My daughter is 5 weeks old today and my wife has been breastfeeding her. She is gaining weight at a normal rate, per our pediatrician. But my wife has had some pain with the feedings as well as my daughter gasping for air and choking on milk on a regular basis (several times during every feed). She does not seem to quite understand the "suck, swallow, breathe" sequence.

So my wife has been seeing a lactation consultant (LC) to help us out. This LC thinks she has a "posterior tongue tie" which is apparently different from the "anterior tongue tie" my son had clipped with no issues whatsoever when he was just a few weeks old. She recommended and ENT she spent 5 years working for in the past and we have an appointment with them at the end of the month to discuss treatment, a laser procedure to correct this issue.

We mentioned these feeding issues again to our pediatrician who discussed with us some options. She said her LEAST recommended route would be to do the laser procedure. She feels that it is not a truly necessary procedure and, as a matter of fact, only one doctor in the entire area that would even entertain the procedure (the doctor we coincidentally have an appointment with). She says he will laser everything.

So my wife and I discussed that we would probably not do the procedure but still keep the appointment with the ENT just to see what their thoughts were. In addition, we have been seeing a chiropractor that specializes in infants with feeding issues. She has been wonderful in stretching our daughter and massaging her masseters to promote a wider mouth when latching. (I was very hesitant going to go see a chiropractor as I did not want her spine to be popped but all they have done is gentle stretching and massage and my wife has been happy with them, saying she thinks she is seeing improvement.)

My wife went to another follow up with the LC today and she appeared very adamant that the stretches and massage are not helping enough. She is fearful that our daughter will eventually start losing weight once my wife's letdown isn't as strong. She basically told my wife that our baby would have to relearn how to breastfeed all over again and we would basically start over because her tongue would be doing things she is not used to. This procedure is also apparently painful for the baby that they will numb the area prior to it and she will have some pain for 3-5 days after the numbing agent wears off.

All this to say, we are not sure who to listen to. Our pediatrician who says the procedure isn't necessary and our baby is fine? Or the LC and ENT who will tell us to laser? Does anyone have any experience with this or have any knowledge? I think we'd benefit from a third party opinion who has no stakes in the game

TIA

We've been through this twice. It's been my wife's mission to help other moms and make them aware. Can she email you at the email in your profile?

Post a quality pic of the underside of your baby's tongue.
Ditch the chiropractor.
Call the La Leche League and have them come to your house and help out your wife and your infant.
Don't get me started on "Posterior Tongue Tie".
^^^^ one man's opinion, nothing more, nothing less.

I can't do right now as I'm on a mobile, but search for ankyloglossia on a previous thread and I put a bunch of information in that one.

Yes, we welcome any information you have

YNWA.2013 said:

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All this to say, we are not sure who to listen to. Our pediatrician who says the procedure isn't necessary and our baby is fine? Or the LC and ENT who will tell us to laser? Does anyone have any experience with this or have any knowledge? I think we'd benefit from a third party opinion who has no stakes in the game

TIA

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Opinion from this Board certified pediatrician: Frenectomies are often nothing more than a fleecing. If your infant can stick her tongue out of her mouth and her tongue doesn't look like an upside-down heart, she is fine. If your infant is gaining weight fine, she is fine. In over 20 years of practice, I have never seen an infant stop feeding at 1-2 months of age because of "posterior tongue tie". The stress your wife is under with all that nonsense is more likely to interfere with successful breast feeding then any frenulum. Pretty much like Kool said, ditch the chiropractor and consider another LC. The only thing I might suggest based on the appropriate history, would be an evaluation by a qualified speech therapist along with a swallow study to evaluate the swallowing mechanics of your daughter. That can identify a problem where a therapist can focus and get her to better coordinate her swallowing. Occasionally, some anatomic problem can be seen on the soft palate that may require ENT intervention.

Agree and thank you. If I recall correctly Kid Doc has said the same the other time this was brought up.

1. Does your wife have lots of milk/fast letdown?
2. Does the LC have IBCLC credentials?
3. Did the LC discuss oral habilitation/oral exercises to improve feeding and/or outcome of possible release?

Posterior ties are somewhat controversial. I'm more likely to look at what *else* might be going on before referring for release for a not-super-obvious/restrictive frenulum. If you sweep your finger under your baby's tongue, does it hit a "speed bump" or "wall"? I know this can be such a frustrating situation!

Found the link. I would recommend that you go through some of this thread:

Tongue tie

We had our 6 week old have a water laser procedure done in the Woodlands at a pediatric dentist. There was a little blood, but literally nursed about 10 minutes after it was done.

There was no pain, took about 10 minute or so and never left the car seat. Spouse felt the laser on her finger by the dentist.

Our son was having issues getting enough suction to cause a let down, which slowed his weight gain. Once the procedure occurred, about a week later nursing became much easier and the body responded to my son's needs.

My son is now 10 and has no adverse effects from the tongue tie procedure.

~egon

Would you mind disclosing where in the woodlands y'all had the procedure done? You can email me at the email in my profile if that's you'd rather keep it private

1) My wife does have a lot of milk and a strong let down. The consensus seems to be that she sucks for a little bit and then just sits there and swallows with no further sucking happening.
2) I am not sure on this, I'll ask my wife and get back to you
3) She gave us some exercises that we could do at home. She then recommended what she called "bodyworks" which, by my understanding, is just therapy/further exercises. We've been going to a chiropractor for stretching, massaging, and exercises. My wife feels that that is actually helping

Thank you for the link. And than you all for your input. When you have so many people telling you different things (and they all have something to gain), it's hard to decipher what is the best course of action. So I really do appreciate everyone's contributions to this thread. My family thanks you

It seems like you are being offered a solution when there isn't a problem.

Your infant gaining weight is very reassuring. If you are still concerned, then I'd seek out a pediatric speech therapist who specializes in evaluating and diagnosing feeding disorders. If you are in the Woodlands, I am sure that you can find one at the TCH facility.

dcbowers said:

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It seems like you are being offered a solution when there isn't a problem.

Your infant gaining weight is very reassuring. If you are still concerned, then I'd seek out a pediatric speech therapist who specializes in evaluating and diagnosing feeding disorders. If you are in the Woodlands, I am sure that you can find one at the TCH facility.

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This.
You're getting very good advice here. I hate that this is getting your wife upset, likely unnecessarily so. When you discuss feeding difficulties, the first question is, "is the baby gaining weight?". Once that question is answered in the affirmative, the urgency and/or severity of the problem goes down. Has your child had pneumonia (the natural consequence of aspiration of food or secretions into the lungs)? If not, and I presume the answer is no, you're also "ahead of the game".

The vast majority of SIGNIFICANT issues babies have with feeding are going to be present at birth, not developed later. They are typically diagnosed very early in an infant's life, not later.

I am very suspicious about this ENT who has a laser and does a lot of "posterior tongue ties" with it. He may walk on water as far as I know, but until proven otherwise I am suspicious that he is the proverbial hammer who sees every kid's tongue as the proverbial nail. He paid a hefty sum for his laser, and, damnit, he's going to recoup that money come hell or high water. That's my rant.

Your wife needs reassurance first. Follow the advice given here in having her see another lactation consultant or work with the LaLeche League. If difficulties persist, ask your pediatrician to order a swallow study through your pediatric hospital. It's likely to be normal or maybe show some reflux or occasional micro aspiration. If there is something significant, you'll know where to go.

I am not alone in getting "torqued up" about this whole posterior tongue tie thing. Our Academy doesn't often put out official Position Statements about things for a reason - when they make statements, those become the "standard of care". That makes it easier for scum bag trial attorneys to go after physicians if their care goes against the standards. The guidelines were put out as a result of an entire cottage industry of people getting really worked up about tongue ties. I see my dentist every 6 months. He always tells me about all of the issues with tongue ties, even though am Board Certified in ENT and Sleep Medicine. They've got it "on their radar", as do some of the lactation consultants and, unfortunately, some ENTs. Go carefully here.

All the best.

1. Sometimes we see a baby "live off the letdown" rather than actively and effectively transferring milk. *IF* there are oral restrictions, your wife's robust milk supply is a good thing here. Changing positions so that gravity doesn't aid the milk flow can help a baby not cough, gasp, sputter, etc. Reclined, "koala" (baby sitting upright on lap, facing mom) and side-lying are all options with "firehose" letdown. The good news is that there's a hormonal shift around 6w postpartum that may downregulate her supply to a more manageable level. The pain can also come in from baby clamping down to limit the milk flow. If you haven't told your wife she's amazing today, tell her and go get her a coffee or other treat she loves. You're doing a great job of reaching out for support!

3. Oral exercises can help strengthen weaker areas, these are usually done with a finger or two in baby's mouth briefly before feeds (20-30 seconds). There are lots of different ones depending on what areas need to be addressed - most involve tongue shape/movement. I know those chiro visits can add up. Skilled bodyworkers used to working with infants often produce results in just a few visits.

If it's any comfort, these are the toughest weeks with a baby. In lots of cases, things improve without intervention thanks to tincture of time. It can feel intimidating to make these decisions! Wishing y'all the best and enjoy those sweet baby snuggles!!

YNWA.2013 said:

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Would you mind disclosing where in the woodlands y'all had the procedure done? You can email me at the email in my profile if that's you'd rather keep it private

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IIRC, it was dr Martinez (female). Don't remember the practice name, but in the middle of the woodlands.

Thank you all for the continued responses. We are grateful for the "outside opinion."

I think we will stay the course, for now. My wife likes the bodywork being done by the chiro. She feels it is helping and thinks baby is feeding better. The LC continues to make her feel like crap after every session, so I think we're gonna switch to La Leche League. We have a follow up with a pediatrician in like 2 weeks. We are looking into a pediatric speech therapist or a pediatric dentist with experience in this department for further reassurance or if pediatrician thinks she isn't gaining weight at an appropriate rate.

We are also interested in if her supply / let down changes at the 6 week mark as suggested in this thread. I am bringing up the change to a koala hold as a possible alternate for her.

And yes, I am fully aware how amazing my wife is. I am convinced that all mothers are superheroes. How they handle all this change both to their bodies and in the outside world is beyond admirable. I have no idea how single moms do it. Just in complete awe.

Thank you all again for offering a community of support and knowledge on here. I am thankful every day I was made an Aggie.

YNWA.2013 said:

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Thank you all for the continued responses. We are grateful for the "outside opinion."

I think we will stay the course, for now. My wife likes the bodywork being done by the chiro. She feels it is helping and thinks baby is feeding better. The LC continues to make her feel like crap after every session, so I think we're gonna switch to La Leche League. We have a follow up with a pediatrician in like 2 weeks. We are looking into a pediatric speech therapist or a pediatric dentist with experience in this department for further reassurance or if pediatrician thinks she isn't gaining weight at an appropriate rate.

We are also interested in if her supply / let down changes at the 6 week mark as suggested in this thread. I am bringing up the change to a koala hold as a possible alternate for her.

And yes, I am fully aware how amazing my wife is. I am convinced that all mothers are superheroes. How they handle all this change both to their bodies and in the outside world is beyond admirable. I have no idea how single moms do it. Just in complete awe.

Thank you all again for offering a community of support and knowledge on here. I am thankful every day I was made an Aggie.

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My $.02 again:
If your wife likes what is being done by the chiro, OK. No neck manipulations.
If the LC you have makes her feel like **** while your infant is gaining weight, ditching that person is the absolute correct answer.
If the pediatrician is concerned about the lack of weight gain, see a pediatric speech therapist, NOT a pediatric dentist.
Keep breast feeding, it's best for the kiddo. Congratulate and encourage your wife for doing so.
Cheers

Agree with the post above. I think you are doing the right things.

Come back in a couple of weeks/months and let us know are things are going.

UPDATE;

Posting an update in case others are in a similar situation and as a thank you to those who have offered help/assistance on this post.

My wife and I discussed further with several others, including JR2007's wife who very graciously and kindly emailed my wife and me her story and provided further insight into her experience (for which I thank her again for sharing). We also talked with my older sister who has four older boys, three of which had the same tongue tie as our little one (maybe hereditary?). They waited for their oldest. He developed some speech difficulties and after the removal, things vastly improved. She said they regretted not getting it done sooner and when two of their other children presented with the same thing, they decided to get it taken care of early on. All four kids live very normal lives so se says they ultimately have no regrets.

It seemed to us (and we could be wrong here) that the downside of this procedure is that it may be unnecessary and cause our little one some short-term pain/discomfort. My wife was still having occasional pain with breastfeeding. After much deliberation, we decided to go through with the procedure, still unsure of we were doing the right thing.

The first 2-3 days were AWFUL! Absolutely devastating. She complained and cried over and over again no matter what we did. We did the exercises to help keep her tongue moving and prevent it from scarring down. We, apparently, did not do a good enough job because at our follow up with lactation, she said her tongue had started to scar down and so she moved her tongue more, essentially ripping the scar. Just when she was returning to normal, we had to start over. So another 2-3 days of hell. Eventually things started to heal and she was more receptive. She has latched MUCH better and my wife has essentially no pain with feeding. Her two week post-procedure visit was yesterday and they say things are going well. We will return in about four weeks for our final follow-up (I can update again then if people are interested.)

My wife returns to work on January 8, so we also need our little one to take a bottle. So that has been our new challenge. My wife did a bunch of research on positioning and how to feed her so that she does want to return to the breast and not go exclusively to the bottle (which is what our son did). On Friday, I gave her her first bottle. It went okay, no real problems. She did return to the breast for all subsequent feeds that day/night. We did the same thing on Saturday where I gave her a bottle in the morning. Everything was fine until her next feed where she did not want to latch. It seemed like she was telling us she wanted the bottle. She was MAD! My wife broke down as we questioned everything we had done to this point. But I was insistent that we keep trying. After many hours of trying and calming her down, she eventually did go back to eating with my wife. This has scared my wife from trying the bottle again. But we will stop the bottle for a few days and reintroduce it in the next day or two. It has been a difficult couple of weeks but I do think the procedure helped overall. Was it necessary? Maybe, I don't know.

We have also been to the pediatrician for her two month check-up and she has jumped a few growth arcs. She is now in the 50th percentile for length and 27th percentile for weight (she was previously in the 8th and 12th respectively). So I think whatever we are doing is working and she continues to be healthy, which makes all the stress and anxiety worth it.

YNWA.2013 said:

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UPDATE;

Posting an update in case others are in a similar situation and as a thank you to those who have offered help/assistance on this post.

My wife and I discussed further with several others, including JR2007's wife who very graciously and kindly emailed my wife and me her story and provided further insight into her experience (for which I thank her again for sharing). We also talked with my older sister who has four older boys, three of which had the same tongue tie as our little one (maybe hereditary?). They waited for their oldest. He developed some speech difficulties and after the removal, things vastly improved. She said they regretted not getting it done sooner and when two of their other children presented with the same thing, they decided to get it taken care of early on. All four kids live very normal lives so se says they ultimately have no regrets.

It seemed to us (and we could be wrong here) that the downside of this procedure is that it may be unnecessary and cause our little one some short-term pain/discomfort. My wife was still having occasional pain with breastfeeding. After much deliberation, we decided to go through with the procedure, still unsure of we were doing the right thing.

The first 2-3 days were AWFUL! Absolutely devastating. She complained and cried over and over again no matter what we did. We did the exercises to help keep her tongue moving and prevent it from scarring down. We, apparently, did not do a good enough job because at our follow up with lactation, she said her tongue had started to scar down and so she moved her tongue more, essentially ripping the scar. Just when she was returning to normal, we had to start over. So another 2-3 days of hell. Eventually things started to heal and she was more receptive. She has latched MUCH better and my wife has essentially no pain with feeding. Her two week post-procedure visit was yesterday and they say things are going well. We will return in about four weeks for our final follow-up (I can update again then if people are interested.)

My wife returns to work on January 8, so we also need our little one to take a bottle. So that has been our new challenge. My wife did a bunch of research on positioning and how to feed her so that she does want to return to the breast and not go exclusively to the bottle (which is what our son did). On Friday, I gave her her first bottle. It went okay, no real problems. She did return to the breast for all subsequent feeds that day/night. We did the same thing on Saturday where I gave her a bottle in the morning. Everything was fine until her next feed where she did not want to latch. It seemed like she was telling us she wanted the bottle. She was MAD! My wife broke down as we questioned everything we had done to this point. But I was insistent that we keep trying. After many hours of trying and calming her down, she eventually did go back to eating with my wife. This has scared my wife from trying the bottle again. But we will stop the bottle for a few days and reintroduce it in the next day or two. It has been a difficult couple of weeks but I do think the procedure helped overall. Was it necessary? Maybe, I don't know.

We have also been to the pediatrician for her two month check-up and she has jumped a few growth arcs. She is now in the 50th percentile for length and 27th percentile for weight (she was previously in the 8th and 12th respectively). So I think whatever we are doing is working and she continues to be healthy, which makes all the stress and anxiety worth it.

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Glad to hear that things are doing better overall. Gaining weight is, at the end of the day, the ultimate sign that things are improving.

One bit of difficult advice - run, as far and as fast as you can, from this woman who told you you and your wife were not doing a good enough job and then ripped up scar tissue that was forming under your child's tongue. It made my blood boil to read that.

Humans have an amazing ability to adapt and infants are born with an incredible will to survive. Breast feeding isn't always easy. Sometimes it takes time for your infant to get the hang of it and for your wife to get the hang of it. Your wife is to be applauded for trying to keep it going.

Don't allow that woman back into your house. That is just my $0.02.