How can I recognize compensating behaviour in my baby?
The next video explains how a baby shows signs of compensating behaviour.
The next video explains how a baby shows signs of compensating behaviour.
Due to the tie the tongue can only move the front and sides a bit. The tongue cannot go up and back properly, difficulty latching on, drawing in the nipple deep. While very often at the same time the upper lip cannot flange out over the breast, because the tie pulls it inward. So the baby slides off easily. Resulting in small latch, letting go of nipple. Latching on and drinking difficult or only works with a nipple shield or bottle. Falling asleep at the breast or bottle, frustrated, doesn’t seem to want to drink, doesn’t empty the bottle.
Tries to hold on to the breast by clenching jaws together. Uses cheek muscles to draw milk. Mother experiencing pain especially at latching on. But not always painful, also just sucking really “hard” or “strong”. Chin quivers from jaw muscles tension. Sucking blisters on lips from friction. This compensating is weary for the baby and especially in compromised growth or premature babies it’s a shame it costs energy. Sometimes babies are called lazy drinkers.
Nipple should come out round, but comes out flattened, with blisters, discoloured and sore. “Raynaud” like symptoms from diminished blood flow to nipple.
Due to the baby’s restricted mobility, only suckles at the nipple and hardly at any breast tissue. There is too little milktransfer as a result. The baby draws in the nipple as if sucking in spaghetti, hangs on nipple like a “cliffhanger”, often pulling and moving the head in an attempt to pull out the milk, sometimes using hands to pull the breast in older baby’s, drinking suddenly painful when teeth come.
Baby doesn’t “empty” the breast (or bottle), drinks often to get enough milk. Plugged ducts, overproduction from drinking often, compromised production in the end.
Baby loses weight more than 7% in the first days, getting back to birth weight takes more than 10 days. Growth stagnates after weeks or months when production decreases. Babies don’t always show; they save energy by sleeping long for example. A sign could be very few poop diapers.
Baby only drinks the “easy” milk, during the milk ejection reflex. Drinks short or very long. Only making the chin tug and drinking when MER or giving breast compression or supplementing at the breast.
Due to the low tongue position, often high palate and the upper lip not flanging out completely over the nipple, bottle or breast, your baby cannot make a good seal and loses suction, you can hear clicking sounds. Also very loud drinking, gulping it down and choking. Complaints of swallowing air.
The swallowed air needs to go somewhere; it goes up or down. Burping, hiccough, spitting, windy, colic. GER or reflux with or without spitting (hidden reflux). In hidden reflux the baby tries to keep the milk down by swallowing again, sometimes forgetting to breath momentarily. During feeding it can be very uncomfortable for the baby and can become restless. It’s difficult to put the baby down to sleep. Parents walk with their baby until symptoms subside. The baby can experience pain from the stomach acid in the oesophagus. GERD. Sometimes medication is given which lowers stomach acid.
Thrush is often confused with tongue tie problems. Although you can see it both at the same time. The tongue may have debris in the papilla (from day of birth) due to the fact that the tongue hardly touches the palate so it doesn’t “rub clean”. Pinching and stabbing pain can be from thrush or compensating behaviour from tongue and lip tie. In tongue tie you can see white debris on the posterior part of the tongue behind the tongue tie, the front of the tongue rubs clean against the inside of the upper maxilla. Thrush is a “pearl white” shine or white plaques on the inside of the lips and on the mucous membranes of the inside of the mouth.
*Note that not all symptoms have to be present at the same time.
Treating tongue- and lip tie is relatively speaking, a minor surgical procedure and an attempt to improve the present situation. This applies to babies, children and adults.
It remains, however, always a surgery.
In general, the younger the patient at the time of the treatment, the more likely symptoms will improve.
However, the degree of success in infants can also be affected by other factors such as childbirth and how the baby drank the breast or bottle prior to treatment. Babies need to re-learn how to use their tongue as they have established compensatory behaviours such as jaw clenching to obtain the milk. Sometimes it takes several days or weeks before results are seen. Often babies can be irritable the first 24-48 hours and can refuse the breast or bottle. If the baby refuses the breast, use a bottle, teaspoon or syringe so that the baby receives some milk.
It is strongly advisable to make an appointment with a Lactation Consultant and/or other therapists if feeding remains problematic, ask the Lactation Consultant who was present at the release which therapy is most suitable. For example, physiotherapy, speech therapy or chiropractic/osteopath/craniosacral care. It is also advisable to have a check up on the wound within a week with somebody who has knowledge.
Older babies may want a paracetamol suppository to make them feel more comfortable after the procedure. Depending on their weight, 60-120 mg. Check at your pharmacy.
The baby can be fed immediately after the release. The baby can latch on to the breast or drink from the bottle. It is wise to choose the feeding method the baby was used to until the release. At the consultation there is a lactation consultant present who can assist and provide additional advice. However, it is not a lactation consultation and is only intended to help the mother and baby immediately after treatment.
For more breastfeeding advice and guidance, we refer to a Lactation Consultant IBCLC near you.
In addition to the aforementioned checklist of signs and symptoms (see FAQ checklist complaints), an assessment at the Tongue Tie Clinic of tongue tie and lip tie in breastfeeding or bottle-feeding can be useful. An assessment can rule out whether the ties are the most likely cause of the complaints. The reasons to have an assessment can be very different and not all complaints described need to be present at the same time. In case of doubt, one can contact the the Tongue Tie Clinic. A short list of complaints and a video or photo of the tongue tie and lip tie does not provide a definitive answer, but can always be mailed to the following address: firstname.lastname@example.org. When making the video or photo, take care of a good posture of yourself and the baby (link). Good light is important. One person lifts the tongue and then the lip and the other makes photos or video. A photo / short video when the baby cries for a moment is also helpful to check the possibility of restricted tongue movement.
Even though a baby grows well, several complaints can be experienced by both the mother and the baby. See FAQ: signs and symptoms of tongue and lip tie
Frequent plugged ducts and mastitis, pain and discomfort can be a reason for the mother. In babies it is possible that a lot of air is swallowed in, sometimes gastroesophageal reflux disease is present, cramps and colic, the high frequency of drinking and often restlessness during feeding can also a be the reason for the tongue tie and/or lip tie to be treated.
In the long run, babies and children may have difficulty with eating solids, speech and overall mouth development (for example, the shape of the jaws and how the teeth are aligned). However, it is not possible to say with certainty whether a baby or child will actually have long term consequences of the tongue tie or lip tie.
It is possible that 24-48 hours after surgery, babies can be irritable and tearful.
Rarely, it may take longer. If babies refuses the breast or bottle, you can give milk orally with a spoon or syringe, or a small medicine cup placed to the lower lip so that you can gently drip some milk into the mouth. A baby will ultimately want to drink again, but may have trouble getting used to the new mobility of his/her tongue. Temporarily the baby may also latch on with a nipple shield (watch this video).
If the baby is still very upset an acetaminophen (paracetamol) suppository can be given. 60 mg depending on the weight. When in doubt about the amount of medication always consult a doctor.
If you have any questions do not hesitate to call your Lactation Consultant. (Or the lactation consultant present if you had an appointment at the Tongue Tie Clinic, you will find her telephone number on the aftercare card.)
Providers use a classification system to describe the tongue tie. This system only indicates where the tie is attached between the floor of the mouth and tongue. Providers usually use four classifications of Coryllos or Kotlow, (see pictures below).
The anterior tie is easy to see when the baby cries or tries to lift up the tongue. It can also be felt with your finger under the tongue. It is attached all the way to the tip of the tongue. Very often it makes a heart-shaped tongue when the baby cries or tries to move it.
The anterior tie is a little further from the tip of the tongue. It is also felt like a guitar string or easily seen when the baby cries or tries to lift the tongue. The tongue stays low in the mouth when the baby cries or tries to move the tongue, very often you see a bowl- shaped tongue when crying (only the edges move up).
The posterior tie is further away from the tip and can be made visible by using a special tool, the groove director, or by using your two index fingers that push back the mucous in the direction of the throat and lift up the tongue simultaneously. The tongue stays low in the mouth when the baby cries, tries to move the tongue, or shows indentation or creases, very often you see a bowl shaped tongue when crying (only the edges move up). With your finger you can feel a “speedbump” or guitar string further back.
The posterior tie is not visible, but “hidden” behind the mucous. It can only be shown with the groove director or with two index fingers that back push the mucous in the direction of the throat and lift up the tongue simultaneously. The tongue stays low in the mouth when the baby cries or tries to move the tongue, or shows indentation or creases, very often you see a bowl shaped tongue when crying (only the edges move up). With your finger you can feel a “speedbump” or guitar string further back.