When baby number 4 was born, the first thing my friends and colleagues asked was, “Is she tongue tied?” Two of my older children had tongue ties, my husband still has a posterior tongue tie, and I release tongue ties all day long in my medical practice. My new little peanut was born almost a month early. She was born tiny, but perfectly
healthy. She nursed beautifully during her first two hours before sinking into her sweet, deep slumber that newborns enjoy. Over the next 24 hours, she was difficult to wake for feedings, so I hand expressed my milk and fed by spoon and syringe. I called in my fellow IBCLC colleagues for support, and all agreed that she had a fantastic suck on digital exam, but was your typical, late preterm sleepy baby. Her oral exam was perfect with no evidence of ties in her tiny mouth. I wasn’t worried. I knew she’d wake up and feed more vigorously soon, and that she did by the next day. I never had a sleepy newborn before, but I didn’t mind. I cuddled her, woke her for feedings, and she gained beautifully. She had already surpassed her birthweight by day 5 of life.
As she reached her official due date, she began to wake up more and for longer periods of time. She fed beautifully, though often times slept while feeding. Her feedings rarely lasted more than 10 minutes, and she nursed about every 2 hours. She was gaining a full ounce per day, and I had no discomfort. This baby was different, however. She was my first and only baby to take a pacifier. She didn’t comfort nurse. I wasn’t worried. She had an intense need to suck, but was easily overwhelmed by my abundance of milk and fast flow. All of my babies were born at 5 pounds and change, but plumped up quickly, crossing several percentile lines on their growth charts by 3 months of age.
At around 5 weeks of age, she became very unhappy during most wakeful hours. She would cry all of the time, only being soothed by bouncing and walking her while sucking on her pacifier. And only I could comfort her. Her siblings expressed concern about her constant crying, and they thought that she disliked them. No one else could hold her without crying. By 6 weeks, she was spitting up with every feeding and between feedings. As her mouth grew, I could see her sublingual frenulum, which was not visible or palpable at birth. But everyone has a frenulum, she was growing, and I had no pain. I was making a concerted effort to wear my mommy hat, not my doctor/IBCLC hat. After all, I diagnose and treat tongue ties and lip ties all day long in the office. I was probably imagining things. All babies spit up. I could comfort her when unhappy. It was normal newborn fussiness, right? I tried to push my concerns of possible ties to the back of my mind. We were amidst a medical work-up for some unrelated issues at that time, which needed to take precedence. At her 2 month well child check-up, I raised concerns of her head becoming misshapen and her development of a right-sided preference. We talked about her reflux and general unhappiness, but chalked it up to normal newborn fussiness. But in the back of my mind, I knew. I didn’t even mention my concern to our pediatrician because she is the one who refers these cases to me!
About 2 weeks later, I felt an abrupt change in my milk supply. My supply had downregulated to meet her demands as normally happens around this time. She was miserable waiting for letdowns, her weight gain slowed to 2/3 of an ounce per day, and her frequent breastfed baby poops slowed to once a day and began skipping days. I performed an oral exam for the first time since her birth and was shocked to find such a thick, fibrous, restrictive posterior tongue tie. I was torn between my concern that a frenotomy might not fix things (maybe it was in my head) and the guilt of waiting so long to do it. I tell all my patients that the sooner you release the ties, the easier it is to get breastfeeding on the right track. I prefer to release them in the first 2 weeks if possible. Although I treat babies at any point in their first year, 2-3 months of age is already considered “older” when it comes to breastfeeding and correcting the latch. It just takes a little more time and patience as compared to treating a newborn.
So I did what any mom would do. I called my trusted IBCLC, Elizabeth Devaney, to come and give her unbiased opinion. My mommy blinders were preventing me from thinking objectively. I prepared myself for her to look at my baby and turn to me with an “I can’t believe you waited this long” expression on her face. And that she did. Tylenol, numbing, and a quick release, and we were done. My daughter cried for only a moment, and I picked her up and nursed her. I didn’t tell anyone that I released her tongue tie because I was hoping for unbiased feedback.
Within 2 days, she was a different baby. She was calm, happy, and relaxed. She actually allowed me to set her down while awake, which had never happened before. She stopped spitting up. She resumed stooling 3 times per day. She could fully drain my breast and hold a pacifier in her mouth. The babysitter (who dreaded my return to work) asked, “What did you do to her? She’s a different baby.” Everyone noticed. My only regret is not doing this sooner.
My experiences with my other children were different. My first was born in 2007, before I had a smartphone or social media, and before I had any breastfeeding education. No, medical school did not teach me anything about breastfeeding. I thought breastfeeding was going great, despite reflux. She was gaining weight faster than expected. I had noticed that my friend’s baby could self-attach to the breast, while mine could not, but that didn’t bother me. Right around 4 months, I felt that I was losing my milk supply. My baby would latch on and off, never seeming satisfied. She was only happy with a very full breast. I reached out to a la leche league leader who reassured me that this was normal 4 month behavior. I figured out on my own that the only way to keep my daughter happy was to pump myself into a state of oversupply. By maintaining an extra 20oz per day, she was happy. When my second child was born, I immediately noticed that something was different. He fed in 5 minutes flat from birth, while my first child took 45-60 minutes per feeding for her entire first year. I looked into his mouth, then into hers. That is when I noticed that she had a tongue tie while my son did not. When my third child was born, I looked into his mouth and right away noticed his class 3 tongue tie. I hesitated at first, being told by the pediatrician that it was normal, while knowing inside that it was not. After 2 weeks of a gassy, miserable baby, my best guess was that my baby was swallowing air due to his tongue tie. This was before Dr. Siegel came out with his aerophagia induced reflux paper. I released his tie, and his symptoms promptly resolved.
As healthcare providers, it is easy to second guess ourselves. It’s impossible to be objective when evaluating our own family members, yet we often hesitate to seek assistance for fear of embarrassment. Every one of us deserves to be treated as a patient when sick, and deserves a lactation consultation despite our own IBCLC credentials. I’m incredibly thankful to have Elizabeth Devaneyby my side as well our fantastic pediatrician, Maureen Baxley, who takes care of my kids so I don’t have to play doctor to them!