June writes:

Please  please can someone help me  identify posterior tongue ties. What 
symptoms  are common?

What do you see / feel in the mouth... 
Is there more  visible damage to mothers nipples.


 ~~~
Hi June,
 
A great reference article is the one by Dr. Elizabeth Coryllos. It was  
stupidly removed from the AAP site, maybe someone here knows how to access it. 
I  have a PDF of it if needed. It lists manifestations of tongue-tie and 
shows  Cathy's finger palpating under a baby's tongue to feel for the 
restriction.  After years of working with Dr. Coryllos, and Cathy Genna, and lots of  
babies,  I make a few additions or clarifications to that article when I  
share it with parents. Depending on the extent, tightness, structure, and  
location of the tie, it may look like : baby cannot latch at all, baby can 
latch  but causes immense pain, damage and transfers milk poorly, or baby 
causes no  pain because the tongue is simply too weak to hurt mom ( weight gain 
may have  been poor resulting in low energy as well). When the baby cries, 
the tongue does  not move normally, when you play with baby's lower lip or 
position the baby with  chin to breast, they do not extend the tongue as they 
need to, or they do not  open their mouth wide, or both. They may "chew their 
way on" to the breast. They  often fatigue out, cry from frustration, fall 
asleep, or get really agitated  before they can finish the feed. They may 
gulp, cough, sneeze, etc as they have  trouble controlling flow, and may 
reflux a lot as well. They may stool  infrequently even with good intake. When 
you feel under the baby's tongue,  sometimes you can see a little band of 
tissue that feels like a really tight  fibrous piece of tissue with little 
"give" in it. It may be a band or be webby.  Posterior ties, in my experience are 
more likely to be thicker and tighter,  whereas some anterior ones are 
quite stretchy. Anything can happen though...:)  Also the tongue may feel like 
it cannot extend and groove well, and may "hump  up" at the back when baby 
tries to use it. One has to rule out other reasons for  some of these issues ( 
reflux, poor intake in general, past experience with  bottles resulting in 
either passive or reactive tongue use, low tone, poor  positioning, being 
rammed onto the breast or having the breast slipped into  their mouth by 
someone, etc.)
There may be things I've forgotten, but I have to get cat food...hope  
that's a good start.
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA

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