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. Additional ResourcesTongue 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.
10 Comments
Beverly Morgan IBCLC, FILCA
10/31/2014 04:40:35 am
There is so much to learn on this topic and this article puts together some pieces that otherwise might take weeks to learn.
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Stacie
10/31/2014 04:44:52 am
Thank you, Beverly! You are right, these are the baby-steps, right here. Your MOBI piece is an incredible overview http://www.mobimotherhood.org/tongue-and-lip-ties.html . Thank you for your work and willingness to share your expertise for the good of moms and babies (and adults affected by TT!).
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10/31/2014 11:04:55 am
Stacie
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Erin Mc
11/1/2014 02:32:42 am
How do you tell the difference between thrush and the phenomenon portrayed in #5? My son has had a TT and ULT release, but we have also been treating for thrush because of his white tongue, diaper rash, and my breast symptoms.
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Stacie
11/1/2014 03:10:42 am
Hi, Erin! It is still possible you guys are dealing with thrush, as well. Have you looked up pictures or oral thrush in infants? Often it looks like spit up or curdled milk in a baby's mouth, and it can be on the inside of the cheeks as well. The bottom is also where yeast shows up, as you mentioned, as a red rash -- sometimes around the mouth as well.
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Amanda
5/4/2015 11:14:37 pm
Can anyone tell me if their lip-tied babies seemed to always have their mouth open? Almost as if they couldn't move their top lip? I found info on lio ties because I was searching for info on why my son's mouth always seems to be open - he's almost 3 months old. I looked, and sure enough, he does have a lip tie and it seems pretty significant. It explains the pain and blisters I had in the beginning (gone now) and why he always pops off during a feeding and has such a shallow latch. So, I'm just wondering if his mouth almost always being open could be a result of the lip tie or if it's s sign of a worse problem (something neurological) I have my self so upset with worry so any responses would be appreciated! Thank you
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Stacie
5/4/2015 11:45:51 pm
Amanda, I am not a medical expert, but I have an idea. What you are describing is an open-mouth resting posture, when the mouth stays open. I don't think it has to do with simply the lip tie, it is more the combination of tongue and lip restrictions, along with the whys and hows of other issues that can come with that. When there is a lip tie, there is, by some estimations over 90+% also a posterior tongue tie. The tongue is supposed to rest on the palate, at the roof of the mouth. With a tongue tie, not only can this be very difficult, there is also a tendency for the tongue to thrust between the teeth, or stay low to the floor of the mouth. With a mouth that stays open, likely baby is breathing through the mouth when the norm is to breathe through the nose. This can simply mean a baby needs some additional help to get things straightened out for better alignment. Let me link you a couple of things:
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Ananda Lowe
2/14/2016 07:13:52 pm
An outstanding resource! I use it with my lactation clients here in Boston!
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