Tongue-tie

“Just imagine you had to drink a big bowl of dense soup using a long thin straw,” the tongue-tie practitioner at the Royal Free Hospital, used this metaphor to describe the struggle babies with tongue-tie often have when feeding.

No wonder Thomas was on the breast for fifteen minutes, then falling asleep exhausted, only to wake up voracious fifteen minutes later. The cycle repeated itself, day and night, day after day. His first five weeks of life are a blur of changing nappies and constantly feeding a hungry and distressed baby. Moments of alertness and smiles were very rare and so extremely precious. I was exhausted and I knew that Thomas’ continuous feeding wasn’t right. Since breastfeeding wasn’t painful and his weight gain was in line with the red book charts, the community midwives explained his insatiable appetite as the sign of a growth spurt. I am now glad I followed my instinct and decided to seek the advice of an experienced breastfeeding counsellor. Among the leaflets collected in my antenatal classes, I found the details of a drop-in held by NCT Breastfeeding Counsellor Cordelia Uys at her house. I got in touch with Cordelia with a text message and she started supporting me immediately, strengthening my hopes. When we attended the session, we were welcomed by Cordelia and her colleagues. Several other mums were feeding their babies and drinking tea. Cordelia diagnosed tongue-tie and referred us for consultation, and eventually treatment, at the Royal Free Hospital. A mum at the drop-in, whose baby had been treated for tongue-tie, reassured me by sharing her experience.

In the waiting room of the Royal free, we met the other parents with babies who had been referred for tongue-tie. The tongue-tie practitioner, who was also a midwife and IBCLC lactation consultant, explained to us that tongue-tie is caused by a tight or short membrane (the lingual frenulum) under the tongue. The tip of the tongue may appear blunt or forked, or have a heart-shaped appearance. The membrane may be attached at the tongue-tip, or further back. Tongue-tied babies cannot extend their tongues very far and this can create problems in feeding, especially breastfeeding. Sometimes mums experience excruciating pain and damage to the nipple, and even mastitis. Babies may latch on poorly, requiring several attempts and become frustrated. Some babies are not able to maintain their latch and slip off the breast. Feeding may be prolonged, and the baby may still be hungry and be irritable, or be ready to feed again soon after. Some babies have problems with excessive wind and may be in pain, some fail to gain weight, or suffer from excessive early weight loss. Some babies also have trouble bottle feeding.

Tongue-tie can be released by carefully cutting the membrane under the tongue. It is a simple and quick procedure, called a frenulotomy, which is a safe in qualified hands. Sometimes there may be a small amount of bleeding, but this generally stops after a minute or so. Babies can be fed straight afterwards, and there is no special after-care needed. We were shown pictures of the procedure and our health concerns and feeding issues about the babies were discussed. Each baby was then individually examined to see if the procedure was needed. Only those babies whose tongue-tie was affecting their feeding were offered a frenulotomy. Thomas was one of them.

The procedure lasted a minute or so. Thomas didn’t have the time to cry because he was immediately latched on to my breast: not only the way he latched looked different, much wider, but it also felt different. Now that he could fully extend his tongue, he was able to breastfeed much more efficiently. He was a changed baby. He started feeding at longer intervals and slept longer. The pain due to his wind decreased. Within a few days of the procedure, we had a “new” Thomas: alert and smiling. My life improved drastically as well. I was finally able to do normal day to day things with my bundle of joy. I felt so relieved and more confident as a mum.

We are immensely grateful that the cause of Thomas’ problems was identified and so promptly addressed. Tongue-tie is only one of the possible causes of a bad latch. If you think your baby is not latching on properly or have problems with breastfeeding, please follow it through. A solution is likely to be just around the corner and it will make your life as a mum much easier.

Claudia Vincenzi, mother of Thomas (and pharmacist with a PhD in pharmaceutical technology). September 2010