Tuesday, October 28, 2014

Resources for You if You Think Your Baby MIGHT Be Tongue or Lip-Tied

normal latch (what we're aiming for)
This is one issue I get emailed about fairly regularly, so I thought I'd make it into a blog post so more people can see it (and I can easily direct questions there instead of retyping everything every time, usually from my phone no less!).  This is by no means comprehensive and I'm not an expert, and each baby & mom is different.  However here's what I have gathered as helpful data through our own two-year-tongue-tie journey.  Ideally you will be able to surround yourself with a team of people to support and help you-- starting with you- the educated parent/advocate-- and including other adult family members (spouse, SO, grandma etc) who will be able to help out, also knowledgable care providers and specialists.  You'll have a winning team around your baby-- Team Baby!

I would start there; you could read through the dozen or so articles Dr. Ghaheri has written in an evening or so, and would be fairly educated on what ties are & aren't, why they matter, what can be done about them (hint:  it should not require full anesthesia or a hospitalization) and what you can do as a parent.  If even that seems too big an assignment, this one article provides an excellent overview, addressing many tie myths.

- Good cautionary word on over-diagnosing lip ties:

How to diagnose tongue ties:
Unfortunately, most care providers (pediatricians, midwives, nurses, dentists, IBCLCs and ENTs) will not know how to recognize all types of ties. So you most likely will need to first diagnose it yourself, then track down someone knowledgable to confirm it.

Reasons to revise
cheek support during bottle feeding
Breastfeeding moms-- Tricks for latching in the mean time- **Note: these links will take you to videos and images of women BREASTfeeding. **  Try one at a time until you feel comfortable, then try another-- you may use two or more tricks at a time, like latching with the "breastwich" technique, then supporting your baby's cheeks during feeding, then using manual compressions at the end of a feeding. 

- cheek support- often called the "Dancer Hand" position- during both nursing & bottle feeding; the fat in baby cheeks is there to help their milk go down their throat properly.  This webpage is aimed at helping babies with Down syndrome, and much of its recommendations are completely appropriate for babies with ties (revised or not). 
- manual compressions during feeding
- make a "breastwich" with your hand in the shape of a C behind the areola to help baby get a good mouthful, roll it in the way you eat a sandwich:  rolled in from the bottom lip first.
- if baby is tucking top lip:  two "tricks" to help
- "flipple" technique (where baby latches over your finger) or have them latch over thumb so you can roll out the upper lip (it must flange)
- "biological nurturing" position where baby is sitting up against you & you are leaning back.
- U-shaped fingers supporting under breast (see here under "cradle position")
- on augmenting supply (usually by 6 weeks a woman's supply changes from hormone-driven to demand-driven, and if baby isn't effectively draining the breast, you may see a dip in supply)- herbal/food measures, pharmaceutical (domperidone).
- on supplementing at the breast: explanation & video
- stretches to ensure the wound heals properly open, not fused back shut exactly how it was:  video and explanation of simple technique, and also a lovely gentle play video that will help keep the wounds open.  In my experience, more frequent gentler stretches are more effective than forceful less frequent ones.

You may need an Occupational Therapist or a Speech Therapist (we had both!) on your Team Baby but these may help in the meantime or in addition or if you can't get to one:
Oral Training 
- oral motor training stretches- do 3-5 times each day, usually before or after a feeding.  We would make these a game, Mommy making funny noises and faces, and talking through them to baby "Top Lip in, out, whee!" etc
- training baby to make a groove in tongue:  use a Nuk toothbrush, your finger or a bottle nipple to draw a "line" gently down the center of baby's tongue
goal of Beckman Oral Motor Training: puckered lips
- with a Nuk toothbrush, finger or soft washcloth, trace the gums with light pressure-- this helps baby feel whole mouth
- after release:  play games touching all around baby's lips, usually accompanied by silly phrases or noises; baby will naturally try to follow with their tongue, which is great for mobility
Example of finger feeding for suck training
-great explanation of suck training: http://www.justbreastfeeding.com/sore-nipple-management/suck-training-tool-breastfed-baby/

- helpful summary of WHY some babies need "extras" and for others, the simple revision seems to be enough:  "Is Your Baby a Tether-Berg or a Tether-Floe?"

Good to Remember:
- Diagnoses depends both on symptoms AND appearance.  A baby with visible frenum may not need revision if there are no problems- but a baby with seemingly less frenulums may be a lot more restricted, as seen by symptoms in mom & child.  Also, a lip tie is almost ALWAYS accompanied by a "twin" tongue tie.

- A child can often bottle feed without being able to properly latch:  the mechanisms are TOTALLY different.  In breastfeeding, the tongue does a wave-like motion; this begins peristalsis that continues all the way down the digestive tract.  If it's impeded it will affect all digestion.  (So don't believe anyone who tells you that "you must be the problem because your baby can drink fine from a bottle."  That MAY be true in your case, but it may not be!)

- Many tied kiddos have a need for "body work:" either & both cranio-sacral therapy (CST) and chiropractic to correct tension from being overly restricted for the first months of life (even in utero).  Just think-- if your arm was tied across your body so you couldn't fully move it for 9 months, and then it was let free, you would feel all "off" and all sorts of tendons, ligaments and muscles would ache as they now had to stretch and totally adjust to the new freedom. It would be great freedom, far better than staying tied up and tense... but still requiring an adjustment.

- Also, most ENTs (and many other care providers) know diddly squat about tongue ties (nothing against them, it's just the way it is right now).  Go to a provider known for understanding ties if at ALL possible (or it's probably a waste of time).  

- Our story is here.

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