Tongue ties and low milk supply.......we usually find the latter with the former. But what should we correct first? Is it the tongue tie alone that causes low-milk supply? Or can low milk supply be a phenomenon on its own when there is a tongue tie present? For starters, most parents have never even heard of a tongue tie. But mothers are almost always concerned about the quality of their milk supply.
Let’s start by explaining the former. A tongue tie is when the frenulum, that band of tissue under the tongue is tight. When a baby is tongue-tied, the frenulum can at times extend right to the tip of the tongue (anterior tongue-tie), or be quite tight and restrictive at the base of the tongue (posterior tongue-tie) Bottom line is, a tongue tie limits the full range of motion of the tongue and can often interfere with breastfeeding.
Tongue ties can cause sore, damaged nipples and lessen a baby’s ability to feed efficiently. Babies with tongue ties often compensate for their poorly functional tongues by using their jaws to feed. The jaw muscle will tire out quicker than the tongue, so babies often become ‘chompy’ at the breast, and tire out faster. At times, you will see their lower jaw quiver from exhaustion. A lot of parents think their babies are cold and shivering when they see this behaviour. But in reality, that poor jaw muscle just can’t keep going any longer. Other times, babies with tongue ties will make a clicking sound or keep popping off the breast because they can’t maintain proper suction.
Once a mother has developed sore damaged nipples, it’s almost impossible for her to achieve a proper latch. If she continues to latch her baby incorrectly, she will quickly fall into that dark deep black hole of breastfeeding hell. That’s when a Lactation Consultant should be on speed-dial!!! Actually, the LC should have been consulted at the first inkling of nipple pain. But most mothers think that some pain while breastfeeding is normal and they should just tough it out and eventually things will improve. In some, but very few instances, everything resolves, but most of the time, help and support are needed!!!!
Quite often a tongue tie will be diagnosed in the hospital and a frenotomy (releasing the tight frenulum) will be performed prior to discharge. But at times, they are missed and don’t get detected until a week or two or three later!! If the latter is the case, breastfeeding has usually suffered and a lot of mothers have given up or have switched to combined feeding.
Ricke et al. (2005) reported that breastfeeding infants who were tongue-tied were 3x more likely to be exclusively bottle-fed at 1 week than matched control infants with no tongue-tie.
So how can such a small, tight little connection under a babies tongue lead to low milk supply which is a major breastfeeding challenge? The two go hand-in-hand due to the following. If your baby has a restricted tongue and cannot move it to its full functional potential, damaging effects to milk supply will occur (and we are not just talking about the ability of the baby to stick its tongue out past the lower lip). The tongue has a variety of functions. It needs to move from side to side, it needs to cup the breast, it needs to move in a wave-like motion, it needs to lift up........If the tongue can’t do all these necessary functions, then it won’t do a very good job at removing milk from the breast. If the milk isn’t removed from the breast effectively at every feeding, then the body thinks it can slow down milk production and at the end of the day, supply diminishes. A baby that is feeding off a breast with a low milk supply will start to become fussy and frantic and is unable to become satiated. As a result, he starts to feed much more frequently in order to help build up the supply. But unfortunately, he won’t be able to do this very well if his poor little tongue can’t move the way he wants it to.
This is usually when I get a call from a distressed mom. Or at times it will be a father!!! If I get a call from a father I know there is major trouble on the breastfeeding-front. The issue is usually presented to me as a fussy baby who feeds all the time, may or may not be gaining weight appropriately, and a mother with sore damaged nipples. She usually has no idea that her baby may be tongue tied.
When I come to see a client, one of the first things I do, (after taking a thorough history) is assess tongue function. If I feel an anterior or posterior tie, I explain what that means to the parents right then and there. It’s amazing to see the relief on their faces when they say “OMG, so that’s what’s been causing all these problems?” So I assess the latch and make any necessary adjustments, ensure there is good milk transfer, and point out some of the ‘less obvious’ jaw/sucking movements that co-inside with a tongue tie.
Generally the breastfeeding care plan goes as follows: Referral to a breastfeeding clinic, where a physician who is trained in performing frenotomies can release the tongue tie. Frenotomy usually provides immediate relief from nipple pain and usually improves the latch right away thereby increasing milk transfer. Then we have to come up with a plan to build mom’s milk supply. The babies weight gain or loss, will determine what kind of plan I will put together. I usually perform a test-weigh for these babies to help determine the need for supplementation or medications/herbs to help build the supply. And of course.....we work on the latch. One of the most important things related to breastfeeding, is to ensure that mom is latching her baby the correct way.
If her nipples are quite sore and damaged, her body will not allow her to be ‘fast and bold’ when latching. Speed is key and the faster she is at getting her baby onto the breast, the deeper, more effective the latch will be. If her nipples are quite damaged, a prescription strength compound nipple cream will also be recommended. This cream is a life-saver!!!!!
At times, these moms will be prescribed motillium to help increase supply. Even though positive results are generally seen right after frenotomy, it takes a few days, to a week, for the baby to realize the full potential of his new and improved tongue. Therefore, the milk supply doesn’t magically improve overnight. It takes time, and an herbal or prescription medication generally helps to build the supply a little faster. Pumping is also recommended post-breastfeeding to help increase supply. Whether she can pump a few drops to a few ounces, additional stimulation and milk removal will help the supply increase.
So for all you Mommies out there experiencing pain while feeding and low milk supply, please seek breastfeeding support sooner than later. Make sure your baby has his/her tongue properly assessed to rule out tongue-tie as a possible cause for your challenges. Remember that knowledge is empowering!! I hope I have been able to share and empower you today!!!!
Please feel free to e-mail me at anytime with your questions or concerns!!!
Leanne Rzepa RN BN IBCLC