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Alistair asked...

Tongue tie issues

Hello, four weeks ago my wife gave birth to our baby son and has been exclusively breast feeding him since then. The problem is that her nipples have been very painful and the pain does not seem to be easing. Various health visitors, midwives etc. have suggested various options (e.g. thrush treatment, which seems to be working to a certain extent) and on Thursday our son has a tongue tie "division" performed. The consultant also said that he has a lip tie which looks more severe but they are unwilling to treat that for another two months due to the general anaesthetic required. Two months for my wife seems an awfully long time due to the pain she is experiencing but she obviously wants to continue breast feeding as it's best for the baby! I was just wondering what AXA PPP would recommend in this situation. Various resources seem to suggest that the general anaesthetic is not absolutely necessary for this procedure and I was wondering whether it could be performed sooner? I do have private health insurance with AXA PPP through my work. Thanks very much.

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The answer

Many thanks for contacting us with your enquiry and congratulations on the birth of your baby Son.

Up to 11 % of babies are born with tongue ties and the severity of these tongue ties can affect how the baby feeds and also speech development. Depending on the severity of the tie depends on whether surgery is recommended. In the case of your son and the difficulty your wife has had with breast feeding it has been felt necessary to perform this to allow the tongue to move more freely.

We suspect that the trauma that your wife has had to her nipples and areola is as a result of the baby suckling incorrectly and this has then led on to the nipples becoming sore, cracked and possibly infected. If thrush is present both the baby and mum will need treatment in order to stop the infection.

You tell us that your wife is still breast feeding and this we would encourage as it is more beneficial to your baby for nutritional, emotional and infection prevention needs. Your wife may find that now the tongue tie has been treated that your son will be able to latch on the breast better and feed better. We would encourage your wife to seek assistance from a Lactation consultant/ Midwife and Breast Feeding support Clinics and agencies. We will give details of agencies etc. later on in my reply.

It is important that your wife is relaxed and supported when feeding as breastfeeding is a skill that needs to be learnt, and it can take time and practice to get the hang of it. There are lots of different positions for breastfeeding. You just need to check the following points.

•Are you comfortable? It’s worth getting comfortable before a feed. Remember when you feed to relax your shoulders and arms. •Are your baby’s head and body in a straight line? If not, your baby might not be able to swallow easily. •Are you holding your baby close to you, facing your breast? Support their neck, shoulders and back. They should be able to tilt their head back and swallow easily, and shouldn’t have to reach out to feed. •Is your baby’s nose opposite your nipple? Your baby needs to get a big mouthful of breast from beneath the nipple. Placing your baby with their nose level with your nipple will encourage them to open their mouth wide and attach to the breast well. How to latch your baby onto your breast 1. Hold your baby close to you with their nose level with the nipple. 2. Wait until your baby opens their mouth really wide with the tongue down. You can encourage them to do this by gently stroking their top lip. 3. Bring your baby on to your breast. 4. Your baby will tilt their head back and come to your breast chin first. They should take a large mouthful of breast. Your nipple should go towards the roof of their mouth.

How to tell that your baby is getting enough milk:

  • Your baby will appear content and satisfied after most feeds.  
  • They should be healthy and gaining weight after the first two weeks. 
  • Your breasts and nipples should not be sore.  
  • After the first few days, your baby should have at least six wet nappies a day.  
  • After the first few days they should also be passing at least two yellow stools a day

Support links which may also help are:

  • The Breastfeeding Network 
  •  National Childbirth Trust 
  •  La Leche League

We hope the above information is helpful in helping your wife breast feed more successfully now. Obviously if this is not helpful your wife could always express her breast milk and give it to your son via a bottle. Breast milk can be stored in a fridge for 24 hours and in a freezer for up to six months.

You mention that your baby also has a lip tie- the procedure that is being considered is a frenectomy. This is a similar procedure to having the tongue tie corrected. This procedure is done if babies are still having trouble feeding but also because it can affect dental development/ tooth eruption and growth.

Research we have done suggests that this is generally done later as there is possibility that the tie can break naturally as the baby uses his mouth more effectively. The procedure seems to be done more under General Anaesthesia than Local Anaesthesia. We would suggest discussing with the surgeon the pros and cons of waiting and in relation to anaesthesia used. There is some thought that as the baby is likely to have teeth erupting or present that it is more difficult to perform this under local anaesthesia.

In relation to cover for surgical treatment we would suggest you discuss your policy cover with your policy team.

Answered by the Health at Hand nurses  

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