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Saturday, February 25, 2012

Posterior Tongue Ties

Our community is getting better and better at recognizing "anterior" tongue ties. Now that more and more mothers are standing up for their right to breastfeed, I run into a wider variety of issues. I am suspecting that we are discovering more posterior tongue ties that are not as easy to recognize as the obvious anterior tie.  Posterior-ties cause lengthy feeds, tight, clenching latches, sore nipples, and poor transfer of milk, shield use. If you are having latch problems or help mothers who have latch problems here is a quick video to help you learn more about this.

I want to stress that I don't diagnose tongue-tie based on what it looks like. Well, I do, but the most important criteria for diagnosing tongue-tie is the description the mother gives:

Sore nipples
open wounds
better with a shield

reflux, food/stomach sensitivity
poor weight gain
lengthy feeds
intense baby
clenching down

It is still common for your health care professionals to not recognize anterior or posterior tongue-tie. It is up to YOU to take responsibility. In most cases your pediatrician is not going to take the lead with this. If everything else your Leader or LC has suggested has not helped your situation, consider tongue-tie. It is not always an easy diagnosis. Learn about tongue-tie and pursue treatment if you still feel, it may be what is going on. The sooner you get treatment and prevent further deterioration of breastfeeding (bad suck habits, low milk), the better off you will be able to provide breastmilk to your baby. Will babies out grow it? Some will. Only if the symptoms are mild...maybe will babyout grow it.

Posterior tongue-tie is easily treated in the office within minutes.

Most of the time no further treatment in the office is necessary.

Here is a link to learn more

Recent Feedback:

"My son was born tongue-tied on January 6th. The LC at the hospital was the only professional willing to "diagnose" him and explain our options. I wanted to breastfeed, and every session took approximately 90 minutes to drain both sides. With an 18 month old daughter too, I was beyond frustrated. I was guided towards an ENT specialist who wanted to put him under with full anesthesia as an outpatient procedure. I followed my mommy instincts and went to Dr Punger. She clipped him so simply and he latched on instantly. I cannot express how grateful I am for her care."

"When I went to see Dr. Punger, I was really not thinking tongue tie, but reflux for my 6 week old baby. I was very sore from the baby clamping down so hard on me. She had to suck very hard to compensate for the difficulty in swallowing that the very subtle posterior tongue tie caused. This caused gulping, gas, reflux, and her never seeming to get enough though I could see the milk dripping from me. Her strong, tense suck also created over active let down and foremilk/hindmilk imbalance=green, explosive diapers. Since the tongue clipping, baby is nursing so much better, finally gaining weight, and is smiling and cooing! Dr. Punger sent me home with some websites, my dh and I did the research and recognized that this was the issue. We acted pretty quickly because of the pain I was in. Dr. Punger clipped her tongue just before her growth spurt where she nursed every 1.5-2 hours and I'm so grateful! She put on nearly a pound within 10 days."


Lora said...

If you are still monitoring comments, I'd appreciate any help you might be able to offer. When I was diagnosing my second child's posterior tongue tie (because none of the medical professionals would diagnose it, or even admit that they didn't know how to do so), I found a website that listed the few practitioners, mostly pediatric dentists, who treated posterior tongue tie. Dr. Kotlow in Albany, NY was one of them, and the one we chose to use to treat our son's tongue and lip ties after finally getting a diagnosis after 5 months of excruciating breastfeeding.

We are expecting our third child and now living in Colorado. Since both of my children have had lip and tongue ties, albeit less severe for my first, I want to be prepared, which includes knowing the nearest practitioner who will treat the ties. Do you know of any sites collecting names of practitioners, or, might you know of anyone in Colorado or the nearby states who does treatment on newborns. I will, obviously, also be securing the name of a lactation consultant who knows how to diagnose these. I am committed to not wasting 5 months in search of diagnoses this time around.

Thank you for taking the time to read and for any help you can provide.

Denise Punger MD IBCLC said...

Hi, I still monitor and I went to observe to Dr. K.
I love that you are preparing ahead! I will check on several of my groups for you. Another option is to ask. Dr. K if he has any doctors from your area come to his trainings.

I try to keep up with the dentists and "tie" in the breastfeeding support and primary care. If you need some help on that end- even from long distance- I may be able to arrange a phone consult.

I will let you know if I find out anything.

Denise Punger MD IBCLC said...

Responses that I got:

Fred Margolis If she's willing to come to Chicago, I would be glad to help. www.fredmargolisdds,com.
Happy New Year!
Yesterday at 6:13pm via · Like · 2

Jennifer Tow There are some folks in Utah-- Susan Johnson, some on Oregon..Bobby Ghaheri and in AZ. Not sure what would be closest.
Yesterday at 6:13pm · Like

Stacy V Cole Google LANAP COLORADO to find dentists with Nd:YAG lasers. Ask if they would do a frenotomy. If they are not familiar, give them links to Dr. Palmer's and Dr. Kotlow's websites and videos.
Yesterday at 9:27pm · Like

Amy Surette said...

Dr. Punger,
I am struggling with this topic for my 6 week old son, and am being pushed in circles between different types of doctors. between my research, and a visit with my lactation consultant, all signs point to posterior. I was wondering if you might be able to assist me with knowledgable doctors in Maryland and neighboring states. (including DC). Thank you so much!

Denise Punger MD IBCLC said...

Amy, I asked my group if there is someone in your area. Did you feel like you may want a phone consult with me to sort out some of your options or breastfeeding concerns?

Annette Skowronski,DDS, FAGD said...

I wasn't aware that so few practitioners were willing to do tongue and lip tie releases, including the posterior submucosal tongue tie. I am a family dentist in southeast Michigan with 27 years of clinical practice and 10 years of laser experience and I am more than happy assist mothers with their nursing infants and toddlers who have lip and tongue ties. The earlier the better!

Annette Skowronski , DDS, FAGD
Member Academy of Laser Dentistry

Mirine Dye said...

Great article, I referenced this for a new mother I saw today , I hope it will help her understand all that I was explaining to her, thank you! :) Mirine Dye, MPH, IBCLC Miami

Mirine Dye said...

Thank you I referenced your article today for a new mother. I hope she finds your site and it offers her some insight!

Mirine Dye, MPH, IBCLC

natalie said...

My 4month old had her posterior tongue tie and upper lip tie corrected a month ago. She was gaining fine, but had excessive gas, poor, weak latch, could not flange her upper lip correctly, slipped off the breast, etc.

We drove four hours to find a competent provider who could revise her tongue and lip tie with a laser. General anesthesia is NOT required! This is a very MINOR procedure. It was quick, maybe five minutes.

The BEST thing for someone to do if they suspect tongue or lip tie is to join The Tongue Tied Babies Support Group on Facebook and read the pinned post which lists all the potential signs and issues with ties. Then post a picture and get some feedback from all the been there, done that mamas, LCs, and docs who are on the page. Then, look at the providers list, and if at all possible see one of those providers. Many ENTs, pediatric dentists, etc, do NOT know how to diagnose a posterior tongue tie, and many do not revise enough. Seeing somebody with experience is SO important. I am so glad we drove the four hours to find someone who had the skill to find her posterior tongue tie and agree that it needed revised. She is nursing so much better. :)

Rachel LaGravinese said...
This comment has been removed by the author.
Rachel LaGravinese said...

Hi Denise, I saw that you responded to Lora about some practitioners in Arizona. My daughter was recently diagnosed with posterior tongue tie and lip tie, and I'm searching for good support in Arizona. I hope you can point me in the right direction! Thank you! (Please reply at I'm not sure if I will be notified of your response via your blog, and don't want to miss it!)

Denise Punger MD IBCLC said...

I may have done a phone consult with Lora. Two days ago Natalie posted the most current list/resource. So come back and check the prior comment. Also call your local La Leche League for a referral. I don't post much here anymore. I am at Punger Family Medicine on facebook.

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