake research in this area, coupled with a lack of awareness that an upper labial tie can affect breastfeeding, and a lack of skills to divide an infant's labial tie. I wonder how many mothers have ended up bottle feeding as a result of an upper labial tie?




What could other impacts be of not having my baby's upper lip tie divided?


"There are no medical or dental benefits of having a tight [...] labial frenulum. There are many major medical and dental consequences that result from tight frenulums." (3) These consequences very much depend on the severity of the tie.


Apart from breastfeeding problems, an upper labial tie has been linked with:
  • having a gap between the two front teeth (2,4)
  • poor lip mobility, affecting smiling and speech (2)
  • increased dental decay on the upper front teeth (2)
Good dental hygiene is of particular importance for a baby with an upper labial tie. Although breastfeeding alone may not cause tooth decay, breastfeeding in conjunction with an abnormal maxillary frenulum attachment may be a contributing cause of tooth decay in a breastfeeding infant (7). This may be because the area around the upper labial tie is difficult to clean, so food particles remain trapped in the oral mucosa.


A study undertaken in 1999 found that although human breastmilk did not cause tooth decay, adding a small amount of sugar to breastmilk did cause tooth decay (8). Therefore it would be wise for children with an upper labial tie to avoid sugary foods which, in conjunction with breastmilk, might accelerate tooth decay.


There is some evidence suggesting a link between childhood tooth decay and low levels of vitamin D (9). Breastmilk is naturally low in vitamin D, so vitamin D supplementation may be a consideration for a breastfed baby with an upper labial tie.


An upper labial tie can cause dental issues later on, so even if you decide against having the procedure done in infancy, your child's dentist may suggest dividing the upper labial tie when your child is older. "Tight frenulums rarely go away by themselves (3)"; however, they can sometimes break: my eldest child accidentally tore hers on a badly-aimed dinner fork, and one of my sons fell and tore his in the skate park. My two youngest sons also have severe upper labial ties. Despite overcoming the obstacle of their upper labial ties without having them divided and breastfeeding them both successfully, I probably won't be able to help that momentary feeling of having been just a little bit short-changed if I'm told a division is necessary in future.

slvrbtrfly
by on Jan. 15, 2012 at 5:16 PM
Did she nurse more, or just more efficently after it was clipped?

Quoting lundaylove:

it definitely could be a contributing factor!  my daughter was only 11wks when she got her lip tie clipped and while she had gained the normal amount for an infant before the clipping afterwards she gained a ton. my sisters son has a lip tie and she refuses to get it clipped and he is a TINY lil guy (my 6mo is almost bigger than he is) yet she thinks its fine. I think if his lip was clipped it would benefit but she wont go for it......



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comf
by on Jan. 15, 2012 at 5:22 PM
I just got my sons upper lip tie lasered last week. He is 11 months. It was separating his two front teeth. He did not have a tongue tie and has a slight lower lip tie but not bad enough to need it cut. I don't think it affected weight gain but it did affect his latch at first looking back, but at the time no one told me or even checked even though I had lots of trouble nursing.
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slvrbtrfly
by on Jan. 15, 2012 at 5:26 PM
What was his recovery time?


Quoting comf:

I just got my sons upper lip tie lasered last week. He is 11 months. It was separating his two front teeth. He did not have a tongue tie and has a slight lower lip tie but not bad enough to need it cut. I don't think it affected weight gain but it did affect his latch at first looking back, but at the time no one told me or even checked even though I had lots of trouble nursing.

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comf
by on Jan. 15, 2012 at 5:31 PM
We kept him awake during the procedure. They swaddle them then give some laughing gas. The Dr comes in to numb it with topical gel then does the laser. He was gone 15 minutes then he came out. He slept in his carseat on the way to lunch for 20 minutes and was eating sauteed spinach and breadsticks within an hour! I usually don't give him grains or flour but it was a special treat (the bread stick! )


Quoting slvrbtrfly:

What was his recovery time?




Quoting comf:

I just got my sons upper lip tie lasered last week. He is 11 months. It was separating his two front teeth. He did not have a tongue tie and has a slight lower lip tie but not bad enough to need it cut. I don't think it affected weight gain but it did affect his latch at first looking back, but at the time no one told me or even checked even though I had lots of trouble nursing.


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comf
by on Jan. 15, 2012 at 5:31 PM
My pedi said if they want to put him under it needs to be done at a hospital so they can be monitored closely.


Quoting slvrbtrfly:

What was his recovery time?




Quoting comf:

I just got my sons upper lip tie lasered last week. He is 11 months. It was separating his two front teeth. He did not have a tongue tie and has a slight lower lip tie but not bad enough to need it cut. I don't think it affected weight gain but it did affect his latch at first looking back, but at the time no one told me or even checked even though I had lots of trouble nursing.


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