Breastfeeding, Tongue Tie, Posterrior Tongue Tie

My mother is a lactation consultant.  When I was in high school she used to pick me up from school wearing shirts that said things like “breastfeeding is babies best start” and shirts with a bottle with a big red X through it.  Needless to say, I was going to breastfeed my daughter whether I liked it or not (just kidding mom)!

I had my mom there with me when I started breastfeeding and also had taken a breastfeeding class.  But my case was an exception to the rule because I had sore nipples for weeks (eight to be exact).  I read that if they are sore for more than a couple of days then you should get help.  Though I was doing EVERYTHING I could to get a deep latch, I still had so much soreness.  What a difficult situation for a new mother… you want to feed your baby that is screaming for food since they get SO hungry SO fast (when a baby is hungry in the first weeks, it feels to them like they haven’t eaten for 10 hours) but, it is also incredibly painful to let a baby who must have their mouths lined with sand paper suck on your nipples every two to three hours.

I went to four different lactation consultants.  The first thought that my daughter may have an upper lip tie (where the frenulum is too tight) because she couldn’t seem to flair her upper lip out like a fish as it is supposed to.  The second lactation consultant thought I just needed to get a deeper latch.  The third referred me to someone else.  The fourth gave me the depressing news that my baby had a posterior tongue tie and possibly an upper lip tie (as the first had said) and that they needed to be clipped.

A posterior tongue tie is different from a regular tongue tie.  It is something you would never notice just by looking at her tongue.  Posterior tongue tie is when a baby’s frenulum is too tight so the back of the tongue cannot raise up high enough to compress the breast between the tongue and the roof of the mouth.  A frenulum is a small fold of tissue that secures or restricts the motion of a mobile organ in the body.  Often, babies with posterior tongue tie have very high pallets too, making it even harder for the base of the tongue to reach the roof of the mouth for proper compression. A traditional tongue tie is when the frenulum is too long and attaches too much of the tongue to the bottom of the mouth, so the baby wouldn’t be able to stick their tongue out.  This lactation consultant said that Emily was upset all the time because she wasn’t able to to suck properly, so she had modified her suck to get the milk out.  This caused me pain and it caused her to get tired pretty quickly and fall asleep while eating.  Then, of course, she would be hungry very soon after.  This meant that I was feeding her ALL THE TIME.  Sometimes one feeding would take 80 minutes.

We tried to find a pediatrician that would clip her tongue without putting her under.  We heard from several lactation consultants that it is a very simple procedure and that putting a young baby under anesthesia is unnecessary and it can be harmful for the baby.  However, the harder thing to find was a doctor that even knew what a posterior tongue tie was.  Most had never heard of it.  We finally found a dentist in Southern California that would perform the procedure.  If you’d like to get his information email me at He wasn’t too familiar with posterior tongue tie himself, but said he could cut a little.  He thought she had an upper lip tie and said that I would notice a difference right away in the pain that I experienced while breastfeeding.

He gave her a few local anesthesia shots, which she cried from of course, and then began the laser process.  It looked like a little wand that had the tiniest bit of fire on the end of it.  It seemed a bit like he was basically burning the frenulum off.  He laser-ed/burned the upper lip frenulum and then under the tongue.  She didn’t like being held in one place, but she stopped crying before we even left the room where she had the operation.  The following day she did seem to be crying from discomfort, but overall, the operation wasn’t too bad.  He said we wouldn’t need to do anything to stretch her tongue since crying would keep the frenulum from healing back.  We did need to stretch the upper lip though, every hour to keep it from healing back to the way it was before the surgery.

The trouble is, I didn’t notice any immediate difference from this operation in the pain I experienced during breastfeeding.  I called the lactation consultant and she said it could take three weeks for the baby’s brain to catch up with her body.  In other words, since the she had been used to sucking incorrectly, her brain will not catch up with her abilities with the new range of motion she has with her tongue for three weeks.  The LC also told me that I would need to nurse, then feed a bottle, and then pump…. at every feeding.  I would also need to rent a hospital grade pump because that is the only kind that emulates the baby’s suck enough to preserve a mother’s milk supply if the baby isn’t sucking properly to preserve it themselves.  She also said that I would need to take my little girl to Cranial Sacral Therapy. I was devastated.

So, for three weeks I did this… night and day.  It was literally my life.  If I wasn’t nursing, bottle feeding, or pumping, I was sterilizing the pump parts (which you’re supposed to do after each use), or trying to shove some food into my body or take a shower.  It really helped to have my mother and mother in law here to help make food and feed the baby a bottle, especially while my husband was at work.  The reason this regimen was necessary is because my baby wasn’t able to suck all the milk out that she needed before getting too tired from her handicapped latch.  So, that’s why I would follow up the nursing with a bottle.  I was told that when she rejected the bottle after nursing, that’s when I would know that I didn’t have to continue with the craziness.  It wasn’t a smooth transition.  Sometimes she would reject it and I would celebrate that we had made it through, then the next feeding, she would still seem hungry and drink three more ounces.  Nevertheless, after about three weeks, all she needed was the breast.  I joke that I am going to nurse her until she is 10 years old because I worked so hard to make it happen!

It is of note to me that she never did flair out her top lip out like a fish, and even though one lactation consultant and the dentist that performed the surgery said that it was her upper lip that was the problem, I disagree.  It still curls under after the surgery (and I did follow the post surgery instructions to flip the lip up several times a day to prevent the frenulum from growing back).

Breastfeeding is such an art… not a science.  I got different answers from different people.  I took my baby to two different Cranial Sacral Therapists.  The first one spent an hour and a half with my little eight week old daughter as she cried harder than I’ve ever seen.  I cried too… it was one of the most difficult things I’ve had to do in my life!  The next Cranial Sacral Therapist worked on her for one hour and she only cried for a couple of minutes.  I really don’t understand Cranial Sacral Therapy, even after I have done quite a bit of reading on it.  My pediatrician advised against it… he said “moving the plates in a babies head doesn’t sound good”.  I don’t see any way that it could possibly work, but I have heard of it helping with latch from several lactation consultants, so I was desperate enough to try.  I wish I hadn’t wasted my money on it because it seems really quack and like there is no possible way it has any benefits, but you live and learn.

The good news is that my daughter is now 13 months old and I am still happily nursing her!  It almost broke me, but doing all that I could to make nursing work was totally worth it.  It makes life so much easier in the long run, and the benefits are enormous to the mother and the baby.  I just read that the childs’ IQ goes up for every month that they are breastfed (according to La Leche League) although if that were true I’m sure some moms would be nursing their 18 year-olds with high hopes of Harvard.


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