Are tongue and lip ties just a new “passing fad” within the breastfeeding community or is it a real challenge that has a solution? I asked women on my Facebook page, “What would you say to someone who states that tongue and lip ties are not a real thing that affects breastfeeding?” Here were some of their responses: (Within 12 hours I had over 300 responses from women who shared their experiences and the improvement they had once their child’s ties were snipped or lasered…)
“We had to do BOTH the tongue and lip. My daughter was only two days old and was very jaundice. It worked. She latched right on and hasn’t stopped since. She is now 24 months and going strong (we opted to do the laser- it only took a few seconds).” -Jennifer
“My son’s latch hurt so bad my husband had to hold his hand over my mouth when my baby latched on so I wouldn’t scream in my baby’s ears. I switched to exclusively pumping for weeks out of desperation until I was able to get both tongue and lip revised. He latched on right away afterwards. Within days we were nursing absolutely pain free and are still going strong at 2.5 years!” –Melodie
“I cried at every single feeding which were two hours apart each day for seven weeks. I saw multiple lactation consultants and they told me posterior tongue ties (PTT) do not exist. Finally, I went to a new IBCLC after being misdiagnosed for thrush and after mastitis. My son had a PTT and they corrected on their lunch break because I couldn’t wait one more weekend with the pain I was in. After the laser treatment, and a good month of my nipples healing, we are still exclusively breastfeeding with NO pain and my lovely son will be 10 months. I see no end in sight and I refuse to believe that tongue ties are a ‘fad’.” –Samantha
“Tell my bleeding, blistered and cracked nipples that tongue tie doesn’t affect feeding!!” –Evie
“Anyone who says it’s a fad has clearly never breastfed a tongue tied baby. By the time I found my way to the dentist, my boy was six weeks, my nipples were shredded, and I cried at the thought of feeding him. She was shocked that he was still exclusively breastfed at the time. Thanks to her, we’re at seven months now, and still going strong.” –Jayde
As you can see from these comments, there are countless women who will tell you it is absolutely not just a fad but a very real problem that can be fixed and greatly improve a breastfeeding relationship. While I can share so many more stories about women’s experiences breastfeeding a baby with a tongue tie (and the improvements they had after they got their baby’s ties revised) I thought it would be great to actually talk with a professional who lasers tongue and lip ties on a daily basis.
I recently interviewed Dr Bobby Ghaheri, MD. A medical doctor who is a feeding specialist in breastfeeding medicine. He has been lasering tongue and lip ties for over three years and working with breastfeeding families in this area is 80-90% of his practice. Dr. Ghaheri told me that both of his children had significant breastfeeding problems. His wife was in pain for years nursing his first daughter, but despite seeing numerous lactation consultants and their paediatrician, no one ever looked in her mouth. After his 2nd daughter was born, their midwives knew something was wrong when his wife started having severe pain again. They saw a wonderful lactation consultant who identified a lip tie and posterior tongue tie and when he saw the improvement in nursing after the procedure at 7 days of age, he felt a need to get involved in this area of medicine.
Here are his answers to our questions about tongue and lip ties and how it relates to breastfeeding!
Meg: OK now let’s first clear up the deal with the tongue and lip tie…do they come in pairs? If there is a lip tie is there always a tongue tie and vise versa?
Dr. G: There aren’t good published data yet, but my experience is that an isolated lip tie is very uncommon (<1% of the time). When a tongue tie exists, I seem to find a lip tie about 75% of the time. We are in the process of completing a study done in my office so hopefully we’ll have a better picture soon.
Meg: Both of us work with breastfeeding women and have seen first hand the dramatic improvements that can be made to a breastfeeding relationship when a baby has their tongue and/or lip tie revised. Yet there is still so much controversy around this issue. Many health care professionals do not even acknowledge that it exists or affects breastfeeding. Why is this such a controversial issue?
Dr. G: There are several reasons. First, most people who don’t “believe” that a procedure can help have very little knowledge about breastfeeding. Most primary care doctors don’t spend time with lactation consultants in training, and are therefore not qualified to make that statement in my opinion. They don’t even examine the baby’s mouth! Or if they do, they do it incorrectly – I show how to do a proper evaluation here. Second, there is a political/territorial battle, which is ridiculous. In my community, some pediatricians are upset that a lactation consultant determines the cause of the problem and recommends evaluation by a specialist, and they feel left out of the loop. They demand to see the baby before referring for a procedure, yet they then use the dogma they learned in training to convince the mom that a procedure won’t work.
Meg: A lot of parents have told me that their healthcare provider said their baby has a “mild” tongue tie and then dismiss the need for a revision. There are different types or classes of ties, however I often tell people, “You either have a tongue tie or you don’t. And it’s either affecting breastfeeding or it isn’t.” There seems to be an obsession with “how severe” a tie is without acknowledging that it can still affect breastfeeding even if it appears to be mild. Do you agree with my thoughts on this?
Dr. G: Absolutely. Severity or mildness of a tie doesn’t predict the presence or absence of symptoms. If a mom is going to see a lactation consultant or breastfeeding specialist, it’s not to flaunt how well breastfeeding is going. It’s because the dyad is experiencing symptoms. So judging the severity of the tie without the context of the dyad’s symptoms is like an orthopedic surgeon saying that an ACL tear that is “mild” on MRI doesn’t need treatment despite the fact that the patient is experiencing severe pain and instability of the knee joint. Furthermore, I don’t trust a practitioner who says a tie is “mild” because they’re looking for a heart shaped tongue typically. Since they don’t know how to examine properly, the description of the tie as mild doesn’t really matter.
Meg: There is such confusion from parents about whether or not their baby has a tie. I always use myself as an example of someone who has a tongue tie (it actually hurts me to poke out my tongue!) but my mother breastfed me without any issues for 2 years! So I do remind people that just having a tie does not mean you are then going to have issues breastfeeding. Why is it not black and white?!
Dr. G: It’s a multifactorial issue. It’s not just about tongue mobility. Mom’s milk supply, appropriate positioning at the breast, muscular tightness of the jaw and mouth, neck problems like torticollis, etc.
Meg: What is the biggest misconception when it comes to ties and breastfeeding?
Dr. G: The a tongue tie or lip tie release will make breastfeeding better quickly. People forget the importance of the IBCLC in navigating the ups and downs that happen after the procedure.
Meg: Breastfeeding is not the only problem that can arise from a tongue or lip tie. What are some other problems or challenges that can happen?
Dr. G.: A whole host of facial and dental developmental problems can arise. Dental malocclusion, upper airway obstruction/resistance leading to sleep apnea, speech problems, TMJ and muscle tension, etc. Toddlers can have problems with solid foods as well. Occasionally, a lip tie can cause cavities around the upper incisors.
Meg: Why do you use laser instead of scissors?
Dr.G: For babies who need it for breastfeeding purposes, I don’t think it matters much what tool you use. I use laser because the minimal bleeding that results allows me to treat older children in the office without the need for general anesthesia. The one other advantage is precision – the laser allows me to remove all of the lip tie off of the gumline, which results in a better result for dental purposes.
Meg: I recently heard this quote and loved it! “All advances proceed ahead of research, then are evaluated by research.” Do you feel as though we are in the advances stage right now? Do you keep track of statistics post-surgery with your breastfeeding families so you can evaluate what is happening within your practice? I’d love to see the outcomes and what you have seen working with these families.
Dr. G: Yes absolutely. There are numerous published papers on the benefit of frenotomy for breastfeeding. Many of these studies are small or have poor methods, however. As a result, doctors and IBCLCs who come in with the bias that the procedure doesn’t work use this to justify inaction. I am in the process of evaluating babies that were treated over a 9 month period of time in a more organized fashion to hopefully improve the quality of the body of evidence.
Please head here to Dr. Ghaheri’s website and Facebook page for some great information on tongue and lip ties including how to examine a baby for a tie, how to do the stretches post-surgery and a heap of other educational information on this topic. It can be very helpful to receive support from an International Board Certified Lactation Consultant pre and/or post procedure. While some women see improvements straight away after the procedure, others will not have improvements for weeks or sometimes months after.