Breastfeeding Problems and How to Properly Identify a Tongue and Lip Tie

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I looked forward to breastfeeding when I was pregnant.

Of course, I wanted to provide the best nourishment for my little one.

I never realized that breastfeeding would end up being one of the most difficult commitments I’ve ever had!

One of the biggest reasons for this difficulty was the fact that my baby girl had both a posterior tongue tie and lip tie.

I had never heard of these conditions, so I wasn’t able to identify either.

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First: What is a Tongue/Lip Tie?

So, before I try to explain what either is, what will help to understand both is what a “normal” tongue and lip look like.

If you were to raise your tongue towards the roof of your mouth you should expect to see a thin strip of tissue extending from the floor of your mouth to the bottom your tongue.

This is called the lingual frenulum.

The closer the frenulum is towards the tip of the tongue, the more difficulties there are when breastfeeding.

These fall under the category referred to as tongue ties.

This is how they look like.

Seattle-ENT-Tongue-Tie-Ankyloglossia
Image via Healthwise

A lip tie is very similar except this frenulum usually extends from the gum attaching it to the inner membrane of the top lip.

The closer the tissue is to the teeth, the more difficult it is for baby to establish a seal also leading to poor and inefficient breastfeeding because your baby is constantly slipping off the nipple.

Babies usually improvise by gumming down on the nipple, just to stay latched, resulting in nipple pain for mom.

This is how a lip tie looks like.

Lip Tie
Image via Youtube

How Do Tongue/Lip Ties Affect Breastfeeding?

Tongue and lip ties make breastfeeding extremely difficult (and painful!) for both baby and mom.

To understand why you must know the physiology of how your baby breastfeeds.

I will assume that you have probably heard about how the “latch” is central to breastfeeding, and how successful breastfeeding revolves around mastering this primary concept.

Plainly said, the “latch” is how your baby establishes the suction over your nipple.

When your baby has a good latch, they are able to efficiently draw milk out of your nipple when you have a letdown.

An effective latch has two components.

First, the lips must be flared out.

Flared out lips usually means that your baby has a good grasp of your nipple, however, it is also important that your entire areola is entirely in your baby’s mouth for it to be classified as a good latch.

A lip tie inhibits the complete flare out of the top lip as it is the tissue that connects the gum to the inner membrane of the top lip.

The closer the tissue is to the teeth, the more serious the lip tie, the less flare there is.

I want to emphasize that it is more important for the bottom lip to be flanged outward than for the top lip, and that some babies are able to breastfeed effectively even with a lip tie (1).

However, if you notice that your baby’s lips curl inward, move up and down, or lose suction often when breastfeeding, then the lip tie is inhibiting proper breastfeeding.

As a result, you might notice that your baby will gum down on your nipple just to maintain a latch and nurse.

Now, this has a lot of negative implications for breastfeeding.

For one, gumming down actually inhibits milk flow.

It’s like trying to drink something through a straw while simultaneously biting down on it.

It also makes breastfeeding extremely painful for mom as the nipple takes the brunt of the clamping down force.

This is why some moms get cracked, split, and even bleeding nipples.

Ouch!!

The second component of an effective latch is that the tongue must extend beyond your baby’s gum line.

The tongue’s roll in (no pun intended) breastfeeding is important in that it draws your nipple well into your baby’s mouth and then “massages” the milk out of it in a rolling motion.

This is why breastfeeding shouldn’t be painful.

If your baby’s tongue is restricted (as with a tongue tie) and not longer than the gum line then it will be painful.

As mentioned earlier, a tongue tie refers to the tissue connecting the bottom of the tongue to the floor of the mouth.

Just as with the lip tie, the closer this tissue is to the tip of the tongue, the more serious the tongue tie and the “shorter” the tongue.

When your baby’s tongue doesn’t extend beyond their gumline, this also results in the gumming of your nipple, and you’re back to inefficient nursing and nipple pain.

For the BEST illustration of this, check out this video:

So, as you can see, recognizing a tongue and lip tie is SUPER important if you want to breastfeed.

The problem is identifying them, and, specifically, the posterior tongue tie!

In my case, multiple pediatricians and lactation consultants did not know how to correctly check for either, so the difficulty with breastfeeding and my baby’s weight loss was often attributed to something being wrong with my milk supply or nipple confusion.

Do these sound familiar to you?

Maybe your baby has a tongue tie or lip tie?

If you would like to assess your own breastfeeding experience, I have outlined the typical signs and symptoms of a tongue tie (a lip tie is similar, just omit point 1)…


No Time to Read Now? Pin it! For Later…

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 1  Short Tongue?

Tongue

Now that you understand how breastfeeding works, you can see why it is important for your baby’s tongue to not be physically restricted or shorter (if you skimmed past this you can read it in the previous section).

For breastfeeding to be painless and efficient, your baby’s tongue must extend well beyond its gumline.

Nursing requires a lot of tongue movement.

I never understood this entirely until after we had gotten our baby’s tongue tie clipped.

After the procedure, we started to notice her tongue a lot more, it’s actually pretty long!

We hadn’t paid attention to it before because it wouldn’t stick out much out of her mouth, which we assumed was normal.

Now I don’t expect you to check the length of your baby’s tongue by manually stretching it out and making sure it extends beyond the gum line.

I hope you don’t do that!

However, you should be able to see your baby’s tongue while breastfeeding.

It will occasionally extend out of your baby’s mouth, just above their bottom lip.

It might not be as noticeable in some babies, so you just try peeling back your baby’s bottom lip just a bit and check that way.

If you don’t see the tongue and instead see your baby’s gums rubbing on your areola, then your baby might have a tongue tie.

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2  Unable to Latch.

As mentioned earlier, babies use their tongue and lips in order to latch correctly.

The latch is how your baby creates the suction over your nipple to nurse.

The lips flare out to create the seal while the tongue helps create the suction that draws the milk out of your nipple and into your baby’s mouth.

A lip tie can inhibit the flaring out of the top lip, while a tongue tie inhibits the efficiency of the suction as it restricts the tongue from drawing in and keeping your nipple in your baby’s mouth.

The result is that your baby will often lose suction and slide off of your breast.

Your baby will then attempt to correct this by gumming down on your nipple. and attempting to nurse that way, giving the appearance of a shallow latch.

Gumming your nipple is an inefficient (and PAINFUL!) way of nursing.

Once we clipped my baby’s ties, I noticed that she was not only able to latch more easily but would also be able to fix a shallow latch pretty quickly with the help of her tongue.

If your baby struggling with having and maintaining a wide enough latch or is sliding off often, they could have a  lip/tongue tie.

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3  Painful Nursing.

Baby’s inability to latch most definitely means pain for mom.

If your baby is not able to create a good seal and suction with their lips and tongue, they have no choice but to clamp down and gum on your nipple just to feed and survive.

This is why some mothers feel a sharp pain while nursing and notice that their nipple comes out flattened after every nursing session.

Their baby is literally gnawing at their nipple.

Over time, this leads to cracked, split, and even bleeding nipples.

Breastfeeding, generally, SHOULD NOT be a painful experience.

With a correct latch, you will feel a soft tug every time your baby sucks, and although let-downs can sometimes be painful, the pain is usually centered around the armpit area instead of the nipple area and usually alleviates over time.

So, if breastfeeding has become a nightmare for you and you dread every feeding session with your baby because your nipples are getting torn up in the process, then it might be time to consider looking into your baby’s mouth for the problem!

And fast!

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4  Nursing Long/ Falling Asleep While Nursing.

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Another consequence of having a bad latch is that your nursing sessions tend to be long (and tedious!) and sometimes even put your baby to sleep.

In reference back to the drinking through a straw illustration, since your baby bites down on your nipple to get milk out, instead of sucking it out, overall less milk comes out.

This is why it takes much longer for your baby to nurse.

Additionally, they are also working harder than they normally would nursing and so they get tired faster and will tend to fall asleep at your breast.

Having a baby that falls asleep sometimes at the breast is normal.

Mommas chest is warm and cozy (and safe!), so if it happens occasionally that’s not an issue.

However, if it happens all the time, in combination with long nursing sessions, that isn’t normal and should definitely be a cause of concern!

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5  Always Feeding But Still Hungry.

A baby that falls asleep at the breast often most likely falls asleep hungry.

This means that you will also have a very cranky baby once they do wake up, and they will be hungrier than before.

This cycle continues as your baby is never fully satiated after nursing despite feeling exhausted after each session.

Additionally, you, as the mom, will feel like you are always nursing AND never satisfying your baby (this is where you start to doubt your milk supply).

This is very physically draining and stressful and feels like a never-ending cluster feed.

Interval cluster feeding is normal especially in the first few weeks (I want to emphasize that there is NO such thing as nursing too much and you should really be worried if your baby is not nursing often), however, your baby shouldn’t appear agitated and starving if you nursed 15 minutes prior.

You could also be experiencing a drop in milk supply (as we will discuss in the next section), so there might not be much milk for your baby to work with, in addition to the inefficient nursing.

If you are dealing with a constantly hungry baby despite always nursing, this is alarming and you should definitely see a specialist as you could risk a failure to thrive for your baby (fed is best and supplementation might be necessary while you try to determine the source of the problem).

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latch problems


6  Low Milk Supply.

Low milk supply is a real concern for breastfeeding mothers.

Although most moms are able to fully produce enough milk to support their own babies (and sometimes even others), tongue and lip ties can actually cause a drop in milk supply.

Milk supply is regulated by breastfeeding through the emptying out of your breasts.

If your milk isn’t being efficiently emptied from the breast (as is the case when a baby has a tongue/lip tie), then there is little stimulation for the production of milk.

Your body starts to get signals that your baby doesn’t need that much milk and so milk supply diminishes.

This furthermore exacerbates the problem.

Your baby ends up having less milk to work with, more inefficient milk expelling and then you start having an even lower supply.

The horrible cycle continues to the point that a mother really can’t support her baby and resorts to supplementation.

If the mother ends up pumping and thus supplementing with her own breast milk, she could save her supply, however, if formula is used then supply often tanks without recovery.

Mothers without the proper support and information often are left with no choice but to abandon breastfeeding, and sometimes even pumping, overall.

If you are concerned about your baby having a tongue/lip tie, I would definitely recommend that you start pumping in order to preserve your milk supply.

While we treated our baby’s ties, I maintained a strict pumping schedule and actually increased my fallen supply to an oversupply.

I would first nurse.

Once I would see that my baby had emptied both breasts as much as she physically could or once she was too tired to continue to nurse (whichever came first), my husband would bottle feed her.

We would only use my pumped breastmilk (it isn’t recommended to mix formula and breast milk because it can upset your baby’s digestion unless your pediatrician recommends you do for your baby’s health) using the paced-bottle feeding method (important!) and I would try to pump the same amount (or more) of breastmilk she would have supplemented.

Your priority is that your baby is fed first.

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7  Engorgement and/or Mastitis.

Another consequence of inadequate emptying of the breasts is engorgement.

Engorgement is when your milk glands are overfilled with milk that hasn’t been properly removed.

This is especially common in the first days after birth as it usually occurs when mom’s milk comes in.

Your breasts feel incredibly painful and have hard lumps, which are the now clogged milk glands, and your nipples become flattened and tight and thus difficult to latch onto for your baby.

If left untreated, engorgement will lead to mastitis, which is a terribly painful and potentially serious bacterial infection that stems from inflammation in your clogged milk ducts.

This infection could make you very sick, and can also end up costing you your milk supply.

My breasts became engorged (I had no idea what that even was at that point) the second day home, and by then my baby stopped nursing completely, she couldn’t latch onto my nipple anymore.

I was already supplementing formula by this point due to my pediatrician’s instruction (I hadn’t acquired a pump by this time).

Since she was able to take the bottle and refused to take the breast, I thought that she was experiencing nipple confusion, which led me to almost quit breastfeeding.

Thankfully, I had a friend who was experienced and quickly identified the engorgement and helped me empty out my breasts through heat compression and pumping (she brought her pump!).

I was able to feed my baby with my pumped milk first, and then re-establish nursing once my breasts softened up again.

Engorged breasts make it difficult for a baby to latch and even more-so for a tongue/lip tied baby.

If you notice that your breasts get harder, especially in the first few days after birth, and your baby refuses to latch, this means engorgement has occurred.

Treat the engorgement and your baby’s hunger, then definitely look into a possible tongue/lip tie.

The good news, though, is that you have a great milk supply, so no need to worry at least about that!

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8  Loss of Weight.

Best-Baby-Scales

The best way to see if your baby is actually nursing efficiently is by tracking their weight.

This is why it is recommended that your baby have a follow-up appointment with their pediatrician two days after being released from the hospital.

This is how I found out that there was a real issue with how my baby was breastfeeding.

I saw that although I was always nursing my always hungry baby, she still wasn’t getting fed.

She had lost over 10% of her birth weight, which is the recommended cap for newborns, in just two days.

That was heartbreaking for me, to say the least, however, it is what pushed me to pump and supplement (which saved my supply and most importantly my baby!) and then to seek out the source of the problem.

Once we figured it out, she started to gain weight immediately!

If you notice all the above signs, especially the frequent nursing yet always hungry, and your baby shows substantial weight loss, this is a HUGE red flag for a tongue/lip tie.

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Long-Term Consequences of Tongue/Lip Ties

So we have already covered the fact that tongue and lip ties can and often do negatively affect breastfeeding.

In some cases, babies that are tongue-tie also struggle with bottles and pacifiers.

However, what you might not know is that the consequences of not treating a tongue/lip tie can negatively affect your baby in other ways and even later on in life.

Sure, people still function well with them, I have a lip tie and my husband has a tongue tie and I can definitely say we are doing fine with them (although I do wonder how it would be like if they were clipped)!

These are just some of the possible implications of not clipping tongue/lip ties…

  • Difficulties chewing or swallowing solids due to limited tongue mobility may cause your child to gag or cough, potentially making the introduction of solids more difficult. This may even have negative implications on your child’s nutrition and even growth (3)!
  • Digestion problems like colic and reflux (4).
  • Gas and bloating due to poor tongue coordination resulting in swallowing excess air (5).
  • Speech delay and/or speech defects (difficulty pronouncing certain words and sounds) due to tongue-tie (2).
  • Psychological implications due to speech impairment including low self-esteem (6).
  • Misalignment of teeth due to tongue/lip ties. Tongue-tie individuals tend to have narrow palates, resulting in teeth overcrowding, whereas lip-tie individuals sometimes develop a gap between the top front teeth (2).
  • Tooth decay is also common in lip-tie individuals as food can get can get stuck in the pockets of the tie (2).
  • Poor dental hygiene due to the tongue being unable to spread saliva across teeth and provide adequate oral cleansing (7).
  • Children with tongue-tie could become mouth-breathers because the tie restricts tongue movement, keeping the tongue primarily at the floor of the mouth which can lead to a high narrow palate, reducing room for nasal breathing, and an open mouth posture. There are a lot of negative implications to mouth breathing which ranges from facial imbalances (affecting your child’s cosmetic features, like causing narrow and/or long face) to things like sleep apnea, getting sick often, and even asthma (8)(9).
  • Tongue-tie babies do grow up to be tongue-tied adults, which means they keep the short tongue. Say au revoir to the ability to do things like French kiss (2). To each his own I guess.

Remember that clipping a tongue/lip tie is much easier and more physically bearable when done while a baby rather than later on in life.

It’s an investment for breastfeeding and beyond!


Re-Cap

The signs and symptoms of a tongue tie are evidently a cascade of effects stemming from the root cause being a poor latch.

It really does all start from a bad latch!

Which is good, in a sense, because the latch is the primary focus of breastfeeding and so usually moms seek help when they are struggling with the latch, increasing the likelihood that a tongue/lip tie is identified thereby saving breastfeeding.

I hope my experience can shed some light on this not so well known issue and can allow a mom in the same boat to actually breastfeed successfully.

Every mom DESERVES that opportunity and I am so glad that I was able to even breastfeed when the odds were stacked against me.

My recommendation to every mom who plans to breastfeed is to learn about tongue/lip ties and how to identify them because they really can prevent you from breastfeeding.

Also, try to find a good lactation consultant, you will need the support!


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Share this with other mommas you know and care about.

We need to help and empower each other to make mom life as easy as possible so we can continue to be super moms in all the important areas!

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Blessing to you on your breastfeeding journey, momma!

Until next time!


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4 comments on “Breastfeeding Problems and How to Properly Identify a Tongue and Lip Tie”

  1. There are many different types of tongue ties. All 3 of my babies were tongue tied and because they were all born at different hospitals and had different pediatricians getting someone to diagnose it was difficult. It was so painful for me to breastfeed each time. I knew after the first day with my last baby that it wasn’t right and still couldn’t get a straight answer. I regret not listening to my gut and heading straight to someone who could help us. I feel like there needs to be a better route for a Momma to get help with this. I feel like I was robbed of getting to breastfeed my last baby.

    1. Hello Amy! I completely understand you. I don’t know if you happened to read my breastfeeding story but I’m there I get more into the details on my own breastfeeding story. NO ONE knew how to diagnose a tongue tie in the hospital by baby was born in. Neither her pediatrician nor the lactation consultant that was assigned to us. Everyone told me the main cause of my problems was low milk supply or my baby was just one of those that couldn’t breastfeed (like are you serious?). If it wasn’t for a dear friend who reached out to me with the same experience and a WIC lactation consultant, I would’ve quit and categorized it as breastfeeding just not being right for us. I wouldn’t know how to identify it myself as it was a posterior tongue tie. The medical community definitely needs to be more educated on this issue as it is crucial to breastfeeding success.

    1. Hello Ajadi!

      No, your baby will still be able to talk although some do end up having a lisp. There are other benefits of having the ties clipped that include dental health among others, so I definitely wouldn’t overlook the issue. If you’re interested, I could refer you to the resource that our specialist gave us.

      Thank you for the question!

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