1. How do we identify lip and tongue ties?
Identifying tongue and lip ties is a subjective diagnosis of oral anatomy, observation of tongue function, and the entire clinical picture. Tongue and lip ties can be confused with normal connective tissue; this is why a detailed assessment of the baby and an observation of breastfeeding are required.
It is normal to have connective tissue under the upper lip and tongue, but is that tissue restrictive? Does it affect function? This is what a healthcare provider will consider. It is common to see a tongue tie if a lip tie is present, and ties are often genetic.
2. What are the signs of lip and tongue ties?
- Painful breastfeeding
- Nipple cracks, blisters, or milk blebs
- Inability for babe to lift the tongue or extend the tongue past the lower gum ridge
- Heart-shaped tongue when crying
- Frequent spitting up
- Frequent clogged ducts or engorgement
- Sucking blisters on baby’s lips
- Weight loss or slow weight gain
- Fussy babe, “popping on and off”
- Inability to achieve a wide and deep latch
- Inability to flange upper lip
Many common signs and symptoms of common breastfeeding issues overlap, creating the importance of a thorough history and assessment by a healthcare provider.
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3. Does lip tie or tongue tie always mean that the baby will have a latching issue?
Ties come in a range of severity, and it depends on the individual baby if a tongue or lip tie correction is needed to correct latching issues. Ties can be confused with other breastfeeding issues. For example, ties can cause frequent spitting up which may be confused as reflux.
4. Are there other health problems or challenges associated with lip and tongue ties?
If ties are severe, they may cause dental, palate, jaw, and speech issues in the future.
5. Should I get my baby’s tie surgically corrected or released?
A thorough assessment by a knowledgeable healthcare professional is needed to decide on surgical correction (Frenectomy). Consultation with an IBCLC can significantly improve breastfeeding satisfaction, whether a surgical correction is completed or not.
An IBCLC can complete a detailed history, provide an assessment of mom and baby, adjust latch, adjust positioning, post frenectomy care, and deal with a range of breastfeeding challenges. Experimenting with different positions and using an asymmetric latch can help with obtaining an effective latch. Referral to a pediatric trained chiropractor, cranial-sacral therapy, or massage therapist may also be helpful.
6. Can my baby breastfeed with a cleft lip?
Cleft lips may be partial or complete, unilateral or bilateral, and may or may not also have a cleft of the palate.
It will depend on the baby and his/her cleft what interventions are needed. But yes, a baby may be able to breastfeed. It would be important to work with a team of healthcare professionals, including a doctor, IBCLC, and OT.
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7. How can I help my baby get a good latch despite having a cleft lip?
The lips stabilize the breast in the baby’s mouth while helping the tongue form a seal. This seal is needed to generate enough suction for milk removal. Some breastfeeding adjustments will be necessary; for instance, a mama may hold the breast like a teacup while feeding, using the breast to seal the cleft.
Mama will also have to focus on establishing a good milk supply, appropriate weight gain and may need to supplement breastfeeding by another method. Other measures may include upright feeding positions, aiming of the nipple depending on the cleft, and hand compression while breastfeeding.
8. What do I need to know about a high arched palate?
A high arched palate can make it difficult for the nipple to get deep enough into the oral cavity, causing pain and inadequate milk transfer.
A high arched palate may be associated with a tongue tie which may need correction. Consultation with an IBCLC early on when experiencing breastfeeding issues, including pain or milk supply, will improve outcomes and allow for necessary referrals.
9. Are there techniques that can help me breastfeed my baby with a high arched palate?
It is important to get a lot of breast tissue in the baby’s mouth with a high arched palate.
Experiment with positioning; try leaning forward and using gravity to encourage breast tissue in the baby’s mouth. Using an asymmetric latch and modified football hold can also be very helpful.