The Curse of the Upper Lip Tie

When Little Miss was born 3 years ago, she refused to take my breast for the first 24 hours, and was fed my colostrum through a syringe. It was a pretty worrying time for me, wondering if she’d ever be able to breastfeed. After a day she seemed to get the hang of it and would latch on, but really, our first few weeks of breastfeeding were pretty awful. She’d scream and turn her head away whenever I offered the breast, and it would take a lot of persistence on my part to actually get her attached. Once on, she fed pretty well, so we (me, Mr McD and all the Dr’s and nurses we saw in those first weeks) all put it down to her being born 3 weeks early, and still a little immature. After the first 2 weeks or so we found our groove and things got much easier; we ended up having a wonderful breastfeeding relationship until she self-weaned at 16 months (by which time I was 4 months pregnant with the Stuntman).

When the Stuntman came along, I was prepared for a similar initial breast refusal, but in fact he wriggled and maneuvered his way up my chest like a newly hatched baby turtle, and attached himself to my boob less than 5 minutes after he came out. It was the most beautiful moment, and I remember crying and exclaiming “he’s doing it, he’s doing it!!” to Mr McD and my mum in the birthing suite, so excited was I that it seemed that he had this breastfeeding business under control.

The Stuntman, 1 day old

A few hours and several feeds later, I noticed my nipples were shaped like lipsticks with a weird line down the centre. It didn’t hurt though, so I wasn’t too concerned about it. I got the hospital’s Lactation Consultant to assess our latch, as well as a couple of midwives, and they all said it looked fine, and that if it didn’t hurt, I shouldn’t worry. The Stuntman was checked over by the hospital Paediatrician, given the all clear, and we were sent on our way home after one night’s stay.

The next few days and nights turned into a blur of excruciating nipple pain, endless puddles of vomit, and some serious sleep deprivation. The Stuntman was wanting to feed every 1.5 hours round the clock, and then vomiting most of it up before falling asleep for less than an hour, then repeating the whole cycle again. My nipples were cracked and bleeding and the poor little Stuntman just wasn't happy. It’s safe to say I was not having a very good time, and I’m pretty sure it was only my Placenta capsules that kept me from going over the edge.

I’d been seeing a lovely lady, Jo, throughout my pregnancy for some wonderful reflexology and massage (to deal with SPD), and she offered me a post-natal treatment as well, to get things back in alignment and re-balance my hormones. To my great fortune, she was also a very experienced counsellor with the Australian Breastfeeding Association, and offered to have a look at what was going on for us. After 2 minutes of watching the Stuntman feeding, she did a quick check and told me that she thought he had an upper lip tie, and potentially a tongue tie as well. The Stuntman at this point was about 10 days old, and had been assessed by 2 different paediatricians, my GP, several midwives at the hospital, the home visiting midwife, and a nurse at the Early Childhood clinic. No one had even mentioned a lip or tongue tie, and all had just told me to ‘work on our latch’ to improve the situation. As a second time mum, it was just assumed that I knew what I was doing and could work it out.

Within an hour of seeing Jo, I had an appointment for the Stuntman with a wonderful husband and wife team in Sydney who specialise in lip and tongue ties in babies. The Stuntman was diagnosed as having a Class IV upper lip tie as well as a posterior tongue tie. An upper lip tie is where the piece of skin under a baby’s top lip (‘maxillary labial frenulum’) is attached too tightly to the gum, and looks like this:

A Class IV upper lip tie. Photo courtesy of Dr Lawrence Kotlow

A Class IV upper lip tie means that the labial frenulum extends down between where the two front teeth will come in, and wraps around and attaches to the hard palette underneath.

We had both ties snipped then and there. It was a quick procedure performed by a surgeon (the Lactation Consultant’s husband), and, while I can’t say it was painless for the Stuntman, I think the worst part of it for him was being tightly wrapped and held down on the table while it was happening. There was some blood and some screaming, but I think I was in worse shape than him!

As soon as the procedure was performed, I was encouraged to pop him straight on the breast. Apparently breast milk acts as an analgesic and can also stop bleeding. The difference I felt on that first post-snip feed was amazing; there was still some pain as my nipples were in really bad shape, but it was only ‘surface pain’, and not the excruciating agony I had been experiencing up until that point. He had the longest feed he’d ever had, and actually fell asleep on the boob – something he had never done before. The consultant explained that he’d had to work so hard to feed before the snip, that he’d probably never quite gotten to that milk drunk stage. 

Milk drunk, at last!

We had to do some lip-stretching exercises over the next few weeks to make sure that the frenulum didn’t heal back onto the gum line, but that was it. This simple procedure actually changed mine and the Stuntman’s lives; without it I really doubt I could have continued breastfeeding (and certainly not still be going strong 18 months later!).

If you have any suspicion or worry that your baby might have an upper lip or tongue tie, I urge you to go and see a qualified Lactation Consultant for an assessment. Early correction can make a huge difference.

Some of the signs that a baby may have a tongue or lip tie that is interfering with breastfeeding include:

• nipple pain and damage
• the nipple looks flattened after breastfeeding ('lipstick' shaped)
• you can see a compression/stripe mark on the nipple at the end of a breastfeed
• the baby keeps losing suction while feeding and sucks in air
• the baby makes a clicking sound when feeding
• the baby fails to gain weight
• the baby cannot poke his tongue out beyond his gum or lips
• his tongue cannot move sideways
• the tip of his tongue may be notched or heart-shaped when he cries
• he may readily gag
• the tip of the tongue may look flat or square instead of pointed.

 (Source: Australian Breastfeeding Association)

I now realise that Little Miss also suffers from an upper lip tie, and that this was most likely the cause of our early breastfeeding issues. She also now has a small gap between her front teeth, and is unable to say the letters ‘f’ or ‘v’. She actually can’t move her top lip up off her front teeth enough to be able to touch her front teeth to her bottom lip (which is how you say ‘f’ and ‘v’). So it looks like we may have to get hers corrected too, but, at her age, the procedure is going to be much more of a big deal. A paediatric dentist will perform it, most likely using a laser to cut the frenulum. I’m somewhat reluctant to move forward with this, but I know I should do it sooner rather than later, or speech therapy might be required for her as well.

I wish I could say that this simple procedure put an end to all of our troubles, but unfortunately we then had to contend with milk over supply (due to the constant feeding), and a long road to discovering that his sleeplessness, fussiness and excessive vomiting was in fact due to a cow’s milk and soy protein intolerance (CMPI / MSPI) (Read my post How we came to be dairy and soy free for more background). 

Here are some great links for further reading about tongue and lip ties.

Mommypotamous has an awesome step-by-stepguide on how to identify a tongue or lip tie.

Dr Lawrence Kotlow is a world-renowned expert on lip and tongue ties (USA) and produced this Fact Sheet for new parents.

The Australian Breastfeeding Association has some great info on tongue and lip ties.

Personally, I’m almost convinced that there is some kind of link between a tongue and/or lip tie and CMPI / MSPI. So many mums of CMPI babies that I’ve spoken with have also discovered that their little one has a tie –too many to be a coincidence in my opinion! 

What about you - does your baby have CMPI and a lip/tongue tie? 
Leave a comment below!