Lip tie and tongue tie - HELP!

[TruthSweet]

DD4 was born late Friday night and fed in delivery room (7 sides!). I noticed she wasn't latching on terribly well but put it down to mec. swallowing and the pain relief I had during my induction (remifentanil PCA - an opiate that has a 7 minute half life in adults and slightly longer in neonates). Biological nurturing didn't work for her (feeding reflexes sluggish though she was very alert) so I latched her on myself in cross cradle.

On the ward she did a blow out mec. nappy and during the nappy/clothes changing crying I noticed she had a quite a thick lip tie. I did Murphy Maneuver and could feel a posterior/sub mucosal frenulum though that was quite thin. She latches with her tongue back although she can stick her tongue out slightly. Ward MW reluctantly did a referral to the TT clinic but couldn't say how long it would be.

I am now exceptionally sore - bleeding, cracked, blistered nipples - and each feed results in wedge shaped nipples with a ridge running over the nipple. I have done exaggerated latch, and am changing feeding position fairly frequently so that the same part isn't getting all the damage. I have lansinoh and am doing moist wound healing but it's not yet working.

DD4 feeds on average 6 sides per feed (I swap sides when she stops suckling but she clamps down with her jaws). The feeding is pretty ineffective as on average she does 7 sucks per swallow, with breast compressions this does get better but still 3 or 4 sucks per swallow. She doesn't open her mouth very wide either. She had 7mls of ante-natally expressed colostrum by syringe on her 2nd night as she fed from 11pm to 6am but she fed straight away afterwards.

She is very mucousy and throws up a lot inc. a spectacular vomit that projectile shot out of her nose and mouth at the same time! She also burps a lot. Her poo was greenish yellow on day 1-2 has been profuse - 8 large poos in first 24 hours - though they are getting smaller and more yellow and is weeing well too.

Is there anything else I can be doing to help her? My brain is slush and I can't think properly. Sorry for epic post but I didn't want to miss any thing out.

[RedKites]

Congratulations on your DD!

I'm sure someone more knowledgeable will be along soon. It sounds like you're doing all the right things. If you haven't, is it worth giving biological nurturing another go, just to see if it gives a better latch? When you're doing an exaggerated latch, are you doing the thing where you flick her lip out (if necessary)? If you scroll down to just before the photos this describes what I'm talking about. Also is it worth talking to your community midwives and/or any contacts you have through the support work you do, to confirm how long the TT referral will take, and see if it can be made more urgent?

[TruthSweet]

The ward MWs were less than helpful and I knew more than them, I got given one of those 'Mothers and Others' magazines on bfing and the early days and that was it as far as help went. The ward MWs hadn't even heard of ante-natal expression .

Thank you so much for the link, I have seen it before but in my sleep deprived state had forgotten about it completely

[mawbroon]

Congratulations Truthsweet!

Sorry to hear about the lip and tongue tie. Bummer.

As per RedKites' post, exaggerated latch and lip roll are the things you need to be trying, as well as giving biological nurturing another go although opening wide may be hard for her to do.

You need revision as soon as possible. I am pretty sure that the only person in the UK doing lip ties just now is the dentist in Huddersfield.

Have you thought about contacting Milk Matters for expert tongue tie advice? Or the FB group?

[TruthSweet]

I did the test on the link RedKites posted and the papilla didn't blanch which is apparently a good sign and it is fairly stretchy so I hope after a TT revision (if I ever get an appointment and they agree with me). If I don't get an appointment through this week or they won't cut it I will contact MM or Ann Dobson as I think she covers my area (Surrey/Sussex borders).

As she has just wanted another feed I tried the exaggerated latch with upper lip flanging and it sort of worked - less squashed looking nipple (I need more practice which I am sure will happen soon ).

[TruthSweet]

RedKite - a big thank you to you I am already starting to heal up, she is only having 2 or 3 sides a feed and she's not falling asleep after every side!

[RedKites]

Oh I'm really glad it helped. I almost inevitably learnt about that page from someone else on this board, so can't really take the credit for it. Hope you can now concentrate on enjoying your lovely newborn baby .

[mawbroon]

How are you doing today TruthSweet?

[TruthSweet]

Latching is getting better, wedging isn't so pronounced and I have even had some feeds with none what so ever. DD4 even had a couple of feeds were she only needed 1 or 2 sides! She has fed solidly since she woke up at 10am though! Lots of switch nursing

Cracks and blisters have healed up nicely as well thanks to the moist wound healing.

[mawbroon]

All sounds good TruthSweet!

Am of snuggles with newborn!

Enjoy

[MigGril]

TruthSweet h
just seen this thread and wanted to say congratulations on your new arrival. Sounds like your doing well considering the TT.

DS had both lip and TT although I didn't spot the lip tie until his to teeth came through. He managed to learn to feed without having the TT snipped (although I still wish we had for other reasons), it was also me who spotted the TT on day one when I was having problems getting him to latch.

[mawbroon]

How old is your ds MigGril? ds1 just had his tongue and lip done the other week. He is 6yo.

Unfortunately he has many of the consequences of untreated tongue tie

[MigGril]

he's 22 months. he has learned to stick his tonge out but that took until 10 months. Personally I would have had it done privately but as DH had a tonge tie that hasn't caused him any problems he's been reluctant for us to do anything.

We have seen the ENT specialist at out local hospital and he is due to see him again next month. So i'm waiting to see what he says this time.

[mawbroon]

Has your dh really had no problems though? Does he know that the following are linked with tongue tie and does he suffer any of them? - allergies and intolerances, digestive problems, orthodontic problems, inflamed gums and increased likelihood of fillings and extractions, sleep problems, migraines, clicky jaw um, what else, can't recall them all, but there are loads of seemingly unrelated things which can stem from tongue tie.

DS1 is 6yo and is about to get braces to correct his distorted palate which is the result of his tongue tie (the tongue shapes the palate, starting from in the womb). His craniofacial development isn't ideal, so he will be getting headgear to wear at night to draw out the front of his face.

Not everyone with tongue tie will suffer the consequences as badly as he has done of course.

Sorry for the highjack TruthSweet, hope you are doing ok!

[MigGril]

Yes I think he probably has, he had orthodontic work when younger and can't swallow tablets but no other ovouse problems. But I know we would have had to have DS cut ASAP to avoid the dental issues as the shape of his mouth is now set, as I believe that happens in the first six months our so.

I do wish I been more instant when he was born but in my foggy hormonal state and found it difficult epically as he did learn to feed well.

Just wish the NHS would do them all as soon as possible just like they used to. then we wouldn't have even had a decision to make.

Good luck TruthSweet I hope you get it sorted asap.

[TruthSweet]

Don't worry about the hijack at all.

Well that was a fun night - after me posting things were going better!

She continued feeding yesterday from 10-2 then had a break for screaming in the pram (we had some errands to run and I thought she might sleep) then fed from 2.45 to 6 with the occasional break for the toilet/nappy change/5 min doze. I took her upstairs then as I was falling asleep at the dinner table (while feeding her of course!)

She then had another feed and went to sleep until 10 when she woke up and started feeding - she had 10mls of expressed colostrum by syringe during the night but fed straight before and fed straight after - she finally dropped off to sleep at 7.15 and then woke at 8.30 for another feed before going back to sleep. She is feeding again now.

This is not normal as far as my experience of newborns goes (willing to be told different) but the feeds are more effective now - lots of 'shush' noises and not so much frantic suckling with no swallowing so she's getting milk, lots of milk! If she's not feeding though she is screaming and her poos are almost always yellow (she's doing about 6 poos in 24 hours and they are always wet plus the occasional just wet nappy)

She is also scarlet most of the time.

She has sucked on my finger overnight and her tongue movement is not peristaltic, it just goes up and down in one movment rather than movement starting at the tip and working backwards. Her tongue also curls upwards when she cries.

I am worried she is going through drug withdrawal (I take an anti epileptic and a SSRI both of which can have withdrawal) or something else is wrong. The MW is coming today so I will check with her.

[MigGril]

TruthSweet as you know the best signs that baby is getting enough is output. So as she's having lots of wet and pooy nappies that sounds good.

A for her behaviour there is nothing that sounds alarmingly out side the normal range. Some newborns are more sleepy then other and you could just have hit a growth spurt day to. Although the amount of feeding could be to do with the tonge tie. It's not really possible to tell on a talk board.

Hope you're midwife visit weren't well.

[TruthSweet]

She's lost 160g which is just over 5% so no worries on the weight front though I did ask for them to come back on Friday just to make sure she's picking up weight rather than losing still. Apparently she looks fine (just me worrying!).

I also checked out the drug withdrawal side with Wendy Jones (BfN pharmacist) and she said there shouldn't be a problem.

[BuffyFairy]

No advice as you know far more than me but wanted to say congratulations on dd4! Hope the feeding issues resolve.

[mawbroon]

DS1 cried constantly for the first 9 weeks unless he was being fed.

Is she taking in a lot of air? I remember my mum once commenting on ds1's tight stomach which we assumed was full of milk, but now I know what I know about tt, I see that it was full of air and probably bloody uncomfortable.

Good to hear that the drugs shouldn't be an issue though.

Hope you get a good night tonight.

[TruthSweet]

Well, DD4 had a teeny tiny thin TT cut today at the local TT clinic but it has made a difference to her tongue movement - it actually goes over her gum line now instead of being far back. She does have a high arched palate as well as the lip tie so the TT specialist thought they may be causing an issue too.

She recommended going through the GP and asking to be referred to the local Max-Fac unit (one of the best in the country) as she thought they would do a revision there.

[mawbroon]

What type of tongue tie was snipped TruthSweet? You are maybe aware that it is possible to have both anterior and posterior tongue tie. Often the anterior is snipped but the posterior remains in place continuing to cause problems.

you may have seen this video before. There's no sound on it.

[TruthSweet]

Oops should have mentioned it was a posterior TT as it was under the mucosal membrane and only visible with a physical exam.

[mawbroon]

It sounds like you've got it all under control Truthsweet!

[TruthSweet]

DD4 is sleeping better too - she has had two naps this afternoon instead of feeding and screaming!