What is the effect of a lip tie on breastfeeding or bottle feeding?

Often only the tongue tie is acknowledged to be important in feeding the baby and the lip tie is dismissed.

The importance of the upper lip flanging out while deeply latching on to the breast or bottle ensures a better seal of the oral cavity. Several studies with ultra sound images show a good movement of the tongue while breastfeeding. The normal tongue movement while breastfeeding is best achieved when the baby can open the mouth wide. This wide opening is best achieved when the baby is able to curl the upper lip, so that the mucous membrane portion of the lip (instead of the dry outer part) is in contact with the breast. This provides a better seal, which is the first step in generating negative pressure in the mouth while breastfeeding. This also applies to the bottle. When a lip tie is anchored to the upper jaw, the outward curling movement is impeded. This results in a smaller mouth opening and forces the baby to take a shallow latch and gives a poor seal while breastfeeding or bottle feeding.

How can I improve compensating behavior

Before the release the baby usually had to drink in a different and compensating way for a long time. The baby already drank the amniotic fluid in the womb with a tongue tie. Sometimes a baby has a lot of tension in the jaws, the baby seems to bite the breast or bottle. Possibly there is a quivering chin (because of the muscle tension) present and the baby could not open his mouth  to latch on. In this video (link) you can see how you can help the baby relax the jaws.

During feeding, a baby can also overstretch or have a preferred position. These sometimes very tense jaw muscles and other muscles in the mouth, throat, and neck area can be helped to relax. You want to give the baby a signal that compensation is no longer needed and that he or she can start drinking differently. Babies with colic or babies who cry extensively also benefit from the possible treatment of a professional such as a physiotherapist, chiropractor, osteopath or manual therapist who has completed a degree at the university. These therapists can help to overcome compensating behavior. Check if the therapist sees many babies and that they check the mouth / neck area especially.

Also look at this page of therapists for addresses of other care providers who use their expertise to further assist the baby in motor development such as the physiotherapist (fysiotherapeut) who teaches you how to apply therapy in your daily care at home, the speech therapist (logopedist) for further development of ​​use of the tongue and mouth with (bottle) drinking, eating solids and talking, the lactation consultant IBCLC (lactatiekundige) for further remediation of breastfeeding problems.

Case studies and research chiropractic and manual therapy:

Dutch case study, breastfeeding problems and chiropractic treatment.

http://www.enhancedentistry.com.au/wp-content/uploads/2015/02/Chiropractic-and-Breastfeeding.pdf 114 case studies.

More articles:






Stimulating milk production

Your milk production could have suffered from ineffective milk transfer. Because your baby’s tongue wasn’t mobile enough. Your baby couldn’t hold on to the breast well. After the treatment your baby can learn to keep a better latch, so that he can empty the breast better.
In order to adjust the production to the needs of your baby, you often need extra stimulation, for example, by switching the breasts more often. Also apply breast compression. It is better to supplement extra milk at the breast with a tube/syringe or using the SNS, (breastfeeding supplementary system). It stimulates milk production at the same time. This video shows how. Here’s how you can use the SNS.

Watch this video from pediatrician Jane Morton how you can pump with compression and massage and also how you can hand express in order to increase your production. Also power or cluster pumping helps.

There are also herbs that help to increase production and the drug Domperidone. Ask the  Lactation Consultant IBCLC for a consultation.

Improving drinking at the breast

After the release your child has to learn to drink differently. Now that the tongue is completely mobile, it is like getting your leg from plaster, as if you learn to walk again. As a result, the baby can be fussy for a day or a little longer. The longer the baby had to compensate to get milk, (remember that your baby was already drinking amniotic fluid in the womb with a tongue tie) the longer. Your baby needs some time to learn drinking in a “new” way. The tongue exercisis can best be done before feeding to stimulate the tongue to make more different movements. Stretching the entire tongue to the palate stimulates the movement upwards, this is essential for creating a good vacuum and prevents reattachment.

Sometimes the change is big for the baby and you can use some help. With breastfeeding it is good to ask your Lactation Consultant IBCLC for a consultation. A different position can be useful and tips for optimal latching or using a nipple shield temporarily . When choosing the right size of nipple shield, often Ardo or Medela Large or Medium is the best and for very large nipples Mamivac has an even larger size. Look carefully at this video for proper use  of the nipple shield.

If a baby does not want latch on immediately, you can first calm your baby with a bottle or some finger feeding (like here), you can also use a syringe like this father. For example, you can let your baby drink 10-30 ml. Massage the palm of the hand, this stimulates the opening of the mouth and hopefully sucking. You can also help lift the tongue by massaging the under”belly” of the tongue (behind the chin), massaging or pushing it upwards towards the palate.

It is possible that your production has diminished due to the ineffective drinking behavior before the release. Also have a look at the FAQ stimulating milk production and use breastcompression (video) all the time.

One way to get the baby breastfeeding again is to let him or her drink start with (paced) bottle feeding. Do this close to your bare breast (with the nipple shield in place can help) and when the baby becomes calm, switch to the breast without moving the baby. If additional feeding is needed, for example because your production has fallen behind, you can supplement at the breast with a tube or use the SNS, this is very simple and promotes going back to the breast and your milk production at the same time.

What if the baby doesn’t want to drink after treatment?

It is possible that 24-48 hours after surgery, babies can be irritable and tearful.

Rarely, it may take longer. If babies refuses the breast or bottle, you can give milk orally with a spoon or syringe, or a small medicine cup placed to the lower lip so that you can gently drip some milk into the mouth. A baby will ultimately want to drink again, but may have trouble getting used to the new mobility of his/her tongue. Temporarily the baby may also latch on with a nipple shield (watch this video).

If the baby is still very upset an acetaminophen (paracetamol) suppository can be given. 60 mg depending on the weight. When in doubt about the amount of medication always consult a doctor.

If you have any questions do not hesitate to call your Lactation Consultant.  (Or the lactation consultant present if you had an appointment at the Tongue Tie Clinic, you will find her telephone number on the aftercare card.)

My baby is growing well, is the release of a tongue tie or lip tie necessary?

Even though a baby grows well, several complaints can be experienced by both the mother and the baby. See FAQ: signs and symptoms of tongue and lip tie 

Frequent plugged ducts and mastitis, pain and discomfort can be a reason for the mother. In babies it is possible that a lot of air is swallowed in, sometimes gastroesophageal reflux disease is present, cramps and colic, the high frequency of drinking and often restlessness during feeding can also a be the reason for the tongue tie and/or lip tie to be treated.

In the long run, babies and children may have difficulty with eating solids, speech and overall mouth development (for example, the shape of the jaws and how the teeth are aligned). However, it is not possible to say with certainty whether a baby or child will actually have long term consequences of the tongue tie or lip tie.

Can I feed directly after the release?

The baby can be fed immediately after the release. The baby can latch on to the breast or drink from the bottle. It is wise to choose the feeding method the baby was used to until the release. At the consultation there is a lactation consultant present who can assist and provide additional advice. However, it is not a lactation consultation and is only intended to help the mother and baby immediately after treatment.

For more breastfeeding advice and guidance, we refer to a Lactation Consultant IBCLC near you.

Does treatment have an immediate effect?

Treating tongue- and lip tie is relatively speaking, a minor surgical procedure and an attempt to improve the present situation. This applies to babies, children and adults.

It remains, however, always a surgery.

In general, the younger the patient at the time of the treatment, the more likely symptoms will improve.

However, the degree of success in infants can also be affected by other factors such as childbirth and how the baby drank the breast or bottle prior to treatment. Babies need to re-learn how to use their tongue as they have established compensatory behaviours such as jaw clenching to obtain the milk. Sometimes it takes several days or weeks before results are seen. Often babies can be irritable the first 24-48 hours and can refuse the breast or bottle. If the baby refuses the breast, use a bottle, teaspoon or syringe so that the baby receives some milk.

It is strongly advisable to make an appointment with a Lactation Consultant and/or other therapists if feeding remains problematic, ask the Lactation Consultant who was present at the release which therapy is most suitable. For example, physiotherapy, speech therapy or chiropractic/osteopath/craniosacral care. It is also advisable to have a check up on the wound within a week with somebody who has knowledge.

Older babies may want a paracetamol suppository to make them feel more comfortable after the procedure. Depending on their weight, 60-120 mg. Check at your pharmacy.

Checklist of signs and symptoms of tongue tie and lip tie

  • Signs of restricted mobility of the muscles of the tongue and the upper lip:

Due to the tie the tongue can only move the front and sides a bit. The tongue cannot go up and back properly, difficulty latching on, drawing in the nipple deep. While very often at the same time the upper lip cannot flange out over the breast, because the tie pulls it inward. So the baby slides off easily. Resulting in small latch, letting go of nipple. Latching on and drinking difficult or only works with a nipple shield or bottle. Falling asleep at the breast or bottle, frustrated, doesn’t seem to want to drink, doesn’t empty the bottle.

  • Signs of compensating due to restricted mobility of the tongue and lip tie:

Tries to hold on to the breast by clenching jaws together. Uses cheek muscles to draw milk. Mother experiencing pain especially at latching on. But not always painful, also just sucking really “hard” or “strong”. Chin quivers from jaw muscles tension. Sucking blisters on lips from friction. This compensating is weary for the baby and especially in compromised growth or premature babies it’s a shame it costs energy. Sometimes babies are called lazy drinkers.

Nipple should come out round, but comes out flattened, with blisters, discoloured and sore. “Raynaud” like symptoms from diminished blood flow to nipple.

  • Signs of compromised ability to get sufficient milk:

Due to the baby’s restricted mobility, only suckles at the nipple and hardly at any breast tissue. There is too little milktransfer as a result. The baby draws in the nipple as if sucking in spaghetti, hangs on nipple like a “cliffhanger”, often pulling and moving the head in an attempt to pull out the milk, sometimes using hands to pull the breast in older baby’s, drinking suddenly painful when teeth come.

Baby doesn’t “empty” the breast (or bottle), drinks often to get enough milk. Plugged ducts, overproduction from drinking often, compromised production in the end.

Baby loses weight more than 7% in the first days, getting back to birth weight takes more than 10 days. Growth stagnates after weeks or months when production decreases. Babies don’t always show; they save energy by sleeping long for example. A sign could be very few poop diapers.

Baby only drinks the “easy” milk, during the milk ejection reflex.  Drinks short or very long. Only making the chin tug and drinking when MER or giving breast compression or supplementing at the breast.

  • Signs of compromised possibility of making a good seal:

Due to the low tongue position, often high palate and the upper lip not flanging out completely over the nipple, bottle or breast, your baby cannot make a good seal and loses suction, you can hear clicking sounds. Also very loud drinking, gulping it down and choking. Complaints of swallowing air.
The swallowed air needs to go somewhere; it goes up or down. Burping, hiccough, spitting, windy, colic.  GER or reflux with or without spitting (hidden reflux). In hidden reflux the baby tries to keep the milk down by swallowing again, sometimes forgetting to breath momentarily. During feeding it can be very uncomfortable for the baby and can become restless.  It’s difficult to put the baby down to sleep. Parents walk with their baby until symptoms subside. The baby can experience pain from the stomach acid in the oesophagus. GERD. Sometimes medication is given which lowers stomach acid.

Thrush is often confused with tongue tie problems. Although you can see it both at the same time. The tongue may have debris in the papilla (from day of birth) due to the fact that the tongue hardly touches the palate so it doesn’t “rub clean”. Pinching and stabbing pain can be from thrush or compensating behaviour from tongue and lip tie. In tongue tie you can see white debris on the posterior part of the tongue behind the tongue tie, the front of the tongue rubs clean against the inside of the upper maxilla. Thrush is a “pearl white” shine or white plaques on the inside of the lips and on the mucous membranes of the inside of the mouth.

*Note that not all symptoms have to be present at the same time.

Other things you may notice after the release

After the release, you may notice things that may last a little longer, such as lip swelling, drooling, gagging, or other discomfort or peculiarities.

* Granulation tissue; This is a small lump of extra scar tissue that can form on the wound. If you suspect you see this, send a photo, it is not serious and if it is a hindrance to drinking it can still be removed.

* Drooling; Because the swallow has to be learned again after tongue tie release, it is possible to notice drooling for a while in a child or baby.

* Reattachment; After the treatment, the wound simply wants to heal with scar tissue.  With doing aftercare you hope the wound does not close too quickly or too tightly. If too much reattachment occurs, the tongue or lip mobility can be limited again. When you live abroad it is the adviceble to check the healing with somebody knowledgable in a week, that can also be done at our clinic if you can stay a few days, but has to be arranged with making the appointment for treatment. In The Netherlands you can call the Tongue Tie Clinic for an appointment.

* Muscle pain; After the treatment the adults and older children notice (muscle) pain or discomfort in the jaws, tongue and throat sometimes as well. See the FAQ about pain relief.

* Baby spits more; Because the baby drinks more effectively, it may be that the stomach is not used to the amounts and it spits back up, but it may also be that the baby is still drinking air for a while.

* Smelly breath / mouth; We sometimes hear this from parents and can last from a few days to a week, it’s ussualy no problem whatsoever.

* Swollen upper lip; This can last for up to 5 days after lipband treatment.

*  Quivering jaws remain visible longer; Because the tongue, after it has come loose, many of the muscles still need to be trained, it may be that the compensation continues with the jaw muscles, but compensation behavior may also need a chiropractor or manual therapist to remedy it. See the FAQ about compensation behavior and videos explaining this.

* You have to help lips flange out; The baby is not used to flanging the lip, this may be helped.

* Suction blisters still present; They can be present for longer, especially on the upper lip.

* Crying doing aftercare; What we hear from parents and notice at the aftercare consultation that the baby cries with the aftercare exercises, but stops as soon as you stop or start feeding or changing diaper and such.

* White plaques/debris on tongue still visible; Because the palate is often high and the tongue is not well trained to stay up, even at rest, the white plaques/ debris on the taste buds remains.

* Bottleteat; We notice that the teats with a broad base cannot go deeper into the mouth, so a teat that can go deeper and gives more mouthfilling, such as the smaller, narrower types, is often better.

* Baby stays upset longer than 48 hours, crying, drinking worse. In the older baby who has had to compensate for a long time with a tongue tie. Before the treatment, often these babies were fussy and drinking poorly and found there own “technique”. Treatment of compensation behavior is often necessary. See FAQ compensation behavior. People often give painkillers for longer. But one also has to take into account a normal virus infection occurs at the same time. You can go to the doctor with a fever, see the FAQ about fever.

* Gagging may still be present after the release.

* A baby cannot swallow the tongue after the release.

* Apnea are also observed in babies . It is not directly related to the release. Tongue tie can be related, read the research.