Having breastfed her older child for 25 months, April Ng thought that breastfeeding her second child would be easy peasy when she fell pregnant again. “I loved breastfeeding and it came naturally to me and Kaitlyn, who is now 5,” she says. “I wanted the same for Shane, and I thought it would be a breeze, as this would be my second time round.”
So, when she checked into the hospital to deliver Shane, she informed the nurses at the hospital that she would like to have skin-to-skin contact and breastfeed him as soon as he was born.
Everything went according to plan. Shane was placed on Ng’s chest when he was born, and she tried to urge him to suckle. “Unlike Kaitlyn who suckled brilliantly, Shane seemed a little reluctant to nurse. During the times he did manage to latch on, I felt this small but sharp pain on my nipple,” she recalls.
Since Ng was tired after the birth, she decided to return to the ward to rest before trying again. Unfortunately, the breastfeeding did not get better. “I kept trying to latch him on, and each time it was even more painful. His latch was very shallow, I was sore and my nipples were chaffed. I was quite confused as to why latching was so uncomfortable this time round.”
Ng decided to express her milk as Shane wasn’t removing her milk effectively and she was feeling engorged. She was also worried that he wasn’t getting enough milk, so giving him expressed breastmilk would ensure that he had enough.
Tongue ties affect 4 to 11 per cent of newborn babies and is often genetic. It also happens more in boys than girls, and can sometimes occur together with other congenital conditions, such as a cleft lip or palate.
By Shane’s first month check up with the paediatrician, Ng had become an almost exclusively expressing mum. “I told the doctor that as much as I wanted to, it was a nightmare trying to get him to latch, and he took to the bottle much better.
The paediatrician took a look at Shane’s mouth and pointed out to Ng that the tip of Shane’s tongue was shaped like the top of a heart. He also seemed to have problems sticking his tongue out far. Shane was diagnosed as having “moderate tongue tie”, which was what was causing Ng all the breastfeeding pain.
What is tongue tie?
Also known as ankyloglossia, a tongue tie is a structural abnormality of the lingual frenum, which is the strip of skin connecting the baby’s tongue to the floor of his mouth.
A normal frenum is elastic and does not interfere with the movement of the tongue when sucking, eating, when clearing food off the teeth in preparation for swallowing and in speech, notes principal speech therapist Wenggie Fong.
“When the frenum is short, thick, tight or broad, it has an adverse effect on oral muscular function, feeding and speech,” Fong explains.
Tongue ties affect 4 to 11 per cent of newborn babies and is often genetic. It also happens more in boys than girls, and can sometimes occur together with other congenital conditions, such as a cleft lip or palate. It is also linked to conditions such as severe hearing loss or cerebral palsy, Fong adds.
How is a tongue tie diagnosed?
Fong lists the factors that are usually considered:
* The appearance of the tongue and its movements.
* The mum’s experiences with pain, nipple injury, blocked ducts or mastitis during breastfeeding.
* The baby is not gaining weight, is vomiting and gagging during feeding.
* Lack of lingual mobility which affects speed and accuracy of tongue movements.
* Eating difficulties caused by poor coordination of oral musculature.
* Prolonged drooling.
* Dental problems.
* Unclear speech – in particular misarticulating tongue tip sounds such as “t”, “d” and “n”.
“It will avoid habit formation and the negative effects of messy or slow eating, funny looking teeth or speech problems.”
While Ng had issues breastfeeding Shane, Fong notes that it is not always possible to predict which tongue ties will inhibit breastfeeding, as characteristics of the mother’s breast also have an effect on milk transfer.
But she adds that the impact of a significant tongue tie on the ability of a baby to be breastfed is often severe. “The infant can experience as much discomfort as the mother – hunger, malnourishment, swallowing of wind, sleep disturbances, vomiting and reflux can be present,” notes Fong. “This can cause incessant crying and the inability to settle.”
Fong adds that breastfeeding in these circumstances can be anything but pleasurable or satisfying and can cause disappointment, sadness and guilt for the mother, and “it can prompt termination of breastfeeding and early weaning to the bottle.”
In addition, some infants may even continue to have problems on the bottle, such as dribbling, swallowing of air and vomiting. Many may also have problems coping with solids when they are introduced.
In the case of Shane’s tongue tie, Ng decided to wait till he was 6 months old to do a day surgery that involved snipping the frenum. “I didn’t want to do it earlier as I felt that he was still so small, and the paediatrician said that there was no rush as he had no problems taking the bottle.”
But Fong recommends early intervention if your baby has been diagnosed with a tongue tie. “It will avoid habit formation and the negative effects of messy or slow eating, funny looking teeth or speech problems, for instance,” she explains.
With no negative habits to eradicate, there is a much better chance of success in correcting the difficulties that poor tongue mobility has caused.
What treatment options are available?
There are four treatment options available to correct the structural anomaly of the frenum:
1. Snipping the frenum in newborns.
2. Surgical revision of the frenum under a general anaesthetic after 6 months of age.
3. Revison of the frenum by laser without a general anaesthetic.
4. Revision by electrocautery using a local anaesthetic.
In addition, a lactation consultant can help with correcting poor sucking and latch issues, thereby improving breastfeeding.
A speech-language pathologist can also help with speech and language problems, while a dentist can help with crooked or decayed teeth and infected gums. The post-recovery process can take anywhere from two hours to two weeks for most young children.
If junior has been presenting with any of the above mentioned signs and symptoms, speak to your doctor at once. If a tongue tie remains undiscovered or untreated till your child grows older, they may face several difficulties, such as the inability to chew solid foods, gagging, choking or vomiting, as well as dental hygiene issues.
They may also experience a delay in speech development and even behavioural problems. “They can lose self-confidence because they feel and sound ‘different’,” Fong says.
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