Breastfeeding and Tongue-Ties: What It Can Mean for Your Baby
Difficulty Breastfeeding? You are not alone.
The first patient to walk into East Madison Dental last Saturday morning wasn’t a typical dental patient–for starters, she didn’t have teeth yet. She was a 2 week old infant tucked into a baby carrier held by her beaming, but perhaps slightly exhausted, mom, Kristen. Since the first time she tried to feed her baby, Kristen had difficulty. The infant would try to latch and would suck hard, but wasn’t getting any milk. The constant attempts were causing her pain, and her baby wasn’t getting fed.
She went to a lactation consultant that was recommended by her ob-gyn, who suggested that the infant might have a tongue-tie that was preventing her from latching properly. That brought them to the multi-specialty dental practice of Dr. Narpat Jain, who would be doing an evaluation to determine if the tongue-tie should be removed with a laser frenectomy procedure.
Kristen’s story is not at all uncommon. The American Association of Pediatrics recommends that babies be fed breast milk exclusively for the first six months of life. However, a UC Davis Medical Center survey in 2013 reported that only 13% of mothers manage to do that, and that more than half are not breastfeeding at all by the six month mark. The main reason women stop? Pain and latching problems.
There are many reasons that mothers and babies struggle with breastfeeding. Just positioning the baby at the proper angle to get the best latch takes time and practice–as much as two weeks, says San Francisco lactation consultant Caroline Kerhervé in an NPR report on breastfeeding. Sometimes the issue is more than just positioning, however, and might be something physical, like a tongue or lip tie.
Tongue-Tie Could Be Part of the Problem
Lactation consultants typically conduct a breast exam and an exam of the baby to determine what might be causing obstacles to proper latching. This will also include a look to determine if a tongue or lip tie exists. A tongue or lip tie refers to a shorter than normal frenulum, the thin flap of skin between the bottom of the mouth and the tongue and the lip and the gums. The condition of tongue or lip tie is ankyloglossia and it occurs in anywhere from 3 to 13 percent of babies. The shorter tissue can restrict the baby’s movement, and ability to grab on and suckle properly.
Left untreated, the issue with latching can persist, leaving babies fatigued and gassy, as well as under-nourished. The mother may continue to experience pain, which can lead to mastitis, an infection of the breast, and low milk supply from inconsistent and incomplete emptying. If the tongue or lip tie is particularly notable, speech impediments and orthodontic complications can arise in the future.
What is a Frenectomy?
Fortunately, removing a tongue or lip tie in an infant is a very quick procedure that does not even require anesthesia. It is called a frenectomy, and it can be done at the hospital or in the office of a pediatrician or dentist. Some providers use scissors to snip the frenulum, while others are now using lasers which provide a more precise removal of the skin. With a laser, the actual procedure takes seconds.
Dr. Narpat Jain of East Madison Dental in Tenafly, NJ has seen an increase in the number of infants coming to his practice for frenectomy consults. To meet the demand as well as the urgency, Dr. Jain has been staying later or working Saturdays to ensure that a consultation is scheduled within 48 hours of the parents calling. “The parents that come in are stressed and worried about their baby, who is often not gaining weight. I try to see them as soon as possible to determine if a frenectomy is recommended,” Dr. Jain explains.
He schedules a 45 minute consultation with the parents to determine if the procedure is needed, and to go over any concerns or questions that the parents might have. The frenectomy can then be done right then and there in the office, usually taking a couple of minutes. Dr. Jain sees about 2-5 babies per day.
Relief with Results
For many mothers of infants with tongue or lip ties, feeding becomes much easier almost immediately after the frenectomy has been performed. Following her baby’s frenectomy, Patricia noticed a drastic change after a few days. “She drains everything in 15 minutes, whereas before it would take 40 minutes and would be painful,” she describes in her video testimonial on the East Madison Dental website, where she had the procedure done.
For others, there is relief, but practice is still needed to get the rhythm perfect. As Kim Conte shared in her New York Times blog post about her experience following the frenectomy procedure: “Yes we still needed practice, but now the practice was getting us somewhere.”
More Research is Needed
The research is still catching up with the demand for more recommendations and advice for women trying to breastfeed. In June of 2017, the National Institute of Child Health and Human Development (NICHD) launched a task force to address this lack of research. Other medical professionals are already starting to conduct their own research based on experiences in their practices, such as Dr. Ghalheri in Oregon who published a report in 2016 on breastfeeding improvement following frenectomy. Hopefully, more research is to come.
Ultimately, the experts seem to agree that reaching stress and pain free breastfeeding requires a multi-faceted approach that looks at a variety of factors. It also requires practice, and time.
If you are experiencing difficulty with breastfeeding, ask your pediatrician to recommend a lactation consultant. You can also reach out to the following north New Jersey pediatric and lactation centers that have well-renowned lactation consultants that can help: