(Extra credit optional info for those who have lingering latch concerns)

Here are some common red flags that MIGHT indicate your baby has a tongue tie (several apply to just poor latch in general):

• Bad nipple pain that you can't seem to fix with latch changes
• Nipple sores/bleeding
• Nipple looks pinched or lipstick-shaped after nursing
• Poor latch/ poor suck
• Baby is slow to gain weight or doesn't transfer milk well
• Inefficient milk transfer can cause your milk supply to decrease over time or frequent plugged ducts/mastitis
• the doctor cut a tongue tie at the front tip of the tongue, but not further back (usually one at the front means there's also one further back)

Tongue ties & lip ties can be a confusing topic because sometimes you'll get different advice from different medical providers. Some doctors believe that most tongue ties are a "fad," some doctors recognize and snip only the most severe ties (often requiring further fixing). Some nurses or lactation consultants have a hard time seeing & diagnosing them.  Some providers will say "yes there's a tie there, but it doesn't matter" (often bad advice). Other providers are not only happy to recognize and fix a tongue tie, but will also recommend things like chiropractic work and other stretches or therapy to help fix & prevent issues that tongue ties can sometimes cause (like muscle tension, headaches, food aversions, speech issues, slow weight gain, dental issues, sometimes even physical development differences due to muscle tightness). 

If your baby has a tie and you're considering getting it fixed, my advice is definitely do it, and the sooner the better as far as recovery. If you need help finding a trustworthy provider to fix the tie I'm happy to help. Many moms feel an immediate difference after the tongue tie is released, but some babies will still need tongue training exercises or therapy to help them build up strength to use their tongue properly. With support, it's doable!

SO WHAT IS A TONGUE TIE, LIP TIE, OR CHEEK/BUCCAL TIE?

A tongue tie (ankyloglossia) is a piece of flesh that connects the bottom of the tongue to the bottom of the mouth too tightly, restricting proper movement of the tongue. Sometimes it is very obvious toward the front of the tongue, but sometimes it is "posterior" or further back and harder to notice unless you know what to look for. In short, a normal tongue should be able to rest comfortably at the roof of the mouth (and hold the nipple there). This ability is essential for proper breastfeeding among other things (some insist it's actually essential for the roof of mouth shape to form properly).

**It is very important to note that sometimes a pediatrician may "fix" a tie by only cutting the very obvious part in the front. It's possible the baby may still have posterior tie that needs more revision, so don't assume everything is fixed if your doctor just did a small clip at the front. 

Lip & cheek ties

An upper lip tie is probably most common. If you lift the upper lip, it typically looks like a string of skin connecting from the lip to the gums. Sometimes it may look like it is pushing the teeth apart.

Similar ties can be present inside the cheek area, from the inside of the cheek to the upper gums further back. That is called a buccal tie or cheek tie.

It may be confusing to tell how bad a tie is based on looks; what is most important is how it affects movement of the lip or tongue. 

How to Examine a Baby for Tongue-Tie or Lip-Tie — DrGhaheri.com

Another thing to look for--if you let your baby suck on your finger, then gently pull down on the lower lip/chin, does the tongue stay with your finger (good) or immediately break suction?

I THINK MY BABY HAS A TIE, NOW WHAT??

Be ready to get a good lactation consultant on your team. Probably your best first step is to look for a trustworthy pediatric dentist or other tie release provider and make an appointment so that you can get it done ASAP. I can help with the search if you'd like. The procedure might not be covered by insurance.

As you wait for your appointment, it's often a good idea to see a knowledgeable chiropractor and/or craniosacral therapist to get started on helping your baby's muscles loosened up in the head & neck area. These can be helpful after the procedure too, and some babies might benefit from a feeding therapist or occupational therapist (you can look up baby tongue tie exercises on youtube also or I can help you find some). Again, many moms see an immediate difference but some babies take a little more work and time to get things right, so be patient.

It's possible for some minor ties to be managed with stretches and good latch techniques instead, but if you're having any of the issues mentioned in the top bullet points, most likely a cut/laser revision is necessary.

What about nursing?

Our first priorities are 1. make sure baby is getting enough and gaining enough and 2. protect your milk supply.

You may need to evaluate with your doctor or a lactation consultant to figure out whether your baby is getting enough from just nursing (remember, check diaper output, and also aim to gain a few ounces a week after the initial slight weight loss after birth). 

You may need to supplement your baby with pumped milk (or formula if needed) via a bottle or SNS (supplemental nursing system--essentially a pouch and tube that you can tape near your nipple to increase what your baby gets when he/she sucks at the breast).

Doing some pumping in general may be good for you to make sure your breasts are getting well-emptied in order to maintain and increase milk production. For babies who are struggling with weight gain, some moms find peace in choosing to pump exclusively and bottle feed to be able to measure what their baby gets for a while. Just shoot for a breastfeeding-friendly nipple if possible (slow flow, and a shape like Lansinoh naturalwave/momma) and remember to pace feed (search "pace feeding baby" to find video tutorials).

This is all pretty general, base-level info because if you're in this situation, I highly recommend you connect with a knowledgeable lactation consultant to work with you on a more personalized level. 

From tongue ties to doctor visits and pumping or supplementing, some moms can find this all VERY overwhelming. It's ok to feel overwhelmed, this is why it's good to have extra personalized support. This may feel like a lot, and it may take time (things might change in days, weeks, or even months for some), but you're going to make it through, and things should get easier for you. Hang in there mama!!

I also want to reassure you that even if you do get the procedure but decide not to breastfeed in the end, you've still made a good choice to fix it to help your baby out with things later on.