AFTER: Here she is a couple months later after having her lip and tongue ties released and you can see that while her eyebrows are still curved there is a more nuanced expressive quality to them and her upper lip looks full, relaxed and flexible.
So many new mothers have a hard time breastfeeding their babies, the latch (suction) isn’t good, the baby isn’t getting enough to eat and it HURTS! This is not how the experience is meant to be, and in so many cases the source of the trouble never gets identified or resolved. A tongue/lip tie is frequently to blame and can easily be resolved.
My baby had both a tongue and lip tie (they often go together) which was identified in the NICU by the lactation consultant and then confirmed by the Occupational Therapist. The easiest way to ID a tie is by listening for a clicking sound when the baby is nursing or bottle feeding. The clicking happens when the latch is weak and their suction keeps breaking. They also often gulp and swallow air while feeding and milk seems to escape and dribble out of their mouth. There is also a certain tight shape to the upper lip and a cloven appearance of the tongue which is easy to notice once you know what to look for.
A “tie” is simply a way of describing an overly tight frenulum. A Frenulum is the connective tissue that is under your tongue and upper lip and gives mobility to your mouth and tongue. When the Frenulum is tied that means that the tongue and lip cannot move as freely or as completely as they should. As you might imagine this restriction and lack of full range of motion in the mouth effects nursing/feeding ability in a small baby but later on it will also effect speech.
In my baby the ties were clearly visible, the tip of her tongue had a cloven appearance and formed a distinctive heart shape, as if the very tip was being pulled inwards by an invisible thread (the tight frenulum pulling from underneath her tongue). Her upper lip looked tight and drawn down rather than relaxed and full. A lip tie also changes a baby’s facial expressions and often a baby with a lip tie will look perpetually surprised, with arched eyebrows and wide eyes. It’s an adorable baby expression so you might not take any notice unless you know what you’re looking at.
BEFORE: The heart shaped tip to her tongue, typical of babies with tongue tie
BEFORE: an example of what my baby looked like Before having her ties cut, her arched eyebrows, drawn tight upper lip and serious expression
AFTER: and here she is After her tongue and lip ties were revised. look at that relaxed, soft, expressive face!
BEFORE: Here are a few pictures where you can really see what her tongue looked like when she had a tie, the line down the center is typical with a tongue tie
BEFORE: and another shot of the heart shaped tongue tip.
My baby’s ties were identified in her first month but the hospital professionals didn’t want to attempt any revision (releasing the frenulum with a small cut) because she had already had so many negative oral experiences in her short life (intubation, tube feeding, oral thrush etc) and they were worried she would develop an Oral Aversion and refuse to take her milk by mouth either breast of bottle feeding. So I waited. I waited until we had come home from the hospital and learned how to breastfeed solidly, I waited until she was gaining weight steadily and relaxing into her home life.
When she was 2 months old I brought her to an infant chiropractor who did some very gentle work to relax the tension in her neck and skull from all the crazy tubes and wires that had been jammed down her throat and nose during her time in hospital. She told me that she thought my baby had significant tongue and lip ties and recommended I get her looked at by a specialist. When my baby was 3 months old I had her looked at by a local Speech Language Pathologist who specializes in diagnosing tongue and lip ties. She looked at my baby for a couple minutes, watched her breastfeeding (the clicking and gulping and leaking milk) and got her to giggle so we could see her little cloven tongue stick out. She confirmed for me that my baby had significant tongue and lip ties and should be seen for a revision and she gave me a list of four locations in the state of Massachusetts. I chose a pediatric dentist named Dr. Martin Kaplan in Bolton, MA who has made his career specializing in infant tongue and lip tie revision . https://boltondental.com/dental-services/orthopedic-orthodontics/infant-tongue-lip-tie-frenectomy/
When she was 4 months old I took a morning ferry off the Island and drove for an hour north to Bolton MA where we met Dr. Kaplan. He examined Hazels mouth gently while she sat in my lap giggling and grinning at this silly bald man in the white coat. He gave me a mini lecture about what a tongue/lip tie looks like and what a Frenectomy is (the process of cutting an overly tight frenulum) and about the kind of laser he would use. Laser surgery is the best possible option for cutting inside the mouth because unlike a knife blade, the laser is much more precise and actually sterilizes the wound as it cuts.
I was a ball of nerves and even though I knew that this was the right thing to be doing for my baby I still felt extremely conflicted, all my bodily instincts told me I was doing something terrible, letting them cut inside her mouth! I tried to calm myself as they carried my tiny baby away from me into the dental room. It took a lot longer than I was expecting and I felt like a mother lion pacing a cage as I walked the perimeter of the special waiting room they had told me to wait in.
Finally Dr.Kaplan came in carrying Hazel and she wasn’t crying, she just looked dazed. He handed her to me and she began to cry then. I immediately started nursing her as that was what they had recommended for post surgery pain relief. She seemed startled when she first tried nursing, as though the milk stung, or her mouth moved differently but she quickly settled in and nursed happily until she was asleep. I sat with her until she woke up and then we drove home. She cried for 5 minutes in the car and then fell asleep again, she was a bit groggy and unhappy on the ferry ride home and I gave her a tiny dose of infant Tylenol when we got home. The next day she seemed fine.
The post operative care instructions were simple including 4 simple “exercises” designed to teach the tongue and lip how to move in new ways and to keep the cuts from healing back into exactly the same tight formation they had been in before surgery. The exercises involved touching the sides of her mouth with my finger to get her tongue to go side to side or up and down following my finger, and also sucking on a pacifier/finger to simulate the tongue movement. She didn’t mind 3 of the exercises and disliked the 4th so rather than make her miserable we focused on consistently doing 3 out of the 4.
The Clicking sound and gulping and leaking of milk immediately went away! She started to gain weight and her whole face softened and relaxed and became much more expressive and subtle. She also began making new sounds and facial expressions in the weeks after surgery. It was as if her tight frenulums had been holding her back from a wider range of facial motion and releasing the ties released a whole new side of her personality! The day after surgery she began to blow raspberries and make fart sounds… need I say more? ;)
BEFORE
AFTER