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!

The week that was - the Stuntman's first week at Kindy

It was ‘ back to school’ week for my littlies this week, with the Stuntman heading off to the same daycare as Little Miss for the first time. He’s been cared for by family members on a regular basis for most of last year while I worked, but he’s never gone to a big daycare centre before, so it’s been a big week for everyone. 

A bright and cheerful kindy room :)

I’ve been experiencing a rollercoaster of emotions all week at the thought of my darling baby boy heading out into the big bad world without me. I called the kindy several times a day to check in on him, and would tear up and have to run to the bathroom at work whenever I thought of his sweet little face searching the room for me. Oh gawd, now I’m tearing up writing this!

During one check-in phone call his carer told me that whenever Little Miss came into the toddler room (she’s in the pre-school room), the Stuntman would grab hold of her and give her a big squeezy cuddle, not wanting to let her go. The carers would have to eventually prise them apart to go to their separate rooms. I’m sure the daycare teacher thought I’d be happy to hear that story, but it actually sent me back to the bathroom for another weep. I’m a sook, I know.

He’s made a surprisingly good transition to the centre, playing nicely with the other kids, going down for a sleep without much protesting, and only a few teary episodes throughout the day (probably less than me if I’m being honest!). Due to his food intolerances, the kindy provides a special allergy-friendly meal for his lunch, but so far he hasn’t been willing to try it, so I’ve been sending along a sandwich for him (on his special soy-flour-free bread) so that at least he’s eating something. Hopefully next week when he’s feeling a bit more secure he’ll be willing to try the prepared meals.

While he’s been pretty much fine at the kindy, at home he’s been a clingy little monster; screeching to be picked up whenever I’m around, wanting boobies all the time, and waking up screaming several times a night. These are all pretty classic separation anxiety signs I guess, which is not really surprising. I’ve been trying to be as patient with him as I possibly can be, but what with the lack of sleep, the constant whingeing, and the aching back from lugging him around everywhere, I’ve been a bit of a grumpy mum this week.

Due to our work schedules, I generally do the kindy drop-off, and Mr McD does the pick-up.  I’ve been feeling like I’ve been missing out on the fun part, but today I got to do both ends of the day, and to tell you the truth, the pick-up wasn’t all I’d imagined it to be! I had a mental picture of both kids running towards me, arms outstretched, so excited to see their mummy, but this was pretty far removed from the reality of it. 

When I walked through the door, Little Miss caught sight of me first and ran up squealing “Mummy, Mummy!!” (all good so far), then grabbed my arm and pulled me towards the art corner where she had some new creations to show me. The Stuntman clocked that I was there at this point, raced over and grabbed my other arm and started pulling me in the opposite direction, also squealing “Mummy, Mummy”, but more upset than excited. He then started trying to climb up my leg, saying “Up, up, boo boo, mine”, while Little Miss was still trying to pull me across the room. 

At this point I overbalanced and toppled onto the ground, almost squashing Little Miss, and pulling the Stuntman down on top of me. Luckily, he’s like a cat and always lands on his feet. Me, not so much; I landed squarely on my arse. Fortunately it’s well padded ;)

The young daycare teacher raced over to see if I was OK, and, much to my humiliation, tears welled up in my eyes. One even ran down my cheek. OMG - why was I crying?? No idea. The poor girl was really worried I’d hurt myself, but I think it was just the shock of falling, and the fact that my emotions have been on such high alert all week. I just couldn’t keep my game face on. That coupled with mega embarrassment just sent me over the edge.

The Stuntman couldn’t have cared less about my predicament, and actually tried to yank down my top while I was prostrate on the floor, in an attempt to help himself to the boobies. While I was trying to haul myself up off the filthy, sticky kindy floor (in black trousers no less), my handbag fell off my shoulder, sending my phone, wallet and multiple lip balms flying across the room. It must’ve been quite a sight for the other mums and dads who were picking up their kiddies.

You can always count on me for some light comic relief.

I eventually managed to sign the kids out, collect both sets of bags, water bottles, hats and artworks without falling over again or dropping anything, and we made it back home in one piece. The kids must’ve sensed I was right on the edge when we got home, as they played beautifully together, ate their dinner without any fuss, and went off to bed like little angels. Small mercies.

I will definitely be leaving the pick-ups to Mr McD from now on!

Any back to school/kindy stories for you this week?