Tongue Tie Looks Differently with Each Baby
To understand how tongue tie impacts breastfeeding, we first have to understand functional breastfeeding. Did you know that babies don’t suck when they have optimal oral function? Instead of sucking, they open wide so they can get a good grip on the breast with their tongue. Then they can create a negative pressure vacuum when moving their mid tongue up and down. This negative vacuum is how they remove milk from the breast. It is also how they slow down or stop the flow when they need to. When a baby doesn’t have enough range of motion with their tongue, they can’t create a seal and hold on with their tongue, they can’t create that vacuum to elicit milk out well, they can’t control the flow with their tongue. When they can’t do any of that, they have to compensate. Now depending on the baby’s compensation pattern (mouth and full body), mom’s breast anatomy, and her body’s ability to help the baby compensate, we will see different symptoms. To understand how the same problem (poor tongue range of motion) can look so different in each dyad (mom and baby as one), here are 6 examples of hypothetical but common presentations.
Dyad 1: Mom has a high milk supply. The baby does not have enough tongue range of motion. Baby can’t control supply (slow flow down) with their tongue as they should be able to. The baby comes off coughing because they are getting too much milk. Mom blames her own supply and strong letdown. The baby is really uncomfortable, has a distended belly, and has daily gas pains from too much milk and air swallowed while trying to accommodate all of that milk instead of slowing it down.
Dyad 2: Mom has a high milk supply. The baby does not have enough tongue range of motion. The baby has learned to slow flow by clamping down on her nipple. He might also adjust his latch backward to be shallower on his own to get away from the milk flow he cannot control. This baby is gaining weight appropriately, but mom’s nipples are in pain and damaged.
Dyad 3: Mom has a perfect milk supply in the beginning. Baby latches on pretty well but doesn’t have enough tongue range of motion to get the milk out. But that’s okay because mom has enough milk in each letdown to satisfy her. She is a passive feeder. Doesn’t need to compensate. Everything is great….until it’s not. Around 3 months mom reports she does not have enough milk or that baby has fallen down on the growth chart. When a baby isn’t good at getting milk out and they have been passively feeding, around 3 months when our milk supply becomes less dependent on hormones and more dependent on the baby’s ability to get the milk out, mom’s milk supply will start to rapidly decrease.
Dyad 4: Mom has just enough milk, however, from the beginning baby hasn’t been good at getting it out because again, they don’t have enough tongue range of motion. They needed to supplement on day 3 because of too much weight loss and mom was told to pump. When at the breast baby is trying very hard to get milk out without enough range of motion to create the vacuum with her tongue, so she is using her gums a lot. Mom may have nipple damage, but also, the baby is not getting enough milk because while trying to compensate with her gums, she is pinching off mom’s milk ducts. When the baby comes off the breast, mom can hand express or pump plenty of milk easily for the baby.
Dyad 5: Mom has a high milk supply. The baby does not have enough tongue range of motion. Baby has always done a good job getting milk but is uncomfortable and spits up a lot. When baby nurses, mom always hears a clicking sound. After nursing, he spits up more than what seems normal to mom, arches his back, and seems quite uncomfortable. The doctor prescribed a reflux medication and said it’s a normal infant presentation. The reflux meds seemed like they helped a little, but mom can still tell something is wrong. That clicking noise is the clue. This baby has enough range of motion in his tongue to start creating that vacuum at the breast, but he loses that vacuum seal with each undulation of his tongue. Breaking this seal allows air to get in and mix with the milk. When listening with a stethoscope, instead of a crisp swallow, it sounds like baby is swallowing a fizzy beverage.
Dyad 6: Mom has just enough or not quite enough milk. Baby has a restricted tongue plus low muscle tone. This baby may also be a passive feeder, taking the easy let down milk in each feed, but not much beyond that. This baby has not gained enough weight from the very beginning. Mom may either have to pump and bottle feed after feeds at the breast or full time. Mom also may have low supply from the beginning, but not because she is incapable of making enough milk, but because she got off to such a bad start with a baby that wasn’t good at getting it out, and no pumping was suggested at first. This mama typically blames herself or her body for not being able to breastfeed.
As you can see, because there are so many moving parts, a tongue tie looks different on each baby and there are so many more examples than listed here. Just as tongue-tie presents differently with each baby, the path to functional breastfeeding also looks different. However, I do find best results when an IBCLC trained in oral habilitation and a bodyworker that is experienced in infants and body compensations caused by ties are involved before and after a release.
Author: Kelly Euperio
Boulder Valley Lactation Consulting
Phone: (719) 930-4897
Appointments: bvlactation.com