“Your baby isn’t gaining weight like he should be,” the pediatrician explained.
My baby was three months old and something wasn’t right. It was right there on his growth chart, with the line going down instead of up. Tears welled up as the pediatrician explained that the cause was likely the content of my breast milk; that it wasn’t nutritive enough. I knew that wasn’t it. This was my third breastfed baby, after all. Still, I was too dumbfounded to respond.
“Let’s supplement your feedings with one 4oz bottle of formula per day and see if that helps.”
“Okay,” I replied. I didn’t know what else to say.
I started bawling as I left the office and I couldn’t shake the feeling that I was a failure. I posted about our checkup on Facebook and I had a friend ask if I had checked for tongue ties. I had previously considered the possibility, but dismissed it because I did not have any pain while breast feeding. After learning about more symptoms of tongue ties, I realized that I needed to look into this.
What is a tongue tie?
A tongue tie is where the tissue underneath the tongue is tight or short and restricts the movement of the tongue. The upward movement of the tongue is what can affect breastfeeding. If the tongue cannot move properly, it cannot help form a seal around the breast to create the vacuum needed to extract the milk and is unable to compress the breast. Later in life tongue ties can affect speech, palate formation, and orthodontic issues. Both mother and baby can experience a variety of symptoms, but not necessarily all of them.
My Painful Realization
The more I read about tongue ties, the more validation I felt for all of the stress and struggles I had been experiencing. It felt like a huge burden had been lifted when I felt the confirmation that there was a reason things had been so hard. Lots of screaming? Check. He was still hungry. Constantly falling off the breast? Check. He lacked the ability to form suction. Falling asleep often while nursing (more than what is normal)? Check. He was tired from working extra hard to get milk.
Then I made an appointment with a lactation consultant to do a weighted feed, where they weigh your baby before and after you nurse them at their office. I learned during the session that my baby was only transferring two ounces from my breast. He should have been transferring four. My poor baby had only been getting half of the milk that he needed. This was not due to a low supply, since I could easily pump. The lactation consultant informed me that I needed to begin supplementing him immediately–either pumped milk or formula after every feed.
I felt relief for receiving guidance, and immense guilt for not knowing about this sooner. I thought he was doing “fine.” I had no idea I was starving my baby.
The Procedure and Results
I brought my baby to be evaluated, and he indeed did have a tongue tie. This was revised via a laser procedure. The laser took only a few seconds to sever the tissue under the tongue. I was given guidance about how to care for the wound, which included stretches to help the new tissue form properly.
The biggest challenge was trying to boost my supply to match what he actually needed by pumping several times a day. This led to a round-the-clock schedule of all things feeding: nursing, bottle feeding, pumping, cleaning the pump parts, rubbing lanolin, and repeat. I felt like I was going insane and I couldn’t think clearly. I cried–a lot. For the first time since becoming a mother, I knew what it felt like to want to quit breastfeeding. Never again would I even blink when a mother mentioned she quit breastfeeding.
After a few weeks, I returned to the lactation consultant. We did another weighted feed and we received wonderful news–my baby could now transfer three ounces instead of two! I immediately felt so much peace. I couldn’t continue the strenuous pumping routine, but we settled into a nice combination of breastfeeding and bottle feeding.
- Doctors Don’t Know Everything. Our pediatrician did a great job in locating one problem: poor weight gain. But what he didn’t figure out was why. Here’s the thing–most doctors are not trained to troubleshoot breastfeeding problems. Tongue ties are not discussed (at least, with any real substance) in medical school.
- There is more than meets the eye. Tongue ties may look obvious or they may not. What’s important is how the tongue functions–can it move up and down with adequate strength and flexibility? Conversely some tongue ties may look obvious, but be asymptomatic. Go by the symptoms, not just what you can see.
- Sometimes lactation consultants are prohibited from talking bout tongue ties. Some hospitals place “gag orders” on board certified lactation consultants because of pressure from local doctors who feel they are being undermined. You have to know exactly what you are talking about and ask the right questions in order to get help.
- Tongue Tie revisions may not be covered by insurance. Some insurance companies do not see tongue ties as a “problem.” Additionally, pediatric dentists are often the providers who have received superior training about revisions, but many insurance companies will not cover their procedures. Dental insurance might.
Moms, you are the best advocate for your baby. You may not have all the answers but you can learn enough to lead you to the right answers for your situation. If you feel like something isn’t right, don’t give up until you find the answer. With whatever you may be dealing with, find support to help you along the way. You can do it, mama!