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Why Every Baby should be assessed for Latch and Tongue-Tie

Uncategorized Sep 21, 2017

My daughter was only 16 hours old when I was first asked to quieten my baby for fear of disturbing other people.  I wasn’t given the help or support I needed that night.  And if someone had paid attention, the following 12 months would likely have been VERY different for us, and I might have enjoyed being a mum.


When a potential client phones me in desperation to see if I can help, one of the first question I ask is “Has your baby been assessed for a Tongue Tie?”


Regardless of whether baby is breast or bottle fed. 


You see, over the last few years of reading and researching the infant digestive system, I have learned a thing or two about the basic physiology of our newborns, especially the shape of their mouth and mouth structures.  And the reflux survey I am running is really shouting out (to me) a high degree of potential latch and / or tongue tie problems.


If a baby has a tongue tie, she could have reflux, silent or projectile.  The thing is, the root cause of this reflux is the tongue.  It is the very same if baby has a poor latch, the reflux could be caused by the latch itself. 


Because in both cases it means that baby is drinking more air than they should be.  And this can be a direct cause of reflux.


It applies to bottle and breast-fed infants, maybe even more so to bottle fed.


So it annoys me that bottle-fed babies are generally over-looked from a tongue-tie assessment point of view.  In fact, many breast-fed babies are missed for tongue-tie too (speaking from personal experience on this one).


What is Tongue Tie/ Ankyloglossia and why does it matter?

If baby has a tongue-tie, it means that they cannot physically touch the roof of their mouth with their tongue, when their mouth is open.  This is particularly relevant to the breast-feeding baby who needs a wide-open mouth for feeding, and needs to use their tongue to compress the breast on the roof of the mouth to release milk.


That said, a severe tongue tie can have a similar impact on a bottle fed infant if they cannot wrap their tongue around the bottle to suck, they will have greater amounts of air in their mouth when feeding.


And a severe tongue tie can have further reaching impacts than just bottle feeding.  It can hinder how baby manipulates food when learning how to eat.  It can result in poor mixing of food with saliva in the mouth which in turn impacts how sugars and starches get digested, or not in this case.  And it can have massive impacts on their speech development.


So why not have this pain-free and quick assessment done for every baby?  Shortly after birth is the best time to do this, but I believe if there are no tongue tie issues identified initially, but feeding problems begin, or continue, that baby should be assessed again at about 4 or 5 weeks old. 


From personal experience, the development of the mouth in the first few weeks can change so much that a mild tongue-tie, or no tongue tie, becomes apparent.  And in the UK, the NHS will resolve a tongue tie until the age of 6 weeks.


What is Latch and Why Does it Matter to Both Breast and Bottle-Fed Babies?


A baby’s latch is the description given to how they attach to the breast for breastfeeding.  For me, however, the description needs to include all babies and how they attach to the nipple, be is a breast or a bottle nipple.


Latch and the Bottle-Fed Infant


With bottle-feeding, the bottle teat does not deform to the same extent as breast tissue and so there is there is more space in the mouth which is filled with air.


In addition, most bottles have a natural flow rate, so baby does not have to suck as much to get the milk out.  An opportunity for air to be in the mouth. 


The action of feeding is a reflex (suck-swallow reflex) for newborns, so if there is air in the mouth it gets swallowed.


Baby cannot get a good latch on the bottle teat because of the shape of their mouth and the shape of the bottle teat.


If baby also has a tongue-tie, they cannot physically touch the roof of their mouth with their tongue when their mouth is open.  This applies particularly to breast-fed infants, whose mouth is open wider than that of a bottle-fed infant.  That said, a severe tongue tie in a bottle fed infant will have a strong impact on their ability to feed properly.


Latch in the Breast-Fed Infant

A baby’s mouth is designed for breastfeeding, designed so that the tongue can press against the roof of the mouth.   With breastfeeding, this action allows for the tongue and breast tissue to essentially “fill” the mouth cavity, removing air from the mouth. 


Couple this with the action of sucking, which causes the inside of the cheek to be drawn inwards, and with a perfect latch baby has virtually zero air in their mouth to swallow with their milk.


What happens when baby drinks too much air?

Basically, wind in their tummy.  And this is more than unfortunate.  This can be a cause of reflux alone.  Because of excess air being swallowed, reflux can be the result.  And no amount of medication is going to “cure” this reflux because the cause of it is still there.


So how do you know if your baby is drinking air? Or too much air?  These are some of the signs….

  1. Splutters, coughs or gags during a feed

  2. Gulps when feeding

  3. Possets or vomits a feed

  4. Can hear milk sloshing in tummy

  5. Milk spills or leaks from the mouth

  6. Squirming and grunting

  7. Lots of wind – up or down

  8. Painful wind or gas

  9. Rumbly tummy

  10. Bloated tummy

  11. Hard tummy

  12. Wants to be in your arms all the time

For some, these symptoms alone are enough for medication to be given.  And over 60% of babies on reflux medication still have symptoms.*


So what to do?

This is the million dollar question. 


Breast Fed Babies

If your baby is breastfed, you have easy access to a location consultant, breastfeeding councillor or tongue tie specialist who will assess for you and be in a position to resolve it or recommend where you can go to get it resolved, if it is severe enough. In the U.K., you can get a tongue tie assessed and resolved on the NHS for babies under 6 weeks old.  After 6 weeks of age your only option is go private.


If you’re breastfeeding and baby has reflux-like symptoms

Go to your local breastfeeding clinic /café and ask for a tongue-tie assessment.


What if you’ve already had baby assessed and they said baby was fine but feeding is a massive battle and baby has lots of gas and wind?

Go again.  To be sure.  And this time make sure you are seeing an International Board Certified Lactation Consultant (IBCLC).  No-one else is better equipped or educated to diagnose a Tongue Tie.


What if your paediatrician said its reflux and not a tongue-tie?

Ask if your paediatrician is certified by the International Board of Lactation Consultants.  If not, get your baby checked by an IBCLC.


What if your GP / Health Visitor / Paediatrician all say no Tongue Tie and your Lactation Consultant says there is one?


Go with the Lactation Consultant.  It’s YEARS of training to qualify as an IBCLB.  They are the most likely to be right in this case.


Bottle Fed Babies

For a bottle fed baby, this is where I am at a loss other than to recommend you find a local tongue tie practitioner and ask them if you can visit and get them to assess your baby.  As you will see below, I will try and build a list of tongue tie practitioners who are support bottle fed babies.


There are some options open to you to try and reduce the amount of air that your baby is drinking with the milk. 


First is to encourage drinking from either a normal glass or cup, a Doidy Cupor a 360 degree cup that requires baby to suck on the cup to release the drink. 


By teaching baby to drink more normally you may be able to reduce the amount of air he is drinking and therefore reduce the reflux episodes that he experiences. 


Do not introduce bottles with a straw as this increases air swallowed.


Medication for Reflux

I believe there is a place in reflux stories for medication, but not if it is a tongue tie that is causing the reflux. 


And when it comes to medication, it can be hit and miss and a bit experimental.  


And sometimes it can be a food intolerance or allergy (e.g. Cows Milk Protein Allergy (CMPA) or a lactose intolerance, or something else entirely causing the problems).  If the reflux is a symptom of this, then medication will probably not work too well for your baby.  And introducing food can be even more challenging.


In Closing

I am out on a limb here.  


I am speaking from personal experience and observations of clients on all of the above scenarios.


Practitioner Call Please

If you are a qualified tongue tie practitioner and are willing to join a list on my website of places bottle fed babies can go for a tongue tie assessment, PLEASE email me or message me on Facebook.  I would LOVE ❤️ to know your views on my opinion.


*Source: The Reflux Report, September 2017, Aine Homer




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