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Wednesday, June 25, 2008

Tongue-tie in the Newborn

I wrote an article about my background experiences with tongue-tie, a minor condition which can be an impediment to successful breastfeeding. I've also included a version of this article as a chapter in Permission to Mother.

As the community is becoming more educated on tongue-tie and the impact on breastfeeding, I get calls from furthur away with seemingly more complex issues.

"Before, I drive 3 hours to see you with the baby are you sure you can treat the tongue-tie in your office? The ENT (or Pediatrician) said my the procedure could only be done under general anesthesia in the OR. He said he could not do a posterior tongue-tie in the office."

Usually with a motivated mother, in the abscence of co-existing conditions, a simple release of a tight frenulum in the office makes all the difference in the world as far as breastfeeding goes.

Satisfaction rate is high, but a loyal reader can imagine that I can't guarantee 100%satisfaction when I haven't seen the problem. The biggest problem is not the "condition," but is the societal belief system that these problems can't be treated easily.

In addition, I don't classify tongue-tie as anterior or posterior. I don't use the other common classification of third degree or fourth degree.

I am not sure who uses that terminology--ENT's and PEDS or ACEDEMICS? Just to make the breastfeeding issues sound more complex and confusing and discouraging? I have also seen these terms accepted and discussed on the Academy of Breastfeeding Medicine's physicians professional group and on holistic mothering community boards, but clinically in real life, classification of severity is not important is not relevant. At least not to me.

The way I look at it is, if it interferes with breastfeeding, I cut it. Pretty simple. I decide the severity on how damaged the mothers nipples look or babies difficulty in gaining weight, labeling and classification on physical characteristics of the tongue-tie doesn't mean much (except to build more maternal fear). It's a simple office procedure. After I snip the frenulum a complete assessment of breastfeeding can be done by me to optimize latch and I can also treat the mother's saw nipples and follow through through resolved. Period.


megan said...

I can say 100% having Ava's tounge clipped was the best thing for us both, she was less then a week old when Dr Punger did it. I cried for her and she didnt even make a peep. My nipples healed quickly and breastfeeding has been great ever since.

Munch75 said...

I was born tongue-tied (cut when I was 5) and so was my son. I later found out my dad was tongue-tied as a child too!

I was very thankful Dr. P was able to take care of this in her office without any issues. Hubby helped hold down my 2 day old son while I sat in the corner and cried ... my son wasn't fazed and he nursed immediately! :) It only took me a few minutes to compose myself! hehe.

Trish Chibas said...

Wow! I thought being tongue tied was a lot more complex. I thought it required surgery. Shows how much I know. At least now I know if my next child is tongue tied it won't keep me from breast feeding. Thanks for the info!

Permission to Mother should be studying said...

Megan, I am so glad to hear how well you and Ava are doing.

You and Munch reminded me of something else I wanted to share: All the mothers have more tears than the babies. I have noticed this over and over and can prepare the Moms for the flood of tears. Fortunately it is a very quick procedure and the baby can go right back to Mom and be comforted and nurse. For the baby it's over and there is no post procedure care except to NURSE!

I am glad you are all on blogger now!

Ann Kelly Parkhurst said...

I have been following your blog for a few weeks now and have a question on this topic. My son never nursed well, and I asked about his tongue being tied and they looked at the hospital and said no. We fought the nursing for over a week and a half before my milk came in, I meet with many people and finally just pumped after 3 weekes of a screaming newborn up to 20 hours a day he was treated for reflux then the crying and hurting conitnued so he was put on a hyproallgic formual and with in two bottles of hte new formula he was sleeping for several hours at a time and was happy for the first time in 8 weeks. This was not the route I wanted to take but after seeing him hurt for almost 2 months it was best for our family at that time. Now to the tougue tie questions :) My son is now 20 months old and not speaking "words" he talkes all day but nothing we understand and I have wondered if he could be tongue tied, what are your thoughts? I amd a reading teacher by trade and now stay home with my little guy and we read and play together all day.

Permission to Mother should be studying said...

My experience with the medical community is that most professionals insist that tt does not exist or to deny that tt interferes with bf. Why? We learn nothing of tt in training. My first exposure to tt was when my
2nd son was obviously tt and I was told then that they aren't treated.

My patient today told me that two pediatricians didn't believe snipping the tt would help. Well, guess what... she noticed an immediate improvement.

Many moms of two year olds (24 month olds) wonder if their child is speech delayed. Many are just learning words at 2 years old. That is not a concern to me. (20 months old doesn't concern me.)Without seeing your son's tongue, I would not know if tt is an issue. From his earlier history, it sounds like a possibility. It doesn't sound like you had anyone medically knowledgeable about bf around you for advice.

It is also a common for pediatricians to prescribe daycare attendance to help a child’s speech. From reading my blog, you would know that I don't agree with that. That's another topic...

turtlewomyn said...

Dr. Punger cut my daughters tongue tie back in 2005 when she was about a month old. Prior to that I was in pain, had mangled nipples, and she wasn't gaining enough weight to satisfy the pediatricians. I was told by three different doctors that tongue tie did not affect breastfeeding, but they could do the tongue tie clip in the OR under GA. Thank goodness I found Dr. Punger. My daughter is still nursing (she is two and a half!). We have moved to North Florida since that time, but I have said it before, and I will say it again, if I ever have another tongue tied infant you can bet I will drive six hours to have Denise clip it (provided I can't find anyone closer!). It made all the difference in the world for us.

susan said...

My son is 12 days old and is tt. His doctor does not want to clip it because he seems to be nursing just fine now. The doctor wants to wai to see if the tt will affect my son's speech before clipping bu I don't want to wait for speech problems to arise. Should I insist on he clipping?

Permission to Mother said...

Hmmm.... not sure how to answer on-line. I don't know where you are froma nd what your local resources are. If you still have questions, will you call the office?


Anonymous said...

My 2-yr old son just had a lingual frenotomy done by Dr. Punger on October 31, 2008. It took less than 2 minutes, and it was not painful for my son at all. I took him home and there still was not any pain for him. ...I am very greatful for coming across Dr. Punger's website. ...When my son was in infant, the doctor advised me that he had a short frenulum and his tongue was shaped like a heart. However he told me that the frenulum will stretch on its own and I had the choice to have it snipped or not. Well looking at my precious 1 day old son, I did not choose to do the procedure at that time believing that it was not a necessity. However, I had I known that his speech would suffer from not having it done, I would of done it at the time. I began to notice that his speech was not as clear as the other 2 year olds I came into contact with and that is when I started to research about it on my own. I began to think about his tongue and what the doctor said when he was an infant so I spoke to his pediatrician and she recommended that I take him to an ENT. However, when I came across Dr.Punger's website. I read her curriculum vitae and her personal story with one of her own children and I figured she would be the best person to do the procedure. That is when I cancelled my appointment with the ENT. I am extremely pleased with Dr. Punger's procedure on my son and I will keep in touch with Dr. Punger to let her know how my son's speech is developing. Thank you Dr. Punger and if anyone else is pondering about the procedure because your child is past the infant stage, do not wait---get it done, you will not regret it and it is quick and painless!!

Beth said...

I have a 3 month old who is tongue-tied (Our awesome LC diagnosed him, after weeks of him losing weight and not nursing well) - but he has no frenulum to clip. My older boys also don't have them, but they had no difficulty nursing (they nursed for a combined 7 years). I have an appointment with an ENT in early December (soonest I could get in); this is the second ENT I'll have taken my son to see; first one didn't help much at all. My ped doesn't think there's anything wrong either, he's satisfied because the baby's gaining weight through expressed breastmilk bottle feeding.

My question for you - are there some resources I can give this second ENT so that I can get the help I need? I have an article by C.W. Genna, but think I'll probably need more than that.

Or is there someone you might recommend in Madison, WI or nearby?

I desperately want to fix this nursing relationship, I cry regularly over this.

Permission to Mother said...

Beth, I don't know how close this is, but I would try contacting Anne. I know her through the Academy of Breastfeeding Medicine. She does evaluate breastfeeding, tongue-tie and she does frenotomies. Probably worth the trip:

Anne Eglash MD
Clinical Associate Professor
Dept of Family Medicine
University of Wisconsin Medical School
600 N. 8th St.
Mt. Horeb, Wisconsin 53572
608-437-3064 (O)
608-437-4542 (Fax)

If you follow my link in this post to "my experiences with tongue-tie" I have three scientific links listed at the end.

I can let her know to expect a call from you if you like me to tell her.

Anonymous said...

I have a 6 mo old daughter that according to her pediatrician has a slight tongue tie. We had significant difficulties breastfeeding in the first 6-8 weeks, my daughter has not gained weight well, and she has significant food intolerances, which I have read can be linked to tongue tie. Apparently I was tongue tied at birth as was my father. Can you recommend any doctors in the San Francisco area that are experienced with tongue ties and that may clip it if we decide that is what we want to do?

Permission to Mother said...

Hi Anon in SF.
I have a great contact for you! Please get your baby evaluated. You will be so glad you did. Hopefully you noticed the rest of my blog in which I discuss elimination diets and food sensitivities quite a bit. You can have the baby (and yourself)tested without a MD script at Here is my contact for you.

Amy E. Evans, M.D., F.A.A.P., F.A.B.M.
Associate Clinical Professor of Pediatrics, UCSF-Fresno, Fresno,CA
Peachwood Pediatrics : ph (559)324-6203 fax (559)324-6282
Medical Director for the Center for Breastfeeding Medicine and the Mother's Resource Center at CRMC ph (559)459-6288 fax (559)459-2148

Permission to Mother said...

Linda Shaw MD
Freedom (Watsonville) CA

alphajenomega said...

Hi there,

My 6 week old daughter is tongue tied. We had her 'posterior' tie clipped by Dr. Wesman in Oakland, CA three weeks ago, but it is still thick/tight and I am still having nursing problems because she doesn't extend her tongue over the gumline.

Unfortunately, it is their policy to clip only 1mm without using general anesthesia.

Is there a doctor anywhere in the San Francisco area that is experienced with this type of tongue tie and is willing to just clip it further (in office)?

Permission to Mother said...

Have you called the San Francisco LLL? Perhaps they canhelp you find someone.

alphajenomega said...

I have been in touch with the LLL, the Nursing Mothers Counsel and countless others and all end up being dead ends. I'll look into Amy Evans in the meantime.

Permission to Mother said...

Amy Evans is ggod. Nancy Wight MD IBCLC is a Neonatologist at Sharpe (sp?). Is that nearyou?

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