Breastfeeding is Hard Enough…

If you are struggling with breastfeeding or experiencing pain when nursing, there may be a reason. It is not normal to experience pain when nursing and may be a sign of oral restrictions such as lip, tongue, and buccal (cheek) ties that can impact a baby’s ability to breastfeed. Lip, tongue, and buccal ties are bands of connective tissue in the mouth called frenums that are normal structures but when too restrictive, inhibit proper functional movement of the tongue, jaws, and lip muscles leading to pain when nursing and many other issues.

Not every mother will experience pain when nursing if their child has oral restrictions. Sometimes a strong let down can mask the issue since the baby doesn’t have to work as hard to engage with the nipple to feed. However, over time this can lead to a reduction in your milk supply if your baby is not sucking effectively and providing the neurological/hormonal feedback necessary for your supply to stay up.

Your baby will often show physical signs of oral restrictions, including:

– Poor weight gain

– Spits up, vomits frequently

– Makes clicking sounds when nursing

– Shallow latch, difficulty staying latched

– Excessive gag reflex

– Frequently falls asleep nursing

– Very long, frequent feedings

– Gassiness, constipation, or difficulty with bowel movements

– Blistering/callousing of the lips

– A high arched palate

– Open mouth when sleeping

– Diagnosed with colic

All of these are signs and symptoms that are associated with oral restrictions that prevent your baby from creating a deep, comfortable latch. A tongue tie restricts elevation of the tongue to the palate and peristaltic, wave-like motions of the tongue necessary for proper suction of the nipple to the soft palate. Lip and buccal ties restrict lip and jaw movement necessary for a wide mouth opening to bring in and create a good seal around the nipple. You may notice your baby has a small mouth, lip blistering, and trouble flaring the upper lip when lip and buccal ties are present. Without the proper suction and seal of the nipple, babies end up breathing in a lot of air causing excessive spit up, gassiness, pain, and colicky behavior.

A lip, tongue, or buccal tie can contribute to issues later in life if left untreated. Children may have trouble eating solids, issues with speech development, increased risk of dental cavities, and problems with jaw growth. Children with tongue ties have narrow palates from the tongue’s restricted ability to elevate to the roof of the mouth, in turn, a narrow airway contributing to the development of sleep apnea.

A procedure called a frenectomy can be done to remove the extra tissue causing the restricted frenum and create more functional movement to allow your baby to latch and nurse effectively. This procedure is done safely in office using a soft tissue laser that gently vaporizes and cauterizes the tissue versus cutting the tissue, reducing post-operative discomfort for your baby.

A heed of caution if your baby had their tongue tie clipped at the hospital or shortly after birth. There is often remaining tissue that is still restricting tongue movement and preventing your baby from creating a deep, comfortable latch. A consultation with a specially trained pediatric dentist may be helpful if you are still experiencing issues nursing.

There is a lot of training beyond a pediatric residency necessary to understand how to diagnose and treat a tongue tie and other oral restrictions. Many providers are not as familiar with how to diagnose the varying types of tongue ties that exist, including anterior and posterior tongue ties, so they often go undiagnosed, especially if a baby is gaining weight appropriately. If you or your baby are showing any signs of having oral restrictions, I strongly recommend consulting with a pediatric dentist specially trained in the diagnosis and treatment of lip, tongue, and buccal ties.

Breastfeeding is hard enough. You and your baby do not need to suffer through the pain and stress oral restrictions can cause. My best advice is to find providers who will listen to your concerns and help you find answers.

Written by Dr. Katie Swanson, Pediatric Dental Specialists of West Michigan
University of Pennsylvania/Children’s Hospital of Philadelphia