While in recovery after my c-section, my midwife said, “Okay, let’s try to give your baby a feed.” She put my daughter to the breast and when she latched straight on, a look of pure relief was exchanged with my husband. This time around, there would be no sobbing in the middle of the night; breastfeeding was going to be smooth sailing, right from that first feed.
Less than three hours later, the midwife was helping me try to feed my daughter for the second time - but the baby wasn’t attaching. The midwife looked in her mouth and said, “I think she’s tongue-tied.”
I was confused – she’d had no problems latching on earlier, so why would there be a problem now? I was told that it’s quite common for tongue-tied babies to do that on the first feed, but they then struggle after that.
“Don’t worry,” said the midwife. “My baby was tongue-tied and we got his tongue released and then he fed fine.”
And so began the conflicting opinions I was told by various medical professionals about the best approach to address the tongue-tie issue.
A paediatrician confirmed tongue-tie and told me that I might have to try formula. I was reluctant to take this path, and luckily a supportive midwife was able to argue my case. I started expressing every three hours to encourage my milk to come in, with the expressed colostrum fed via syringe to my daughter. Once my milk came in I was able to breastfeed using nipple shields, while the paediatrician advised a ‘wait and see’ approach to releasing the tongue tie – usually done with surgery.
Doubt kicked in once I was home from hospital and I had my first visit from the early childhood health centre nurse. “You’re going to need to get that released,” she said. “If you’d had the baby in a public hospital it would have been done straight away. The paediatricians don’t see the problems down the track like we do.”
According to the Australian Breastfeeding Association, tongue-tie occurs in about 5 per cent of the population. While some tongue-tied babies can successfully breastfeed, it can also lead to problems such as nipple damage, poor milk transfer and low weight gains in the baby, and recurrent blocked ducts or mastitis due to ineffective milk removal. Down the track, tongue-tie can also contribute to speech impediments and poor oral health.
Sure enough, another week down the track, our feeding problems started compounding. When my daughter was two weeks old, I came down with mastitis in both breasts that was resistant to the standard antibiotics; they recurred again when she was six weeks old. By the time my daughter was four weeks old, her mild jaundice was yet to clear and her weight gain was very slow.
She was also sleeping a lot. I thought that was good, but in reality, it was her body’s response to inadequate calorie intake. I called the paediatrician’s office and when the receptionist heard about her weight gain issue, we were given an appointment that afternoon.
At the appointment, the paediatrician advised us that we could either get our daughter’s tongue-tie released – and due to the thickness of the tongue tie, release by laser would be the best option – or we could change to bottle feeding. We decided to get the referral for the laser surgery.
Six weeks after my daughter was born, her tongue-tie was released by a specialist dentist with a laser. From the first feed I could feel a difference in the strength of her suck. And over the next two weeks, we were able to stop using nipple shields to attach, and the tears of frustration in the middle of the night started to ease. I was able to wind back my exhausting and time consuming pumping regime as our daughter finally started to gain weight at an appropriate rate. Happily, feeding became the easy and enjoyable experience I had been anticipating since that first feed in recovery.
I was fortunate that I had the confidence to persist with breastfeeding, from having successfully fed my first daughter, but the conflicting opinions on the best treatment certainly added to our stress levels. The support of the nurses at my local early childhood health centre’s free breastfeeding drop-in clinic was invaluable and I attended weekly for about 10 weeks. I often heard other mothers there trying to get help with breastfeeding their tongue-tied babies – and I can only hope that they too ended up being successful and happy with their choices, too.
What is tongue tie?
Tongue-tie occurs when there is a piece of tissue (called a frenum) between the tongue and the bottom of mouth, when this piece of tissue restricts tongue movement. It can interfere with breastfeeding and bottle feeding, and can later cause trouble with eating or saying some letters of the alphabet.
It’s not known if tongue-tie is hereditary. It’s thought that between 2 and 5 per cent of babies are born with the condition.
How is it treated?
Children can grow out of tongue-tie, as in some cases the frenum can become looser over time.
In other cases, they may need to have surgery, known as a frenectomy. In this procedure, babies under 12 weeks of age are usually given a local anaesthetic and the frenum is then snipped with a surgical blade or laser. Studies show that there few issues or risks with this procedure, and the baby is able to feed straight after.
In older children and adults, it can take longer to recover, and stitches may be required to help the area heal.