Prior to an initial consultation appointment, I correspond with the lactation consultant working with mom and baby in order to gain background knowledge on their sessions together. This allows us to work together to best gauge a baby’s progress (or lack of progress) in nursing.
If breastfeeding issues including inadequate latch, poor breast draining, painful nipples, fussiness at the breast, have not improved and a lactation consultant is concerned about a possible tongue tie, she will refer over mom and baby. Not to worry. As I’ve written in other posts, a tongue tie can be released by a procedure called a laser frenectomy. The resulting benefits I have witnessed in improved breastfeeding make the procedure well worth it.
The purpose of this post is to show you briefly how I examine an infant to determine if he/she has a lingual frenelum that is overly tight and therefore, restricting latching ability and suction formation while breastfeeding.
How I Examine A Tongue Tied Infant
Unfortunately, physicians and dentists are not specially trained in school on how to properly examine babies for tongue ties. Therefore, I have personally chosen to undergo training in this area and am passionate about helping moms and babies. Without proper techniques and knowledge, it is easy to arrive at the conclusion that a tongue tie is not present or not interfering in the breastfeeding process – when in fact, it may be. A posterior tongue tie, for example, is not visible to the naked eye and requires manipulating the base of the tongue for full visibility.
Here is a brief overview of my process, which shows the proper techniques I employ to arrive at a definitive conclusion on the existence, or lack-thereof, of a tongue tie in an infant’s mouth:
1. Proper Lighting: By using proper lighting and magnification, I am able to free both of my hands for gentle exploration of the infant’s mouth. Like many problems in life, shedding light onto the situation is the first step for proper problem solving.
2. Adequate Positioning: Positioning of the infant and myself is extremely important during this examination. The parent and I face each other with our knees touching. This creates a sort of “table” for the baby to lay on. I primarily have the baby’s head towards me, laying on his/her back.
3. Gentle Probing and Examination: My main goal during this assessment, is to establish the level of tension in the infant’s lingual frenelum as it relates to the surrounding tissue. I complete a number of exercises to measure the tongue’s range of motion and overall mobility. While doing so, I gauge the baby’s reactions (squirming is a tell-tale sign that tension is causing them discomfort). I also assess the labial (upper lip) frenulum which will turn white where it attaches to the upper jaw and create a dip in the upper lip if it is too restricted.
A Caution About “Do-It-Yourself Diagnosis”
While it may be tempting to attempt this examination on your own, I highly recommend that you allow a trained professional to perform it. Why? Experience is necessary to determine what level of tension warrants a lingual frenectomy and what does not. Diagnosis of a tongue tie is not simply based upon appearance – it is largely based upon symptoms experienced by mom and baby as well as tongue function.
I conduct a thorough examination of the baby’s mouth to determine if the lingual frenelum is causing interference in the movements that are important to proper latch and tongue function. While it is not certain that a tongue tie is responsible for your infant’s inability to properly latch or create suction, I have the experience in evaluating infants in order to make that determination.