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10/8/2024
October 08th, 2024Let’s get the milk flowing on some hot topics regarding breastfeeding and tongue ties! People are getting on the Tongue Tie Bandwagon.
Excellent. For years, I advocated for tongue tie releases, enduring ridicule, hostility, and receiving countless letters and emails expressing peoples opinions on what I was pursuing. I was actively seeking out dentists for assistance, literally flipping through the Yellow Pages. Some of you may not even be familiar with what the Yellow Pages are. I certainly knew them well as I marked off “NOs,” “maybes,” and arranged face-to-face meetings with those who said “YES.” I was dismissed as someone who knew little about breastfeeding. “She just thinks everything is a tongue tie now”. I was accused of receiving kickbacks from dentists. Critics claimed I shouldn't be in business, with some even urging families to cancel appointments with me. Now, multiple offices in our town are performing revisions. We officially have more dentists in this city doing revisions than I know of IBCLC’s in private practice. We have people who are flipping lips but overlooking tongue ties. Babies are undergoing revisions without a comprehensive assessment of their overall needs. People are not asking what additional issues require attention. Is the baby truly prepared for a release? Is the FAMILY ready for it? Timing is crucial. Preparation is essential. Aftercare is important. Infant oral autonomy is significant. Lactation Consultants play a vital role in ensuring that families receive the support they need before and after a tongue tie release. It's important that they work closely with families to create a holistic plan that addresses not just the physical procedure but also the emotional and practical aspects of the procedure. There are activities and exercises we can do with infants to support their success post release. And if breastfeeding has been a symptom, we need to address the breastfeeding concerns post revision. Education about the potential benefits and limitations of tongue tie releases is key. Furthermore, a multidisciplinary approach is beneficial. This team approach helps in making informed decisions that are in the best interest of the child and family at this particular time of their lives. Some offices that do releases in other cities will not even allow a family to book an appointment without vetted IBCLC referrals because they see the big picture. I am not saying I want access gate kept, however, it is crucial to ensure that families receive the highest standard of care and support. By requiring vetted referrals, these offices aim to connect families with qualified professionals who can provide expert guidance and assistance. This approach helps ensure that families are not only receiving accurate information but are also empowered to make informed decisions regarding their care. The goal is to foster a supportive and nurturing environment where families feel confident and well-informed. While access should be as seamless as possible, maintaining a level of quality and trust is equally important in delivering effective and compassionate support to those in need. Ultimately, the focus should remain on the well-being of the infant and supporting the family through informed choices, compassionate care, and thorough follow-up. By prioritizing these aspects, we can ensure that tongue tie releases are performed thoughtfully and effectively, with the best possible outcomes for everyone involved.  Do you know what can mimic a tongue tie? Terrible breastfeeding technique can. The number one cause of many breastfeeding concerns or issues is positioning and latch. A good latch is vital to milk transfer. Good supply is dependent on milk transfer. Weight gain, pees and poops are dependent on supply. Swing back full circle to latch and latch is dependant on good positioning. This is true in the majority of cases. Add in that good positioning and latch should also make things easy, comfortable and pain free for mother. It should also make things easy, comfortable and effective for baby. When we see concerns with breastfeeding we must start with full maternal and infant assessment. This cannot be skipped. This includes a history on the birth and the start of breastfeeding, how feeding has been going, any know medical issues that contribute to breastfeeding concerns with mom and baby, a feeding assessment including positioning and latch, and structural exams of both mom and baby. Sometimes we have breastfeeding issues and concerns that are easy resolved by refining breastfeeding techniques. It can be that simple. Sometimes you will get breast-feeding technique (position and latch) perfect but there is still lots of trouble. We have pain, we have inadequate transfer, we have low weight, low pees and poops, etc. These are times we need to look further. There can be lots of reasons for this but today I am going to highlight tongue ties. Tongue tie or poor breastfeeding technique? I am all for fixing tongue ties. If they are a problem they are better resolved than to be “pushed on through”. However, I am more if favour of through assessment of breastfeeding & comprehensive follow up if a procedure is deemed warranted which is why I am drawing attention to this point today. Assessment of breastfeeding MUST include watching a feed amongst structurally examination of mothers and babies. And we have to address position and latch. The sooner we do this, the better. Why? Because if we have position and latch causing pain and damage, it is hard to tell if position changes are helping the pain or not. If we have damage and trauma, even a good latch will hurt until that is healed. So, then if look at a baby and see what visually looks like a tongue tie, we start to get blurred lines. The simple presence of a frenum is not a tongue tie. Diagnosing a tongue tie requires more than just looking. It is an assessment of function. Now when we are dealing with breastfeeding infants that function includes transfer of milk, weight gain, position needs, maternal comfort, visual of babies like folds in the lips, blanching of the frenum, blisters in the lips, etc. The people that can assist us in revision of ties are doctors and dentists and I am grateful to have them as part of our team. But, let me ask you how many doctors and dentists are watching feeds? How many would know how to throughly assess a breastfeeding session? How many know what to look for structurally in a mother? And throughly for an infant? Doctors and dentists that we rely on in resolution of breastfeeding concerns by revising tongue ties are typically only looking for a tongue tie as the reason to why you are presenting themselves to them. Their brains are actually wired to look for a possible intervention to try and resolve the issues based upon their skill level, experience and ability to help. Have you heard this quote before? “If you hear hooves behind you, don’t expect to see a zebra when you turn around. Chances are it’s a horse.” This means, first look for the simplest, common explanation to the problem presenting first. Once we have done this, then yes, we should go ahead and look for rarer & more problematic causes. In the medical community this is know as differential diagnosis. How do you know what is causing your breastfeeding issues? The most important key is to telling the difference between the horses and zebras. You cannot do this without a through evaluation, by a skilled practitioner. In the case of breastfeeding, these practitioners are International Board Certified Lactation Consultants. We have to be cautious of not assigning more importance to one element of breastfeeding than another, just because we think it is important or because we think the title of a certain practitioner is important or because that person thinks they are so important. There is another term for this which is “availability heuristic”. It is a bias towards things which you deem as more important because you readily recall it so deem it more probable. So, as someone looking at tongue ties most of the time this is front and centre in their minds. So, it is likely a dentist or doctor would go to tongue ties as a common cause of breastfeeding issues. As IBCLC’s we start at the basics, with the most common explanation of position and latch and move from there. The differential diagnosis mentioned about is what an IBCLC would do. This is why an IBCLC should be a first stop and why I think referrals for revisions of tongue ties should not be done without an IBCLC assessment. I bring this up because I am seeing moms & babies after tongue tie revisions who I didn’t see before. I don't know what the baby looked like before but more importantly what I am seeing a little more frequently than what I would like is bad breastfeeding technique. I cannot help but wonder, if we had just corrected positioning, would that have been enough. Did we have a true tie or did we have symptoms of bad technique that are also symptoms of tongue tie. Looking back at the information presented above about assessments, evaluations, horses and zebras & availability heuristic people you can see where my concern is warranted. Where do you go from here for support in resolving breastfeeding concerns? Be wise in your selection of care providers when you are struggling with breastfeeding. Step #1 should be an assessment with a skilled IBCLC. From there we will make all appropriate referrals to other members of our team that assist with getting breastfeeding back on track. If you are in Regina or in the Regina area, I would be happy to help you navigate your breast-feeding challenges. You can give me a call or easily book online. |
Kim Smith
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Lactation Consultant (IBCLC) Breastfeeding Support Regina | IBCLC Regina | Lactation Consultant Saskatchewan 306-550-6143 [email protected] |
Quick facts:
IBCLC since 2010 — over 15 years of supporting families through the beautiful ups and downs of feeding. Advancing my training in CranioSacral Therapy (CST) — integrating gentle, restorative bodywork to help babies release birth tension and feed with greater ease. Certified TummyTime™ Method Instructor — helping babies grow strong, mobile, and comfortable from the start. Former Birth Doula (10 years) — because I know firsthand that how a baby enters the world deeply impacts how they feed. Retired Medical Laboratory Technologist — grounding my clinical care in both hard science and heart-led compassion. Wife and Mom of Four — I’ve lived through the cluster feeding, the sleepless nights, and everything in between. Chai Tea Latte Enthusiast — because a little comfort goes a long way. |