7 November 2012

Posterior Tongue Tie

When it comes to breastfeeding, my first two children were pros. They latched on well the first time, which was immediately after birth for Charlotte.  Even with his more traumatic delivery, Kieran took to it immediately.  Both were above birthweight within six days of birth.  Yes, there were some problems (thrush, mastitis, biting, oversupply), but the children never had problems, really.

Because of that, I knew something was off almost immediately with Leo.  He had trouble latching at first, and feeding him hurt.  At first I assumed this was just because he was newborn and because I hadn't nursed a child in months, so I didn't think too much of it.  But then the same thing happened with every feed, and I could hear his tongue clicking during feeds.  He also developed reflux.  Thanks to various friends and blogs, such as Dispelling Breastfeeding Myths and The Analytical Armadillo, I knew some of the signs of the posterior tongue tie and I began to suspect that was the problem.

So at 3 days old, I expressed my concerns to the midwife.  She wasn't surprised, and told me to discuss it with the pediatrician.  The pediatrician appointment was at 6 days old.  Leo was 5 ounces below birthweight, which worried me given that the other two were above birthweight at that age.  I mentioned my suspicion of a posterior tie.  Unfortunately, the doctor wasn't familiar with posterior ties, just with the classic, anterior tie.  Since Leo could move his tongue, she didn't think he had a tie. I should note that I really like the pediatrician; sadly posterior ties aren't spotted as easily and so many doctors miss such ties.

Unwilling to accept that answer, I contacted an IBCLC.  When I enumerated the symptoms Leo had, she thought it sounded like a posterior tie and warranted further investigation. She gave me the name of a pediatric ENT.  It was a Friday afternoon, though, so I had to wait until Monday to speak to them.  In speaking with the receptionist, I discovered that the doctor doesn't take Medicaid (I hate that we're on it!), and suggested Nemours.  I immediately rang them and set up an appointment for Wednesday morning.  In the meantime, I went through a list of symptoms to note down I was seeing; incidentally, I ended up with a page-long list.  I was optimistic going in, but then the doctor looked in Leo's mouth and declared that he didn't have a tie because the frenulum didn't extend to the tip of the tongue and Leo could extend his tongue past his bottom teeth.  While those things are true of the classic anterior tongue tie, it isn't true of a posterior tie.  He then said he could snip it, but only under a general, which of course isn't recommended for such a young child.  Since he wasn't convinced Leo even had a tie, I wasn't exactly confident.  I was also none too pleased when he just suggested bottle-feeding, admittedly with my own milk, instead of resolving the problem.  The appointment ended with me in tears and him suggesting that we just wait and see.  I fed Leo and then wept the whole drive home, praying for relief for Leo and begging Mary to pray for him, too.

Once home my husband and I decided to phone the first ENT again and just pay out of pocket.  Amazingly, the receptionist said they could work in Leo this afternoon, so off we went to another appointment.  I didn't know what to expect, but the doctor came in and immediately recognized Leo's posterior tie.  In addition, he also spotted a slight anterior tie that I hadn't spotted.  He gathered the necessary instruments and, after applying a local, snipped the posterior tie and cauterized the anterior one.  He was pleased with the results, and we went home.  One of the first things we noticed was the absence of hiccups! Usually if he gets upset or in on his back, he gets violets hiccups, but he hasn't had them since the division.  His latch isn't perfect yet, but is definitely better.  Praise God!  I'm so glad the doctor could do it, and that I knew enough to keep looking for a doctor who would listen.


  1. Great post, great mom, snazzy detective work. I'm happy for all of you. Happy nursing!

    1. Thanks! Now to figure out the lip tie. . .