In the online world of parenting groups, certain topics come up that it seems like everyone either has direct experience with or knows someone else who does. In breastfeeding forums when my oldest was born 6 years ago(!), a hot topic was dairy/soy allergies. While approximately 6% of children aged 0-2 years have a food allergy according to a 2010 study, food allergies, especially dairy and soy allergies, were often suggested as a cause of many breastfeeding and newborn care issues.

Was it baby acne or a rash?
Could be a dairy/soy intolerance.

Why won’t eczema go away?
Look into a dairy/soy allergy.

Was it normal amounts of spit up or an allergy?
Could be allergies to something mom’s eating?

Whether someone’s child was truly affected by this or not, the end result is it got moms talking and raised awareness. Allergy talk took a back seat to the increased attention paid to tongue and lip ties when my second child was born. Pictures flooded forums with questions posed by those with breastfeeding struggles or out of curiosity. Someone knew someone whose baby had a tongue tie revised after a struggle establishing breastfeeding. Was their baby’s tongue-tied? Does this look like a lip tie? I’d read articles that floated by or casually follow along with the conversations, but I didn’t think it affected my family.

…Until my third child was born.

When I had my third, I wanted to try the breast crawl. I wanted to try laid back breastfeeding positions too after mastering side-lying nursing with my second. Immediately after he was born, we were able to do both. Fantastic! But as the hours went on that first day, he didn’t latch on as well as my others had. And when I tried putting my pinky finger at the side of his mouth to gently disengage him, he only clamped down harder! Ouch! What was going on?

Thanks to all the awareness raised in the two years I’d been seeing moms post about their experiences, I knew to look up the Kotlow Diagnostic Criteria for tongue-tied infants.*

Kotlow Scale
For educational purposes only.

Even though I felt pain on day one, I thought I could keep working on his latch. And it helped, sort of. He’d latch ok for a few minutes, and then get tired and start clamping down in an effort to keep the milk coming. Unfortunately, this meant pain and nipple trauma for me. Then there was the spitting up, fussing and gassiness, and I knew things just weren’t right. I worked with my baby for three weeks before getting an appointment to see a pediatric dentist well educated in tongue and lip tie revision. Dr. Ghaheri, a well-known provider out of Portland, Oregon, shares the proper way to assess if your baby may be affected in this blog post. At the end of this post, I’ll share resources to find providers local to the Chicagoland area. I traveled to a dentist in Peoria as I was paying out of pocket for this procedure and I’d heard many good reviews of his expertise. After getting evaluated to determine what type of tie he had, my son was swaddled and had little goggles put on. I was able to watch the procedure so I could share how the procedure went for educational purposes**. When I say laser, people tend to think of this:

James Bond

I promise it doesn’t look like this.

Here are common questions parents have about ties and getting the procedure done.

My pediatrician/OB-GYN/lactation consultant/nurse/friend/mom said it doesn’t look like my baby has one. 
As Dr. Ghaheri explains in this blog post, not all providers have a lot of education on this particular issue. Does it mean they’re a bad care provider? No. However, if you are dealing with pain with latching, please consider a second or third opinion. If your baby is having issues with breastfeeding, it doesn’t automatically mean there is a tongue or lip tie issue present, but it is worth getting checked out. Follow your instincts if you feel something is wrong.

My child is done nursing or was bottle-fed, so why bother having the procedure done?
Tongue and lip ties affect a lot more than we realize. From tooth decay, because the tongue can’t stretch to the back molars to clean food out from between the gums and the inside cheek, or from a tight lip tie trapping bacteria between the front two teeth; sleep issues including sleep apnea; speech issues because the tongue can’t properly move in ways it needs to create certain phonic blends; feeding issues including gagging, aversion to certain textures and more because swallowing is impeded; and nursing issues including gassiness, spitting up, milk spilling out of baby’s mouth at the breast because they can’t transfer the milk to the back of the mouth to properly swallow, pain during nursing, bleeding or cracked nipples, and more.

In my oldest son’s case, he had a tongue tie that didn’t affect nursing but affected his speech. Revising the tongue tie helped immediately with the speech issues, but we, unfortunately, did not act quickly enough to avoid decay in all 4 sets of molars because we didn’t realize his tongue couldn’t reach to clean out food stuck near his back teeth. That was thousands of dollars of dental work we could potentially have avoided that hopefully my third and fourth kids don’t have to deal with.

What’s the difference between using scissors or using a laser? Is one better than another?
Both methods can revise a tie, but what really matters is the skill, expertise, and education of the provider. Generally speaking, your family dentist may not know about or feel comfortable performing the procedure. It’s important to do your research on providers, their fees, and methods. Most providers will do a consultation before performing any procedure so you can have your questions answered and feel at ease. The consultation will also help determine if your baby or child needs the procedure done. In some cases, parents may wait a few years to revise their child, or determine with the provider there isn’t an issue at the present time.

My newborn baby seems to be gaining weight okay and I have enough milk. Almost too much milk. Is this a problem?
When babies are new, your body is still figuring out how much milk to produce. If a baby is not removing adequate milk, in the beginning, mom can develop an oversupply because she still feels engorged. This can be a tricky balance because that can send signals to mom to produce more milk. The more milk is removed, either from pumping or nursing, the more milk is produced to keep up with demand. In the tongue-tied baby, they can coast on the oversupply for a few months, until mom’s body stops producing as much because the baby isn’t removing a lot of milk. Then baby can fall down the weight curve, in which case baby might need supplementation. Add in using nipple shields and increasing frustration with latching, and mom can feel like her body is defective and she just can’t breastfeed. In reality, her body is doing what it should be doing, but the baby is experiencing impediments in effectively transferring milk. Because of the lack of education on this issue, so many parents don’t know to ask about an evaluation or know where to turn to for an educated provider.

How long does the procedure last? Do the babies cry hysterically?
As babies, the procedure can take mere minutes. The laser tool looks a little larger than a pen and works only when the provider presses a button. It reminded me of a video game because the provider is aiming for just a certain area. My third son was nearing his nap time when he had his procedure, so he was getting a bit cranky. I was right there in the room with him, and he didn’t cry any more than if I’d taken a few minutes to get him after waking up from a nap or wanting to eat. His cry never got to the hysterical, inconsolable stage. My 6-year-old was fine during the procedure (we didn’t stay with him) but he did get some topical numbing. Numbing babies can vary from provider to provider, but it’s generally not considered a good idea because numbing agents like Orajel can slide down the baby’s throat on their saliva and we want to avoid that. The provider will go over with you proper dosing for Tylenol, Motrin (if the baby is old enough) or homeopathic remedies like Arnica. I do recommend from experience giving pain relief soon after the procedure. I waited a few hours with my third and by then I think he was getting bothered. I didn’t wait with my other kids and they did not complain of a lot of discomforts afterward. Pain relief varied from child to child as well, and tends to vary when I hear others’ experiences since every child’s situation is different. If you’re concerned about pain relief or the healing process, it’s always a good idea to check in with your provider.

I read about tongue stretches and they sound like torture. How can I put my child through that?
After the procedure, the area under the tongue will have a small diamond shape. The idea of the stretches is to reshape the attachment as the area heals. My 6-year-old thought he’d have a diamond shape under his tongue forever, but his frenulum looks how it did before. My 6-year-old was more anxious about the idea of the stretches than the stretches themselves. Stretching only takes a few seconds a few times a day. Different providers have different guidelines of how often you should get stretches done. During the first few days after the procedure, you may want to give pain relief as they adjust, but you can discuss this with your provider.

Ok, I did the procedure but we’re still having latching issues. Now what?
I recommend working with an IBCLC to re-train your baby with latching. If you think about it, the way they latched before was the only way they knew how. It’s a new sensation to learn and this can take time to undo the old habits. Same thing with speech issues in older children. Don’t get discouraged. This is where a breastfeeding support group and a home visit with an IBCLC can be a great encouragement! Seek out a speech therapist as well if you haven’t already. Bodywork with a chiropractor versed in working with small children and babies or a myofascial therapist can help.

Oh my gosh, my baby is ___ old and I just now discovered this! Are future children going to have this issue?
In my personal case, three out of four of my children have this issue. All boys, all posterior ties. Is there a genetic component? There can be. Will it happen with every child? Not necessarily.
With my oldest, we didn’t put all the pieces together till he was older. By the time I had my fourth, I made phone calls our first full day postpartum to make an appointment with my pediatric dentist and worked with the hospital IBCLC to use a nipple shield to minimize any potential nipple trauma. My fourth was revised on day 2 and the effects were immediate.
Will this be your experience? Your experience won’t be exactly like mine. Everyone is different, the level of restriction is different. A class IV tie does not indicate severe attachment, like how we think of cancer diagnosis ratings. It just refers to where the attachment is.

How do I find providers near me?
In the Chicagoland area, providers include Dr. Lin and Dr. Talati in Buffalo Grove, Dr. Geivelis in Bartlett, Dr. Furusho and Dr. Kollmann in Chicago. In the Peoria and Bloomington/Normal area, Dr. Wynn and Dr. Roberts.
There is a Facebook group where parents can discuss different providers, ask questions about aftercare, and more.

*Any information in this blog post is for educational purposes only. I am not a medical professional, and I cannot diagnose, treat, or otherwise determine what is going on with your personal experience. I share this information so you can make an educated decision regarding your family’s care, but any decisions or diagnoses are made between you, your baby, and your care providers.

**Results not typical. Usually, parents are asked to stand outside while the procedure is performed, and I only observed my one child’s revision. The other two children I stayed in the waiting area. This can cause anxiety for parents, understandably, but the procedure is very quick.

I hope this helps! I share so that other parents feel comfortable asking questions and seeking out help if they feel they are experiencing a similar issue.