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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