Answer # 3: Latch Technique for Infants with a tight frenulum

Here I am back to posting another one of the answers I received to my question Help! My baby is still not latching at 6 weeks!

MG,

I'm afraid that I can't be much help to you. If you are already working with a lactation consultant and probably have researched the matter yourself, then I probably can't give you better advice. I know very little about tongue-tie and have never dealt with it personally nor know anyone personally who has dealt with it.

Here is a study from Pediatrics, a publication of the AAP. They list a lot of previous studies, including those that talk about problems tongue-tie can cause as the child gets older. Difficulties swallowing, poor speech, poor oral hygiene, malformation of the teeth, malformation of the palate and dental arch, and gum recession have all been linked to tongue tie. I don't think that jaw recession is caused by tongue-tie except in extreme cases.

If it was my baby, I would have him evaluated by at least one expert, specifically an oral surgeon, pediatric surgeon or ears, nose and throat specialist (even better if it is one who has dealt with this in the past). They could better tell you how severe it is and if the potential for long term problems exist based on that severity.

Answer to Question 1: It is possible that the tongue tie will remedy itself with time, depending on how serious it is, and your baby may be able to breastfeed at some time. However, if work with the lactation consultant and repeated tries are failing, then I'm not terribly optimistic that the baby will be able to breastfeed anytime soon and possibly throughout the first year. Here is a latch technique you can try if you haven't already:

"Infants with a tight frenulum can often breastfeed with special attention to a deeper latch that maximizes tongue contact with the breast. An asymmetric latch, where the nipple is presented to the infant's upper lip so the baby extends the head back slightly, opens wide, and latches on with the lower lip and tongue tip as far away from the nipple as possible can help achieve this goal (Eastman 2000). It may also be helpful for the mother to position the lower lip on the areola, and roll or pivot the baby onto the breast. If the baby chokes or sputters during feeding, leaning back so baby is almost lying on mother's chest can improve his ability to handle the flow of milk. The mother can be encouraged to be patient with the baby and not expect him to be as efficient as other infants. A tongue-tied infant is especially vulnerable to failure to thrive if feedings are timed or rigidly scheduled."

You can also try pumping a little right before latching to draw your nipples out to help counteract the flat nipples.

Answer to Question 2: If you are concerned about developing oral skills of the typical baby, you can try a few things. You can try a special feeder along side your nipple, which could possibly be painful for you dependent on how your baby sucks. You could finger feed from time to time, or simply just give your baby your finger to suck on. You could also try giving your baby toys designed for mouthing, such as various teething toys. You may not want to start it in effort of having to break it later, but babies can happily suck their own thumb.

Because of your toddler to look after as well, don't feel guilty about using a bottle. I had difficulties nursing my baby during the first week, she had jaundice and she was very sleepy. I tried feeding her through a syringe and tube at my breast, but it was becoming tedious and she wasn't able to suck down breast milk through it. I gave her a bottle and cried and cried and cried. I felt like she would never breastfeed, and I was permanently sabotaging it. I would always try to latch her on first, and then give the bottle. Out of curiosity, I tied to latch her on AFTER giving her the bottle as well, and it worked. We successfully breastfed for two years after that point, although she always had latch issues. It is hard to take another strike against you by getting him to use the bottle, but at this point, I don't think it will make a significant difference. If you decide to see a specialist, then you might want to wait it out until the outcome.

I think tongue-tie can be hereditary, so maybe your daughter had a mild case of it that she was able to overcome, maybe it was the flat nipples.

I applaud you for trying so hard to get your baby to breastfeed and your willingness to continue to pump. Here is a link to several articles on tongue-tie from a breastfeeding site I think is great. You might find further info there

kellymom.com - Breastfeeding a baby with Tongue-Tie

Notes on Related links:

Some of the links cited in the original letter are no longer active so I've removed them from the post. For example, I could not locate the study by the AAP on the probems of tongue-tie. However, here is the link to the breastfeeding topics page of the American Academy of Pediatrics.

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