Tongue-Tied in Connecticut
Branford CT USA
From: NEW BEGINNINGS, Vol. 20 No. 6, November-December 2003, pp. 212
Tom and I met three years ago. Within a few months, we were married. I had three children from my first marriage, ages 16, 14, and 10, and Tom had no children. I was 37 and Tom 41 when we decided to try for a child of our own as soon as possible. My pregnancy was uncomplicated and a welcome delight to everyone in my family. My labor and delivery experience was perfect, quick and unmedicated. Katherine Ann was born on April 23, 2001. She weighed eight pounds, four ounces, and was 20 inches long. The nurses and doctors in the hospital all said they had no concerns about us.
The day we brought Kate home from the hospital, I noticed something unusual. Kate had a short string attaching the tip of her tongue to her lower gum line, a condition commonly known as "tongue-tied" or short-frenulum. It was most visible when she was crying. Although I work as a pediatric nurse in a large practice, I did not know anything about short frenulums. I was about to learn a lot.
I decided to wait until my one-week visit to the pediatrician to state my concerns. My baby was nursing every two hours and having straw-colored wet diapers. However, her stools didn't look normal to me and my breasts were becoming increasingly sore and feeling less full. Kate was unable to extend her tongue and I knew that her suck felt different from my other babies who were breastfed.
At Kate's two week check-up, I was alarmed to find that she had not regained her birth weight as would be expected at this age. In fact, she had dropped to seven pounds, five ounces. At that point, my pediatric care provider had me start double-pumping with an electric breast pump after feedings to rebuild my milk supply. I started offering Kate expressed milk by bottle in addition to breastfeeding in order to help her regain her weight. My husband and I were committed to breastfeeding but wanted to know more about why Kate was having such difficulty. I started searching the Internet and found Dr. Jack Newman's Web site about breastfeeding. In his "Problems" section, there were photos of tongue-tied babies with descriptions of exactly the same problems I was experiencing. They included painful or damaged nipples for the mother. For babies, there was often slow weight gain or failure to thrive, very long feeds, inability to latch-on, and inability to sustain and suck for long. I consulted with a lactation consultant who agreed that a short frenulum could be the cause of Kate's breastfeeding problems. We learned from our research that a frenotomy was a simple office procedure that required no anesthesia and would help the baby to suck better immediately. At that point, we insisted that Kate be referred to a specialist for an evaluation.
A major problem that we had to overcome was finding an ear, nose, and throat doctor who was willing to perform the procedure. The one doctor that we had heard about who performed frenotomies was on vacation for two weeks and another doctor in our health plan refused to do the procedure because of Kate's young age. We were referred to a pediatric general surgeon. My husband and I went with Kate to meet the general surgeon expecting the procedure to be done the same day. We were shocked when we were told that Kate would be scheduled for the operating room to have the procedure done under general anesthesia with an IV and ET tube. After discussing this with our provider, we decided this was not an option. We urged our provider to continue searching for a doctor that was experienced in performing a frenotomy without anesthesia as soon as possible.
The name of a pediatrician who specialized in breastfeeding medicine was provided to us. When we spoke with her, she said that she became trained in performing frenotomies as a result of having the same frustrations with finding a specialist for her patients. Her name is Dr. Tina Smillie, a member of LLLI's Professional Advisory Board, of Stratford, Connecticut, USA. She sent me information on building up my milk supply and supplementing Kate until we could meet with her.
Within a few days, a nervous Tom and I went with Kate to meet with this doctor. We talked with her and her staff of lactation consultants to discuss Kate's eating habits, sucking problems, weight, and medical history. The doctor had me feed Kate until she was groggy and then put her on the exam table. The staff explained that the frenulum was simply a piece of extra cartilage that could be snipped with a small scissors with little bleeding and virtually no pain. We agreed to the procedure and within seconds it was over. Kate cried more about having her head held than about the snipping. A piece of gauze was applied to the area to stop the bleeding and she was handed to me. Immediately she began nursing! Her suck was vigorous and I began to cry with relief.
It has been two weeks at this writing since Kate's clipping. She has passed her birth weight and we've been able to decrease supplements. We are now finally a happy breastfeeding couple!
Editor's Note: Incidence of tongue-tie is rare. Sore nipples are more often related to improper positioning at the breast or incorrect latch-on. For help with either of these situations, contact your local LLL Leader.