A Case Study
I saw a mum (let’s call her G) and baby (let’s call her baby F) yesterday and they were struggling with a variety of these symptoms. Baby F is 5 weeks old. She is developing perfectly, gaining weight well, and when her latch has been observed “it looks good” and feels comfortable for G.
G was understandably frustrated that she is being told everything is fine, yet still having ongoing struggles.
The main concerns for this family are:
- baby F not latching well initially
- taking a few attempts to get her latched on well and settled
- her often clamping onto the nipple and pulling back instead of latching
- struggling with lots of wind
The Assessment
On assessment, baby F’s latch did look pretty good, BUT G was having to hold her breast for the entire feed on one side, so baby F didn’t slip off. This leaves her at risk of both shoulder and wrist injuries.
It is sometimes necessary to shape the breast to latch a baby on, and when supporting a baby to improve their latch and tongue function, but this can’t go on for prolonged amounts of time without causing problems for the nursing parent.
If G took her hand away, immediately baby F slipped off. This was a huge red flag.
A baby under 6 months should have an incredibly powerful suck reflex. If you put your finger in their mouth they should immediately be sucking and very strongly.
This means, the tongue is elevated and the mouth closed when baby is both asleep and awake. Baby (and all humans) should breath through the nose. Baby F has her mouth open most of the time, and when we close it and encourage her tongue into an elevated position, it immediately loses suction.
On further assessment, baby F was holding some tension in her neck, which has a direct impact on the tongue’s ability to function. Her tongue function was impaired and her suck reflex poor. On assessment, initially she wasn’t sucking at all. Through doing some gentle body and oral work, her suck did improve during the 90 minute appointment. I was able to relieve some of the neck tension, but there was some residual tension. A cranio-sacral osteopath is the best placed person to address this, and any other tension in the body that will also be having an impact.
So what is the cause of baby F’s poor suck reflex?
It’s always important to look at the entire picture. Baby’s body, tongue, latch, and history.
Babies can have tension due to the position they are in as they move down the birth canal. If a ventouse/ kiwi or forceps are used, there is almost always tension. Sometimes this is also due to the position they are in, in the womb. Tongue tie can also cause tension.
Like all things with the body, it can take some trial and error.
From scoring on the ATLEF (most recognised tongue tie scoring system internationally), it indicates that baby F has a tongue tie. Though visibly this didn’t marry up.
Through my work and experience, I know that this can mean one of two things:
- the tongue tie is “hidden” in the tension, often called a posterior tie
- the tension is causing the poor function and score, and once the tension is relieved, the tongue function will be normal
Whatever the case, the treatment is the same. Body and oral exercises each day, 3-5x per day carried out by baby F’s parents. See the osteopath to support other areas of tension and imbalance. Then re-assess in 2-4 weeks.
The Treatment
If it is a “hidden” tongue tie, or posterior tongue tie, in this time, the frenulum should become more apparent and separate from the body of the tongue. This means that if the family chose to go ahead with a tongue tie division, then the frenulum would be the only thing that is cut/ divided, and no risk of accidentally cutting the tongue, which is both painful and causes un-necessary scar tissue.
This is why preparation work needs to be carried out before a tongue tie division. To both prepare the tongue and the frenulum. Meaning minimal pain, minimal bleeding, minimal scar tissue, and optimal function and improvement in the following weeks, months, and years.
If alternatively, tension is what is causing the poor tongue function, combining cranio-sacral therapy and daily exercises, this should resolve over time without any need for surgical intervention.
Conclusions
G was relieved to be listened to, have her concerns addressed and be told that something is indeed amiss, and not just “she is gaining weight, everything is fine” or “if feeding doesn’t hurt, then it is fine”.
You’re not going crazy. If something doesn’t seem quite right, then the likelihood is that your instinct is correct.
There are a variety of symptoms of oral dysfunction and tongue tie. Today we have covered only a few.
I’m Candy Elsbeth, I am a registered nurse, specialising in tongue tie and oral dysfunction.
I offer in-person consultations, where I assess and offer support for your individual needs, be them chest/ breastfeeding / bottle feeding and/or oral dysfunction + tongue tie.
If West Sussex is too far for you, I also offer virtual consultations.
If you’re not sure what you need, send me an email at [email protected]
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