Tongue Tied and Breastfeeding Difficulties

A couple asks PSP members about their baby with short frenulum/breastfeeding difficulty - and here is the advice they received.

Important Message from Park Slope Parents (PSP):

Just a reminder:  PSP member posts are not checked for accuracy. The content is for general informational purposes only and is not a substitute for medical advice. ParkSlopeParents.com is not intended to, and does not, provide medical advice diagnosis or treatment.  Never disregard professional medical advice, or delay in seeking it, because of something you have read on the PSP Yahoo! Group or on the www.parkslopeparents.com website. Never rely on information in an e-mail or on our web site in place of seeking professional medical advice.  

 

The parents write:

"Our 17 day old daughter is having great difficulty with breastfeeding, to the point that she has given up through frustration. It has been suggested to us by lactation consultants that she has an operation to snip part of her tongue to give it more flexibility and that this might/ should help her. Our midwives and paediatrician agree that this might help also.

But (obviously) we're a little reluctant for our 17 day old to have surgery unless we're pretty sure that it will help. So we're wondering if anyone has had this operation for the baby and if it made a difference with their breastfeeding.

Thanks

Bob and Betty (parents of XX)"

 

REPLIES:

 

"I've heard a lot about this from the experts and also from people who have had it done. It is almost painless. Maybe one drop of blood. People who have it done say how much easier it made life and how much less pain for mother's nipples and baby's frustration and feeding. Is Judy your LC? Trust her. Don't forget that this will help your child's speech clarity later and save you both frustration on that account, as well. Good luck. You'll be pleased with the result.

(la Leche League leader)."

 

"I'm a little late in responding to this post, but wanted to say that we had this procedure done on our twins when they were about 3 weeks old. Baby 1 & Baby2 were born with pretty "severe" tongue-tie (tongue attached at bottom tooth gumline). It made breastfeeding an absolutely horrific experience. Following the procedure, which really was extremely quick and with minimal blood, their breastfeeding improved enormously, and was far less painful for me. While it is in effect surgery, it was an in-office procedure that takes seconds at this very young age. They each breastfed within seconds of the "clip" and were fine later that day."

 

"I just wanted to echo the below post from T. My guys were born with pretty severe tongue-tie as well, with the attachment being at the gum. Breastfeeding was incredibly difficult and painful to boot. We saw a lactation consultant (Freda) who recommended having their frenulums "liced". While our Ped was against it, the entire BFing experience was so difficult that we took Freda's advice and saw her referral, Dr. Goldsmith, when the boys were about 3 weeks old. As T wrote, the procedure was over in seconds and their discomfort was over in minutes. Dr. Goldsmith is wonderful, and breastfeeding absolutely improved after the procedure. I would not have made a different decision (except perhaps to have the procedure done sooner)."

 

"Our son was tongue-tied as well and breastfeeding for the first 3 months was extremely difficult for him and painful for me. (Also, my supply was not great in the beginning). I had clogged ducts every other day for a while as a result. He wasn't able to suck properly because his frenullum (that stretchy stuff under the tongue) was attached to the lower gum, rather than back in the palette of the mouth as it should be. We saw Jan Wenk (lactation consult) at 9 weeks, (from Heather Kelly Assoc) who recommended that we have the frenullum clipped. She also gave us jaw massage techniques and finger feeding routines to try as well as nettles tea for me to increase my supply. Our pediatrician wasn't too keen on the idea of clipping it and asked us to wait a bit and see if it didn't correct itself. It didn't. So the ped then made us see their lactation consultant (and pay another fee) who gave the same suggestions as the other. She also gave us the name of an ear, nose, throat specialist that is affiliated with our ped. who then gave us a referral to have the frenullum clipped. (You can't have the procedure done without the referral from the pediatrican). Anyway, we finally got the thing clipped at 3 months. It was a 5 second procedure and he cried for 5 minutes and then was fine. The specialist (Ari Goldsmith on Atlantic Ave.) told us that it could have caused speech problems as well as major gum and dental problems later on because of its attachment to the gum. It totally made sense to us. We thought he was excellent btw. The breastfeeding immediately improved and we're still going strong at 9 months. Hope this helps."

 

"When my son was about 2 weeks old we were having some nursing issues. The lactation consultant we went to said that he was "a little bit" tongue tied (among a list of things) and gave us some exercises to do before he nursed. It seemed to help -- after a week we could see his tongue extending more while he nursed."

 

Tongue Procedures and Doctors Compilation 2018

Looking for wisdom/advice/opinions on newborn tongue ties. We just got home from the hospital and the LC on staff said our daughter has a tongue tie which is making breastfeeding terrible for me.

We have been given quite a few names of specialists to see and as I do my research and talk to people, I'm seeing that procedure is either done by an ENT or DDS, and either with "scissors" or a laser.

We've made appointments to see Alison Maresh with Weill Cornell (ENT) and Robert Convissar (DDS) tomorrow.

I'd love hear people's experience/opinions on the type of procedure and between the professional background and if anyone feels strongly either way, and if anyone has experience with the doctors we're going to see.

Also it seems some people have the opinion that this really isn't a big deal and I might be overthinking it all.

Thanks, all!


---------

This has become an area of conflict as you have discovered! Go to a board certified pediatric ENT and not to a dentist. The issue is clouded by the fact that the procedure is relatively simple with a low rate of complications and a very very high reimbursement rate. You want to go to someone who has the ability to judge clearly and say it won’t help if it won’t help. Lactation consultant overdiagnose tongue tie as it has become a vogue. I usually use Rosenfeld and Goldsmith in Brooklyn Heights, but Alison Maresh is a good smart doctor and will do a sensible assessment . You can also speak with your pediatrician .

Dr. Gordon
Medical advisor to PSP

---------


We had our then 5-day-old's lip tie clipped by Dr. Rosenfeld last year. I've never regretted seeing him...in the interest of time, I'm copying and pasting what I wrote to another PSP user several months ago...feel free to ask any follow ups. This stuff is so stressful but you're doing great!

I actually opted NOT to use Dr. Dahl, as my wonderful LC felt she erred on the side of clipping every potential tie situation without exploring other options. She referred me to Dr. Richard Rosenfeld, who was fabulous. (Info below.) He immediately recognized that my 5-day old daughter did not have a tongue tie but did have a severe lip tie, which often goes unnoticed. He was able to handle it on the spot and was wonderful with my daughter (and me, who was probably the neediest person in the room. :-)) Good luck! Let me know if I can answer any other questions!


--------

We had that done when my son was 4 weeks old (which is rather late) by Dr. Richard Rosenfeld (then at LICH; he's on Montague St now, apparently: (718) 780-1498), whom I would recommend. My son screamed bloody murder for several minutes until I got him to nurse to calm him down and because the doctor wanted to see him try, but after that he showed no sign of distress. It definitely improved his nursing - not all at once (I didn't notice anything at that first feed), but I think later that day I had one painless feeding, the next day it was a couple, and within a week or two it was just routinely painless (and presumably more effective).

The rap against the procedure is that there is some tiny chance of an error (from a slip by the doctor or a badly timed movement by the baby) that could damage a salivary gland or something. Not high, but not completely zero. That said, I think it it worthwhile to fix nursing problems. Otherwise, most tongue ties are not a big deal (according to Rosenfeld, and borne out by my own family history, only about 25% of babies with tongue ties have trouble nursing). My son inherited his from me and mine doesn't bother me, although I have slightly worse diction as a result and have never been able to manage a proper Spanish "r"; my brother, who also has tongue tie, can, though!

--------

My son had a tongue tie that we got corrected at NYU when he was 8 days old. We had a great experience with their staff (Dr. Scott Rickert).

I held him while the doctor and PA applied a topical numbing cream and snipped his frenulum. The whole experience was well under 5 minutes. He didn’t love it, but seemed more bothered by the number of hands in his mouth than anything else, and was over it and sleeping within another 5 minutes. There was very minimal bleeding. My doula compared the feeling to getting your ears pierced.

He fussed about the same amount when he got his Hep B shot.

It it will make breastfeeding so much better!

------------

My son had a tongue and lip tie that was ultimately diagnosed by the 3rd LC we saw. LCs, pediatricians, and our midwives all commented on his dysfunctional/weak suck, but none mentioned a tongue/lip tie so I thought it was simply something he would outgrow. After 5 weeks of excruciatingly painful nursing, we decided to pay out of pocket yet again for another LC's opinion. The 3rd LC let us know that our son's issues would need to be addressed by a surgeon and that the previous LCs we had seen were all of the anti-tongue tie intervention camp (we had no idea this was such a polarizing issue).

We saw Dr. Scott Siegel for the laser procedure and cannot recommend him highly enough (http://www.drscottsiegel.com/tongue-lip-tie). Based on my conversations with other parents, I think the laser procedure is preferable. I know babies who had to have the procedure re-done after the scissors release grew back. It's very uncomfortable for babies so I would do everything to avoid needing the procedure a second time around.

Within two weeks of having the procedure, my husband and I felt like we had a completely different baby. Our son was less fussy and could finally suck normally. He still struggles to suck on bottles and pacifiers, but breastfeeding has improved significantly and he can self-soothe much more effectively.

I am still confused by the opposition to resolving tongue and lip ties that we encountered. I understand the desire to avoid unnecessary interventions, but if your baby can't eat or soothe effectively and you are experiencing pain then it is an absolutely necessary intervention in my opinion. Tongue and lip ties can also negatively impact speech and dental health down the road so resolving them sooner rather than later can avoid a whole host of problems. Not only did we change LCs, but we also left Tribeca Pediatrics because they ignored our feeding difficulties and I later read on their website that they do not believe in tongue/lip tie interventions.


I wish you the best of luck resolving your baby's tongue tie. The recovery and re-learning how to nurse correctly take several weeks but were well worth it.


------------

We saw Dr. Rosenfeld (pediatric ent) for two of our kids when they were both about 7 days old. He used the snip method. The procedure was done in the office, took about 30 seconds and there was no recovery time just an immediate and wonderful difference in latch. (I however needed a few minutes to recover .... I recommend bringing a partner with you if you can .... I needed my husband to hold them both during the procedure because my post partum hormones couldn’t handle it ??).

-----


My daughter had a tongue tie and we got it snipped by Dr. Linda Dahl at 120 E 56th St. She was recommended by our pediatrician and she was good -- she just used scissors. This was August 2016.

Our pediatrician told us that tongue-ties tend to be overdiagnosed and that there *are* some unnecessary procedures being done -- but she also said that our daughter had a really severe one, and it was making nursing pretty much impossible, so for us, it was an easy choice to get it done.

For what it's worth, the procedure itself is EXTREMELY fast and easy. A few seconds and it was over. Our daughter cried for maybe 20 seconds and it never bothered her again. So at least on that front, I can reassure you that it really no big deal and I think just about any reputable doctor who takes your insurance would be absolutely fine.

Hope this was helpful - I'm just remembering how stressful the whole thing was at the time! But it really was quick and simple to resolve. I hope you have the same experience.


---------

My 17 month old son just had this procedure done at Downstate Medical Bayridge with Richard Rosenfeld who came highly recommended by his pediatrician. The procedure took about 10 minutes and he was groggy the rest of the day and then fine the next. It has taken him a few weeks to learn to stick out his tongue more, which makes me happy.

He had an initial snip of the frenulum when he was 4 days old in the ENT office...BF was so painful (I had to stop for a few days). I took him to the first ENT I could find that had the soonest appointment (before he saw his pediatrician for the first time!—I would have never have done that with my first kid). His tongue was snipped but the tongue tie was so severe that ENT couldn’t do anymore but the snip was sufficient for breastfeeding without pain. Then at age 4 months we took him to Rosenfeld who said it was a significant tongue tie and he wouldn’t do it in office bc they are so bloody (oh thanks!). And to wait until about 18 months when he’d be bigger and better for going under anesthesia. But that he would need it as it would for sure impede his speech. And sure enough, it was. Since the second snip we understand many words that we could not before. So my kid had his tongue tie done 2x! All good. Scary for mommies no matter what though.

-----

My son had a minor tongue tie and breastfeeding was also really hard. I took him to Dr. Linda Dahl (ENT) who specializes in breastfeeding issues. She did clip the tie, which took all of 30 seconds, and then worked with me to get him on the breast and latching properly. He had been mostly bottle fed at that point, so also had "nipple confusion" (what an awful term), and while I did successfully get him to nurse at her office, he still screamed bloody murder when I tried again at home. I gave it a couple more tries, but he reacted like I was trying to kill him with my nipple, and it just wasn't worth it to me to make feeding time so unpleasant. So I pumped exclusively after that.

All this to say: 1) I'd use an ENT, and she was helpful since breastfeeding was her focus; 2) even if you clip the tie, it may not solve the breastfeeding problem (but it will help avoid future speech problems, so not a bad idea to do it anyway); 3) the procedure itself is super minor, and the quicker you do it the better. My son was under two weeks, and he barely even cried - there were some babies in the office who were closer to two months, and they went nuts; and 4) if breastfeeding doesn't work for you, don't do it. Pump, or formula feed (I did both at different times), but feeding has to work for both of you. If you're miserable breastfeeding, it isn't worth it. I know that's heresy, but for my son, feeding was so much more peaceful with a bottle, and I was able to relax and just bond, instead of doing acrobatics to get him to latch and gritting my teeth because it was so uncomfortable.


--------

My son had a posterior tongue tie, which we had released at 3 weeks (after much agonizing about whether it was a good idea). We went to Dr. Siegel on Long Island, who uses a laser. He is very popular. He also has an office in Manhattan. I’m so glad we did it. He basically couldn’t breastfeed at all and but was able to after the release. For many more opinions, reviews, and info, I’d highly recommend joining the NY and NJ Tongue Tie group on Facebook. There’s lots of wisdom there.

-----------

So sorry you’re dealing with this. I’ve been there. We brought our son to Dr. Scott Rickert at NYU Langone to fix his tongue tie after a miserable 3 weeks of not only difficulty nursing but barely eating and he was wonderful. Kind, gentle, and quick. Explained things well and made it clear he wouldn’t do anything unnecessary. Referred to him by our lactation consultant. If you call and say you have a tongue tied infant they’ll get you in ASAP. The procedure was super quick and while it bled a bit healed quickly if I recall (that time is such a fog), and was probably more painful for me to watch:). Made a huge and nearly immediate difference in my now big eater 18 month old’s ability to eat.

https://nyulangone.org/doctors/1841413077/scott-m-rickert

------------------

Both of my kids were tongue-tied. With my older child, we didn't figure it out until week 6, when breastfeeding was already not working well and my nipples were raw and sore. We saw Dr. Dahl and had the typical scissors snip. They say it doesn't hurt the baby; in my experience, that was not true, and my son was miserable for at least a week. The cut was deep and painful for him. Eventually breastfeeding improved, but it was never great. Contrast all of that with my experience with my daughter -- we caught the tongue tie immediately and had the laser treatment when she was 13 days old. Still uncomfortable, but they used numbing cream, and the laser automatically cauterizes the wound. Everything about the experience was better, and breastfeeding has been so much smoother. Happy to answer any other questions you have. Good luck!

-----

I want to share my experience because I had a tongue tie procedure with both my children. My son has the ENT procedure and he screamed, bled a little and was fussy for a few days. My daughter had the laser procedure and literally cried for a few minutes. That being said, neither helped with breast feeding because they both had very high palates and once my supply regulated I realized that her BF had not improved, she was just drinking my oversupply(my son took bottles the whole time so he just developed a preference to bottles and never figured out that he had a weak suck). When my daughter could no longer nurse efficiently, we had to start a bottle which took her a little while to catch on to and was the scariest week of my life because we could not feed her. Everyone I talked to was very pro frenectomy but I wanted to share my experience so you can ask about the palate and if that would continue to effect breastfeeding even with the release. Also the stretches are important but suck exercises were not stressed enough so make sure you google them or ask an LC for some to make sure they are using their tongue properly after.

--------


My son had a tongue tie and our pediatrician advised having it cut. I too was shocked because I never heard of it before. After the first week, however, our son was not getting enough milk. We even hired a Lactation consultant who also suggested cutting the tongue tie.


Turns out I have one too. I suppose I may have struggled in some small way with speech but I don’t remember. My mother did confirm that she had to give up breastfeeding me after a few days though.

My father is a retired ENT and he felt it was unnecessary but I don’t always simply agree with him. My dad did say that it would be a simple procedure and very quick to recover from. So, at a few weeks old, it would be an optimal time to do it.

It was very very quick procedure. I was so nervous.

He cried for a few seconds. The dr blotted the drop or two of blood from under his tongue then I was ready to nurse and he was calm after that. I distinctly remember other babies in the waiting room that were a few months old, 6 months old. And their wails were much much much worse. I was glad I did it early on.

Hope this helps. Feel free to ask any more questions.

I totally understand your concern!!!!

--------------


I am sorry you are going through this! I had a baby in Sept 2017 and he also had a tongue tie and slight lip tie. Breastfeeding was pretty excruciating (toe curling pain!). We worked with Kate DeMarco Ruck www.theparentingstudio.com/ and she is the one who noticed it.

She referred us to Dr Siegel DDS. He does the laser procedure. It was a 45 second process and then we had mouth exercises to do for a few weeks after. He was very caring and it seemed like he does many of these a day in his office. There were SO many babies there- it was shocking!

http://www.drscottsiegel.com/


Breastfeeding didn’t improve immediately but eventually with some time, persistence, and sucking practice he got it and we now have a wonderful breastfeeding relationship. He continued to struggle with his latch for awhile but I think the laser procedure set us up for the exercises to be successful. It wasn’t a quick fix but I do believe it gave us the foundation we needed.

Always happy to discuss more. I remember feeling really nervous and scared about our 2 week old having a procedure.

----------------


Congratulations! I know this feels like so much so early on. We went to Scott Siegel http://www.drscottsiegel.com/tongue-lip-tie

when my now 10 month was 2 weeks old and had a tongue and lip tie lasered. He was latching well but was really inefficient. I had a lip tie that was not discovered into my teens and I had multiple jaw surgeries; after I read not fixing it could lead to speech and perhaps other maxillofacial issues later on, there was no question in my mind. I have no idea if my own stuff was caused by my ties but my mama gut told me that for my son, this was the right move. Siegel seemed to be one of the best, so we did it. He screamed for the 2 minute procedure and then was calm and nursing within 2 minutes, he was a little cranky afterward for a few hours and by the next day was much better. At 10 months, he nurses like a champ and loves to stick out his tongue. In short, whatever you decide to do will be best for your kid. I am glad we had the procedure.


----------------