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Totally Tongue-Tied

Sheila F.
From: NEW BEGINNINGS, Vol. 19 No. 2, March-April 2002, pp. 56-57.

I was excited to discover I was pregnant again after trying to conceive for several years. I had breastfed my two older girls and I was looking forward to nursing my new son. Kyle was born three days after his scheduled due date, weighing a modest six pounds, three ounces. We attempted our first nursing experience in the delivery room, but Kyle was not able to latch on correctly. I continued to work with Kyle to establish breastfeeding, but whenever he latched on, it felt as if he was nursing with jaws of steel! He would clamp down hard, mainly on the nipple. I told the nurse it was far too painful, and something was wrong with his suck. She told me the lactation consultants would make their rounds the following day.

I knew I needed help sooner than that so I called Suzie, my local La Leche League Leader. She was excited to hear from me and find out Kyle had arrived. I described the problems I was having. She replied, "This sounds a lot like a tight frenulum. Have you checked his frenulum? I wouldn't know what a normal frenulum (the small band of tissue that connects the underside of the tongue to the floor of the mouth) looked like if it bit me. He latched on, painfully, while I was on the phone with her, so I figured I'd follow up with the doctor in the morning. Midway through the night, the pediatrician made his rounds. I explained to him the difficulties we were having and asked him to check Kyle's frenulum. He told me there was nothing wrong with Kyle's tongue since he could extend it out past his lips.

The lactation consultant never made it to our room prior to my leaving the hospital, despite my repeated requests. Since Kyle was latched on when the nurse made her final rounds in the afternoon, she presumed all was well and discharged us. Our follow-up, well-baby visit was scheduled for Monday, three days later.

Over the next few days, Kyle became a very fussy baby. I was still having a lot of difficulty nursing him, and latch-on was excruciatingly painful. My right nipple was now cracked, and he totally refused to take the left side at all, as that nipple is more flat and difficult to latch on to. I spent most of his waking hours trying to nurse him and burp him between the screaming. He was rarely quiet or happy looking. These problems intensified as my milk came in and I became engorged. I had to syringe-feed Kyle several times to get anything into him at all, and I was frequently in tears attempting to console an obviously distressed baby.

Monday finally came, and I was determined to speak with a lactation consultant. The nurse came in and weighed Kyle while we were waiting. He had lost six ounces. We nursed painfully for a bit in the room while waiting. When Martha, the lactation consultant, finally got to us, I explained to her the problems we'd been having, especially the excruciating pain with latch-on. Martha opened Kyle's mouth and became immediately concerned. She then proceeded to show me how the frenulum had his tongue basically pinned down to the floor of his mouth stating, "No wonder your baby can't nurse properly. He's totally tongue-tied!" I was exasperated, since I'd specifically asked the pediatrician to check this.

The next five hours were a flurry of activities. I was rushed to the back room to pump off some milk to ease my engorgement. We needed a way to feed Kyle. He couldn't suck, so Martha brought us some plastic medicine cups and we poured the milk into his mouth. It was quite a sight to see this tiny baby drinking from a cup. We gave him two ounces of expressed human milk from the cup. Kyle was content at this point and went into a quiet, alert state; eyes open, taking in the world around him. What a difference from the previous days!

We had his frenulum cut that day. The procedure itself took only seconds to perform. The nurse practitioner had me nurse Kyle right afterwards, but he didn't nurse very enthusiastically so it was difficult to tell if the problem had been corrected. Kyle started nursing much more frequently throughout the rest of the day, latching on with less difficulty each time. Over the next couple of days, nursing was still painful and he remained fairly fussy. My engorgement was not significantly better, so I kept pumping a few times daily. I let him nurse, then gave him human milk with a syringe. I put in another call to the lactation consultant department to let them know we still had a problem. I waited for the return call to come until, a day and a half later, sleep deprived and exhausted, I once again called upon my La Leche League resources. I obtained information regarding a breastfeeding clinic held daily at one of our local facilities. I took Kyle in first thing the following morning.

One week and one day after Kyle was born, his weight had continued to drop. It was now 13 ounces under his original birth weight. This was more than the 10 percent margin they allow as normal weight loss after birth. The lactation consultant at the clinic began working with me to latch Kyle on to nurse. "He has a lazy, uncoordinated suck," she told me. She was clearly concerned and wanted to feed him some formula right away. I preferred that formula not be used. They didn't have a breast pump in the clinic but I was already leaking and had filled two breast pads, so I hand-expressed some milk into a medicine cup to feed him. She then showed me how to syringe feed Kyle while he sucked on my finger. We were to return to the clinic every day until he began to gain weight while finger-feeding expressed human milk at home.

The next 24 hours were spent pumping, nursing Kyle for a minimum of 20 minutes at the breast, and then finger/syringe feeding an additional 45-60 ml of expressed human milk. Kyle's wet diapers picked up dramatically, but he was developing an aversion to the breast, preferring to be finger-fed. Saturday morning we returned to the clinic. His weight was up by three ounces! The lactation consultant was impressed he had done so well in only one day. I voiced my concerns regarding his balking at the breast. We decided to switch to a nursing supplementer to encourage him to nurse. Using the expressed human milk I brought with us, the lactation consultant set up the supplementer and we worked on Kyle's latch-on and nursing. After 20 minutes of trial and error, he finally got the hang of it and started. A few really good burps and he was off to sleep for several hours.

We used the nursing supplementer at home with a lot of difficulty and few completely successful sessions. After 24 hours of frustration for both of us, I switched back to finger feeding with a syringe. When we went in for our weight check at 11 days old, he had not gained any weight from the previous check, but he hadn't lost either. Kyle was also still pinching my nipple with his nursing, so the lactation consultant showed me how to latch him on by facing the nipple up first so he'd take more breast with it (called an asymmetrical latch). He had a lot of ineffective sucking, and squirting expressed human milk into his mouth with a syringe while nursing caused him to change his suck pattern to a more productive one. I was also instructed to "massage" his tongue for a few seconds prior to each nursing session, pushing down and pulling out on the tongue before latching him on. His big sisters, Kaitlin and Breanna, also helped with his suck training program by repeatedly sticking their tongues out at him until he would copy them and stick his tongue out too.

I was frustrated that it was taking so much work to train him to suck, but the lactation consultant reminded me, "He hasn't been able to move his tongue out of his mouth for 9 months. It's going to take more than a few days to teach him to use it properly to nurse." The next day, I noticed Kyle was actually sucking and swallowing while at the breast, so I started massaging the breast while he was nursing to encourage the milk out and his swallowing per suck ratio increased dramatically. He was still requiring about an ounce of additional expressed human milk after nursing most of the time, but this was major progress. At three months, Kyle is now nursing totally independent of any supplements, and only occasionally requires adjustment of his sucking.

I never expected my third child to be the most difficult to breastfeed. I feel very fortunate to have an extensive network of support from friends and family. I am eternally grateful for a loving and supportive husband who feels as strongly about the importance of mother's milk as I do. I am also thankful for the support and encouragement I have received from my La Leche League friends. Without them, I feel I may not have been able to provide my son with the best nutrition available to him, his mommy's milk.

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