If you've read my post on my experiences establishing breastfeeding, then you know that I've dealt with the very controversial topic of tongue and lip ties first hand.
I had a lactation consultant who refused to admit we had an issue with latch, despite my horrible pain.
I had a pediatrician who insisted the lactation consultant was more credible than I was when I complained about the awful pain I was experiencing. The lactation consultant said we were fine so we were, according to the pediatrician. I saw my OB who directed me back to the lactation consultant. I begged the pediatrician to evaluate for ties, and finally he admitted the labial frenulum was tight but "there was nothing that could be done, and [I] breastfed for a month and could start formula now". I had never been so ready to commit a crime in my life...
I felt hopeless. I felt anger. I felt the urge to find a solution and prove this jerk wrong. And that's exactly what I did.
I had friends in my hometown who talked about how tight frenulums affected their nursing relationship and how local physicians treated them. I knew something could be done.
After a massive emotional breakdown, on the verge of giving up, while my husband left for an unexpected, emergent military assignment, and with my mother's encouragement and support, I packed up my 6 week old and drove 8 hours for an appointment with a doctor "back home".
I was so lucky the dental practice was willing to fit us in right away since we were from out of town. The dentist could not believe that I had been put off by more than one "professional", or that I had hung on for as long as I had. The procedure was scary, and expensive (read: cheaper than a year of formula!) so we went for it.
The procedure made a world of difference. Within a week I was one hundred percent nipple shield free, and besides some lingering nipple pain from previous damage, and a short learning curve for the bear, I was pain free, at last.
With my second child I noticed he had an obvious lingual frenulum at just a few minutes old. We struggled with latch for a bit, but we figured it out and haven't had to seek any corrective treatment yet (I am concerned about language development, but for now, things seem to be going well).
Clearly, this is a hot button topic that experts drastically disagree on. How does that affect families? Emotionally? Financially? Logistically?
Unfortunately there is no industry standard on tie diagnosis and treatment parameters. Experts disagree about when treatment is required, what kind of treatment is required, and how to ensure the best healing from revision. A popular lactation publication recently released a roundtable discussion between these experts, and the differences between care providers are astounding. And the interesting part is none of them are incorrect and none are correct. Each has their own approach to dealing with this topic and each gauges success differently.
How can we create an industry standard? That's a great question that is being explored by the industry. There are assessment scales in place already. But unfortunately, this kind of diagnosis (or lack there of) is extremely subjective, and that's hard to change. Nothing can change that different people perceive things differently, and unfortunately there is no truly objective data one can take on the appearance of a frenulum. There is however, other key evidence that can give insight to the effect of the frenulum on our nursing dyad.
Symptoms of Tight Labial and Lingual Frenulum
Although each has it's own symptoms, many are overlapping...
Poor Weight Gain (indicates poor transfer)
Low Milk Supply OR Oversupply
Difficulty latching/maintaining suction (clicking sounds)
Nipple Pain and Damage
Blistering on the Lips (related to lip tie disallowing lip flaring)
Heart shaped tongue
Inability to lift tongue to pallet or move freely.
There are many other symptoms, but these are some of the most frequent indicators of a possible problem. Please take note that some of these symptoms can accompany other conditions when no tie is present.
You can find out more about tongue ties here.
I think it is a very accurate assessment that "ties" have the potential for being over diagnosed and over treated. The question then becomes, is this a problem or not? We must then begin to look at the motivation behind treatment. Is it monetary? Is it an over reaction? Is it genuine?
At the end of the day, I contend we give the power back to parents. Let's give parents ALL the information and ALL the options. In nursing school, we were taught that patients are the most important player on the healthcare team... So why aren't we treating them like it?
Parents: Educate yourselves. Advocate for your family. Get that second opinion if you need it. Assess ALL the facts. Is baby symptomatic? Are there unmanageable struggles? Or could a different approach with a different provider solve your issue?
With my bigger little bear, I have never regretted the decision to surgically treat him. We are still nursing, and he's two and a half. We never would have come close to reaching our goals without treatment.
What are alternatives to surgery? Sometimes craniosacral therapy, chiropractic care, occupational therapy with a feeding specialist/Speech Language Pathologist, suck training, etc. There are many physician and non-physician practitioners who specialize in oral restrictions.
Educate yourselves. Advocate for your family.
At the end of the day, I can't tell you if you should revise or not. What I can do is encourage you to educate and advocate for yourself. What I can do, if I'm providing your postpartum breastfeeding support, is help you assess and understand your symptoms, other ways to manage the symptoms, and direct you to more information to help you make your decision. If you're struggling, please get support. Attend a local support group meeting. Find a physician or lactation consultant to support you. Or contact me for more information on support.
Do you have experience with tongue and lip ties? Did you seek surgical treatment? Did you find an alternative treatment that helped? Did you experience other challenges later on like an affect on dentition or speech development? Share your experiences below!