When wondering if your baby might have a tongue tie or lip tie, many questions arise. Shared here are some visible, physical features babies with Tethered Oral Tissue may manifest. In dialoguing with hundreds of moms, these seem to come up again and again. These tips can also be helpful for doulas and other first-responders helping breastfeeding moms in the early days.
Before we begin, a few notes:
Image 1: Lip blisters are often thought to be a normal part of nursing, but these can actually be a sign of something more. That cute little callus under your baby’s philtrum could show he has to compensate with extra lip-grip versus being able to stay latched to the breast via a well-moving tongue and lip combo.
An upper lip that doesn’t easily fan over the breast often folds (image 2) or tucks (image 3) during nursing. If baby has what I term “smeared lipstick mouth” after nursing, this shows the lip didn’t flange as it should. Of course this can be positional, as well; if this frequently occurs, even with increased attempts to improve baby’s latch, it can be something to super sleuth.
Image 2: Accordion fan of a tight lip – see that horizontal line under the nose? Instead of opening to the breast, the upper lip folds. The crease will show as a red line once baby unlatches, as in image 1.
Image 3: Another compensation for a tight upper lip is that it tucks inward. Some moms can manually turn out the lip by sweeping with a finger; other moms report the lip seems to turn into a tight band of tissue that is difficult to manipulate – it depends on the flexibility of each baby’s frenulum and lip.
Image 4: An easy way to get an idea of potential for tongue tie is to flip the upper lip and see how the frenulum attaches to the gums. This is less invasive than digitally checking your baby’s tongue. Many professionals agree, 90% of the time there is an upper lip tie, there is likely a posterior tongue tie. This can be a key in deciding how to proceed.
Figure 5: “Two-tone tongue” is a phrase Cathy Watson Genna shared with me when I mentioned something I noticed on my own baby. It is often mistaken for thrush, but often there is a line across the tongue, unlike thrush which can come in patches and doesn’t seem picky about where it develops. If the tongue has impairment in function, it doesn’t get the normal help shedding cells (think about a tongue scraper), and the white color reflects that.
Figure 6: Another low-hanging fruit feature is how a baby’s palate looks. When a baby cries, yawns, or is just hanging around, you can often take a peek to see his palate. Ideally, the palate is a horseshoe-shaped, wide surface, because proper swallowing and tongue movements shaped it before birth. Babies with restrictions often have vaulted palates – arch, bubble, channel, or otherwise, due to their inability to make these ideal movements.
Figure 7: I don’t know if there is a technical term for this, but many moms report their babies have “tongue dents.” These dents can occur as the tongue is being pulled by the underlying restrictions.
Figure 8: When crying, a baby’s tongue may curl or cup up. Again the force of the restriction is controlling the range of the tongue’s motion.
Figure 9: If you feel brave enough, and baby complies, you can try to feel for the frenulum yourself. Your baby may be upset by this, but as his parent, your fingers will be the most comforting to him – so if you are really wondering what’s going on, get in there and see for yourself. Place baby in your lap with his feet at your knees and come in from above his face. Gently use your index fingers to try and lift his tongue...and better if you have a partner ready to snap some pictures.
I don't claim to use proper terminology. I always welcome feedback and corrections. Find me on Facebook.
Much appreciation to Dra. Kelly Marques Oliveira, IBCLC, for translating this into Portuguese.
Tongue Tie Babies Support Group, on Facebook. A peer group with over 20,000 members. A great place to learn local option, ask all your questions, and get support from other families impacted by ties.
Advocates for Tongue Tie Education (ATTE) is a group for parents and professionals. Resources on their website include parent info sheets, educator packets, provider toolkit, and a tie gallery. They also have a Facebook group.
Catherine Watson Genna is a treasure trove of information. She is a woman with vast experience and an inquisitive mind, and she offers her knowledge on her website, in books and papers she authors, and in presentations that she travels around the world to share.
Dr. Bobby Ghaheri has been exploding with informative, relevant blog posts. He is not only an incredibly experienced ENT who performs revisions, he is also a father and husband whose introduction to the world of ties came through his wife and baby.
Dr. Larry Kotlow has a great site that can be a starting point for any parent looking for pictures and presentations.
Beverly Morgan is an IBCLC who wrote an exhaustive article full of tons of links, and she shares her own experience of revision as an adult.
Dr. Brian Palmer made extensive contributions to the world of breastfeeding and infant oral health. His website addresses ties, palate and jaw development, caries, and more.
International Lactation Consultant Association is the best place to find an IBCLC who can assess and evaluate a breastfeeding dyad's situation.
International Affiliation of Tongue-Tie Professionals (IATP) is the leading professional organization, and IATP offers resources for parents as well.
With my 4th and final baby, after some conflicts with finding a local hospital-based midwife and hospital I was comfortable with (we had moved away from our homebase of fabulous midwives), I chose to birth at home with a licensed midwife. I was offered a few names by families in the area, but one name kept standing out: Linda Cowley.
If I was impressed by my hospital midwives and their relaxed ways in the office, being at home for my prenatal appointments was even better. When I told Linda I wasn't sure if I wanted to do the gestational diabetes lab work, she encouraged me to trust my gut and make the decision I was comfortable with. Knowing she trusted me to make decisions about my health helped me trust myself. I do believe we have inner wisdom that guides us, and this was a way I could build that up instead of the scare-tactics and what-ifs that often push us into making choices we don't feel good about.
Something I still find amazing is what was going on behind-the-scenes when I was in labor. I waited until 5:30 am to call Linda as I didn't want to wake her too early; little did I know, she was already awake because she had another mama in labor. This other woman had a history of fast labors. I am so grateful Linda was calm and selective in what information she shared with me that morning, meaning, she didn't say, "Oh, I was already up because another client is in labor." I would have panicked! Instead she said she would get ready and come see me...and we live about 45-ish minutes apart.
With my third baby, I returned to the same practice of midwives I loved. When I went into labor, the midwife lived about a half an hour out of town. I called their answering service at about 7 at night. She was soon on the phone and she asked me, "Should I come to the hospital now?" I didn't want her to drive down if things weren't going yet; I told her to wait until I or a nurse updated her from the hospital. Carolyn decided to come down the hill anyway. Shortly after I was settled into my room, she walked in, and I felt an immediate release of tension I didn't know I was carrying.
After witnessing the incredible midwife-assisted birth of my nephew, I did, indeed, avoid an OB the next time around. We moved when I was 7 months pregnant, and I had this idea I would return the three-hours home to have my baby with the original midwifery group I started with. After a few trips, though, I decided I was finished with the traveling, and traveling in labor would be even worse. I found a midwifery practice in my new town of Chico, CA.
At my first appointment I was struck by how quiet the office was. I liked that I checked my own weight and dipped my own urine -- I was trusted to report my own findings and they were noted in my chart. I had my almost-two year old with me, and I was worried he would be a burden and get us the nod of disapproval from this office; instead, at my first appointment with Karen, she had a puppet on her hand with which she entertained Jacob while she and I had a great discussion about my fears and concerns. She took a full hour with me that first appointment, and the office immediately scheduled me weekly so I would have a chance to meet all three midwives.
When it came time for the birth, I knew it would be one of the three on-call for our hospital birth. I soon learned it was Karen, and it all just felt right. She was there with me during my labor and drawn-out pushing phase (as my baby was posterior-born, weighed 9 pounds, 9 ounces, and took 90 minutes to push out). She never rushed me, she helped me try different positions, and she filled the room with positivity when it seemed I was cursed to push forever.
There are two conversations we had during prenatals that have never left me.
The First Midwife I Ever Met...
The first midwife I ever met was Sharon, the amazing Sharon. She was my sister's midwife, and my sister was three months behind me -- we were both pregnant with our first babies. My sister planned to have her baby at home, and I planned to have a traditional hospital birth with a female OB -- I thought that would close any gap there might be between me and a doctor.
I actually knew Sharon before she became my sister's midwife -- we went to church together. She was a good friend to me while I despairingly tried to get pregnant. Sharon understood the depths of worry and sorrow I experienced. She truly offered me empathy when others were telling me to just "relax." Because of our relationship, once I was pregnant, I brought all of my questions to her.
I don't think I knew enough about birth in general, and homebirth specifically, to think my sister's plans to birth in her bedroom were anything short of crazy. I was able to be there at her birth, and although she did birth in the hospital due to her water breaking 5 weeks early, the difference between her experience with a midwife, and mine were burned into my brain. As Sharon massaged my nephew's head out, gently coaxing, "Come on, Baby, your mama still has room to stretch," I felt a thousand tiny knives pierce my heart for the loss of that kind of nurturing during such a miraculous, life-altering experience. That was when I decided I would never birth again unless I had a midwife assisting me...and the next time I did birth in the hospital with a midwife.
All my love, appreciation, and gratitude to Sharon and the amazing way she served families for years by helping them birth safely within the walls of their own homes. She will always be treasured by our family.
These pictures are from the triumphant homebirth of my sister's second baby.
I have doula clients right now I LOVE. This is the first official birth I have taken since Ezra was born and we moved away from Chico. They are an awesome couple, and I can't wait for their birth! At our first meeting, the mom shared her birthplan with me. While she knew the importance of advocating and working to make decision that would shape her experience, she wasn't sure how to best format her birthplan. To get the ball rolling, she formatted her plan after a template a relative used.
While I love birthplans as it gets mom and partner talking and on the same page, there are lots of things I don't like about them -- the biggest one being, when they are offered up like a terrorist's list of demands to hospital staff (I am sure I have Teri Shilling or Connie Sultana to attribute that to). Looking for a more engaging, palatable way to offer one's wishes for birth is something I whole-heartedly agree with. Along those lines, I came with a few examples of birthplans for this couple to contemplate.
I have to admit, I found this picture-birthplan in a doula group online, and I am still working on citing that doula to give her credit -- once I have it, I will post it here. My client borrowed this template to use for her birthplan, and she shared it with me last night. See, I am there, as is our back-up doula, who has also been invited to the birth...we both have bags, although my back-up's bag is lost in her mane of gorgeous hair!
Now, which birthplan is more appealing to you? Which one says, "I am a Type-A personality, trying to control every aspect of birth?" Which one says, "I am fun and flexible!" Which one invites help and support? Which one might contribute to defensive or negative feelings?
Most of us know we can't control everything about birth -- and we do know our choices shape our memories -- even when things don't go exactly as we imagined. When crafting your plans for birth, get creative, be different, and don't be afraid to show your personality!
♥ four young boys and a boy dog (offspring)