Zettie Taylor, England
Adapted from a write up of a discussion led by Vicky Jordan at a Spring workshop on 21st March 2015 in Rainham, Kent, England by Zettie Taylor. First published in La Leche League Great Britain’s Feedback (Leaders’ newsletter) reprinted with permission.
Vicky Jordan, an LLL Leader in Kent, England and vivacious speaker, was initially a nurse by profession and recently certified as an International Board Certified Lactation Consultant. Vicky trained as a tongue-tie practitioner in Southampton, England in 2014. She presented a workshop session about how tongue-tie can affect breastfeeding; and what we can do as Leaders to support mothers and babies who are affected.
As a National Health Service (NHS) volunteer breastfeeding peer supporter and mother of three children under five who all had a tongue-tie division* performed in their early days, I was keen to hear what Vicky had to say. So, it seemed, was everyone else. Questions and lively discussion arose from many aspects of Vicky’s talk, and she engaged us with her extensive knowledge, experience, enthusiasm and humour. Vicky’s memorably named session (modestly attributed to her partner, Graeme) was framed around a game to “spot the symptom” and try to identify the signs of tongue-tie using images on an overhead projector.
Vicky discussed how classic signs of restricted movement on and beneath the tongue include:
• a heart shaped, bowl or “stingray” shaped tongue
• a tongue that does not lift well even when a baby cries or
• a tongue that cannot stay flat when it moves from side to side (it twists instead)
It is the ability to lift the tongue that is crucial for breastfeeding, while lateral movement tends to be more important for when babies move on to solid food. I discovered that the position of the tongue-tie or where it ties the tongue to the floor of the mouth is not directly related to the severity of the tongue restriction as many factors have to be taken into account.
Vicky showed us how many other, seemingly unrelated signs can suggest a problem with tongue mobility. I learned a lot. For example, the shape and behaviour of the mouth can also be indicators that suggest a baby is not latching or cannot latch effectively. Signs to note include:
• a small gape
• distinctive sucking blister on the middle of the upper lip
- an exaggerated “Cupid’s bow”’ mouth
- a high or bubble palate
- persistent nipple damage
The palate is formed in utero by the baby’s tongue pressed against the roof of the mouth. A high palate formed with either a “plateau” or a “bubble”’ shape can indicate a tongue with restricted movement. Tongue-tie can also cause vasospasm in mothers (see Nipple Vasospasm and Breastfeeding for further information).
Perhaps the most salient fact I learned from Vicky’s talk was that babies with tongue-tie often have a white patch at the back of the tongue, a harmless milk residue that accumulates because of the tongue’s restricted mobility and lack of contact with the breast. This struck a chord with me, since my second child was wrongly diagnosed with thrush in the early weeks.
Although we may notice symptoms of poor tongue function, a Leader’s role is not to diagnose a tongue-tie but to suggest who a mother might turn to for assessment or treatment when needed (see The Role of the LLL Leader in the Breastfeeding Support Landscape). Leaders support mothers and babies. So, most importantly, Vicky’s talk moved on from diagnostic symptoms to a discussion of what we can do to support mothers and babies when breastfeeding a baby with a tongue-tie or after a frenotomy. Vicky discussed how tongue-tie division itself is only a small part of the answer to many mothers’ initial breastfeeding difficulties. These mothers need ongoing support in order to establish and maintain breastfeeding for as long as they choose to do so. She spoke about emotional support, ongoing reassurance and encouraging mothers in building their own support network, as well as use of nipple shields. Ultimately the discussion boiled down to positioning and attachment, certainly the cornerstone of successful breastfeeding. Techniques that can make a difference are laid-back breastfeeding (also known as biological nurturing), making a “breast sandwich” by compressing the breast with fingers, or tilting the nipple towards the roof of the baby’s mouth. It took me five months to establish smooth-running breastfeeding with my tongue-tied firstborn—and it was the support and expertise of people like Vicky who made that possible. Thank you Vicky!
* A tongue-tie division is also called a frenotomy, or frenulotomy, and is a minor procedure in which a doctor, dentist or other qualified practitioner snips the tie.