Tongue ties are largely misdiagnosed especially in breastfeeding infants. The common conception is that breastfeeding causes pain, and that is normal. So when mothers take their baby to the doctor for excessive nipple pain or damage it is commonly advised that the pain the mother is experiencing is normal. It is common to be told the baby will grow out of it eventually without a further thought. This unfortantely, is the average experience for so many struggling breastfeeding famlies.
Breastfeeding is not actually supposed to be painful. If you are experiencing sever pain while breastfeeding, this tells me something is going on and you should really be evaluated by a lactation consultant. Tenderness is expected in the first week or two, but not pain. If the pain you are experiencing is greater than if you were to touch a bruise than I would highly recommend to be seen by a knowledgeable lactation consultant.
In some cases this severe pain is caused by a shallow latch. This can easily be corrected with proper positioning and attachment. But, if the pain is still there even with proper positioning and attachment there may be some oral restrictions causing excessive pain.
A tongue tie is when the frenulumn that connects the tongue to the floor of the mouth is developed too tightly, too thick, or too short. This can all impact the function and mobility of the tongue. The tongue needs full mobility to suction the tip of the nipple back towards the soft palate in the roof of the baby's mouth. If the baby is unable to do this then they will have a shallow latch with the tip of the nipple rubbing on the hard palate in the roof of the baby's mouth. This is where pain and damage comes from, the nipple rubbing on the boney part of the mouth rather than the soft part. It also prevents the baby from emptying the breast completely, which may impact their weight gain.
In this situation a lactation consultant can help by seeing if the pain can be fixed with proper latching. If the pain isn't reduced we can then perform an oral evaluation on your baby. We will used gloved fingers to expose the lingual (tongue) frenulumn. Then well will evaluate baby for function and range of movment of the tongue and or lip if neccessary. Depending on the results of this evaluation it may be recommended to seek out an ENT specialist or a pediatric dentist for a revision. As lactation consultants we can not officially diagnoise, per our scope of practice. But we can evaluate and report those findings that would indicate an oral restriction to share with the provider who may perform a revision.
If your baby does recieve a tongue or lip revision it is important to work with a lactation consultant who is knowlegable about oral restrictions. At this point your baby has to relearn how to breastfeed now that they have full function of their lips or tongue which is new for them. It's important to make sure they are learning the correct way to breastfeed and not reverting back to old habbits.
If you are concerned about a possible tongue or lip tie its important to choose your lactation consultant and or provider carefully. Not all lactation consultants or providers are trained in tongue ties. Prior to choosing who to go to, please ask about their experience and education with tongue tie babies. This will help you find someone who can provide you quality care in this difficult time.