Minor tongue tie - does it need to be snipped?

[digitalgirl]

Ds2 is feeding really well, 22 days old and now weighs 4.8kg (b/w 4.06).

I struggled with his latch in the first week - resulting in blisters & bleeding. Went to several bf clinics and got help with positioning and latch which has helped a little.

He was diagnosed with mild tt but that it didn't necessarily mean he needed it snipping if I was extra careful with his latch. I have had some painfree feeds. But latch isn't always good - and my nipples are still misshapen after a feed. Ds2 is fussing on my left side a lot - initially choking on the letdown, then slipping off the latch or repositioning himself so it ends up pinching more.

Bearing in mind he's gaining weight and is obviously getting plenty of milk, do I just need to persevere with latch and wait for ds's mouth to get bigger. Or will it not improve and should I get it snipped?

If the latch isn't great, you have misshapen nipples and you are in pain with a fair few feeds it sounds like something is up. The form of the Tongue Tie doesn't necessarily equal the function of the TT IYSWIM - some babies can have quite tight, thick frenulums and bf without problems and other babies can have the merest suggestion of a frenulum and yet bfing is traumatic for all involved (even if the mum is 'extra careful')

Who diagnosed the TT? Could you see them again to ask for a referral to the TT clinic to be reassessed?

50% of babies with a TT will feed just fine - the degree of tie really doesn't relate to the degree of interference with feeding, a small tie can still cause big problems. Only you can decide whether to snip or not, it may be that things will become comfortable just by correcting the latch, but then again it might not....

It is also worth knowing that although your baby is gaining weight ok now that might be due to a very abundant milk supply. With a sub optimal latch the supply may not be properly stimulated and as your baby grows and you supply moves over to the supply and demand phase rather than the hormone controlled lactogenesis II stage that you are in at the moment you may find that your baby does not gain weight as well.

Personally I'd get it snipped now and rule it out as a problem but totally understand that some mums don't want to do this. The faster it is done the faster you will see results.

I'd get it snipped now. Apart from the feeding, it might affect his speech later on. Mine did - my TT was diagnosed and snipped at 11 and I really, really wish someone had picked up on it earlier.

Thanks, that's very interesting re: lactogenesis stage. I genuinely thought that by now it was a supply and demand thing. A Paediatric nurse/lactation consultant diagnosed it. She said to see how I got on over the next week (2 weeks ago) and if his latch didn't improve enough that she could refer us. I'm going to see her again tomorrow.

The thing is - ds always latches on beautifully at the clinic, but if I'm feeding when out and about I don't always get such a good latch, and the night feeds tend to cause trouble too (I'm too sleepy to move onto a chair and get all the right cushions so I feed in bed and he always ends up slipping a bit). So I just don't know if it's me not being careful enough or if DS should really 'know' by now how to latch on and stay latched on.

I can totally understand your dilemma OP. it is after all a surgical procedure albeit a minor one. Unless feeding is affected there is no reason to have the snip (there's no reason to believe that your DS is in the small minority of children whose tongue tie affects speech, especially as tie is only minor). However there is an argument for saying that feeding IS affected if you're in pain as baby gaining weight is not the only factor to consider, YOU are as well.
Having said that not everyone who decides to get DC to have the snip reports improvement in feeding or latch.
Perhaps you could ask your GP or bf counsellor or anyone else that you really trust for their opinion and then decide what to do.
hth

digitalgirl - the feeds at clinic do they result in squashed/misshapen nipples too?

truthsweet yes they are misshapen after feeds at the clinic - not as bad as at home - but it has been noticed.

Doesn't hurt so much on the right side, even though I can see the 'point', but he's pulled out a couple of new blisters on the left which make the latching on much more painful and hurts throughout the feed too. Oddly, my left was the less painful one last week when I was recovering from mastitis in my right. So I know he can latch onto the left one ok, just this week he seems to have forgotten.

If the nipple is misshapen even with a 'good' latch, it's not really good is it? The alteration in the nipple shape is indicative of a latch where the nipple is being compressed against the hard palate not the juncture of the soft and hard palates (further back in the mouth). One of the signs of a 'good' latch is that the nipple looks the same at the end of a feed the beginning (it may be a bit longer though!).

Are you having any colour change or pain after the feed ends btw? Also, if there is a risk of the mastitis reoccurring if the original cause was poor breast drainage due to the TT (sometimes TT can mean the breast isn't drunk from equally so there may be ducts that don't get as much milk removed and this can lead to mastitis).

It really sounds like revisiting it would be a good idea tbh!

Yes to pain after feeds. And left side is whiter after a feed - assumed that was because skin was newer from healing after a particularly bad wound from the first week.

Looking like getting the snip might be in order. Glad I made that appointment now. Thanks for all the advice.

I would definitely get it done. It takes approx 30 seconds (including application of anaesthetic gel) and most babies are completely unbothered by it. The bloke who did DS's said the risk of anything untoward happening was teeny tiny.

I second what's been said about possible supply problems when your breastmilk supply downregulates. Far easier to have the snip now than have to deal with supply problems down the line.

Really sorry to hijack thread OP but wondering if I could get opinions on this- DD's posterior tt was only diagnosed recently and she has an appointment for the snip this week (she is 14 weeks). Her weight gain has been slow but not unusually slow; she had been tracking 9th centile and at her 3 month check up last week had dipped just a tiny bit under it for weight (another 100g and she would have stayed on it). Health visitor was fine with this.
My nipples are as OP describes after feeds but I think I may have become used to the discomfort and don't notice it so much anymore-just sometimes.
I live in Ireland where tt is still not widely understood and have been on the receiving end of some horrified medical opinions that I would even consider 'having a baby's mouth cut!'
The LC who referred DD to get the snip was of course lovely and said even if DD is gaining okay I shouldn't have to suffer on with cracks and sore nipples and it still might be worth getting it done.
But I'm getting cold feet, is 14 weeks quite late? Should I just leave well enough alone?

I was told dd's TT was minor by the paediatrician. Got an experienced LC to look at it who said otherwise (80% restricted). This was at 11/12 weeks - I could have cried as I'd been to bf groups, had people look, spoken to the GP etc etc. in the end mumsnet advice made me keep pushing.

We got it snipped but left it so late that DD's latch was difficult to reteach as she was older.

By the way, dd was gaining weight - I have an oversupply so she didn't have to work for it at all. It's so much milk that dd only feeds off one boob and has done for a couple of months with perfect weight gain. And it didn't take any adjustment.

Get it snipped. After 12 weeks I think they need to do it under general anesthetic.

My ds had posterior tr. I had to fight hard to get it snipped. 2 gps told me to ff! I eventually self referred with support of a LC. Can't. Recommend getting it snipped enough. Was amazed at difference. He was fascinated by his tongue and kept sticking it out but his latch adjusted really quickly.
Good luck!

I really would get it snipped while it's a minor procedure. By the time I had mine done it meant a GA and a night in hospital, followed by speech therapy.

Update- got it snipped today. She was as good as gold and only cried for a second. Thanks ladies!

Fantastic. Hope it makes a world of difference.

That's good to hear fanefeyre, especially at 14 weeks, hope dd starts putting on more weight.

My referral came through and have an appointment on Tuesday. The lc who put the referral in rechecked ds' tt. She said that as it's so minor and because he's putting on plenty of weight they may decide against snipping him. She also said I may be at risk of engorgement and oversupply afterwards. Breastfeeding has actually been less uncomfortable lately, nipples still flat on one side after a feed but no blisters lately, so thinking maybe ds's latch is slowly improving as his mouth gets bigger.

Why would you be at risk of oversupply? How would your DS having a better latch (and therefore better ability to remove milk) mean you made too much milk/not enough milk was removed? You are more at risk of engorgement with a baby who can't remove all the milk you make (as what might happen with a TTed baby).

Not sure I follow the 'logic' of that proclamation....