"will anyone check this baby for oral restrictions...?"

Disappointed would be a understatement....

My younger sister has just given birth to a beautiful healthy baby girl. 37 weeks, scheduled emergency c-section, a great set of lungs. My job as big sister was to help take care of the baby until my sister was out of surgery.

Tongue and lip ties, tethered oral tissues, it's what I do for a living. I'm a dental practitioner, an 'oral specialist', one of the few Orofacial Myofunctional Therapists in Australia.

My job is to assess oral dysfunction and then to treat it. This requires lots of rehabilitation of underused, poorly toned oral muscles as well as 'calming down' overworked facial muscles. The tongue, lips and cheeks should work in symphony with each other, taking equal shares of the daily burden to eat, swallow, speak, and assist with breathing. Unfortunately in our dysfunctional modern world, this doesn't happen naturally.

The first breastfeed for my niece was awkward. My sister was totally relaxed, the baby was hungry and willing. The midwife assisted the baby to latch but she 'couldn't stay on'. After several attempts the midwife decided 'a different hold might work'. This baby had been out of her mothers womb for less than 45 minutes and was thrown into 'how can we compensate' mode already!! Shocked. The football hold didn't work either, so the midwife started to 'hand express' my sisters breast and gather her colostrum with a syringe.

I had already made my diagnosis. I had checked my nieces mouth as soon as I met her. I knew she had lip and tongue restrictions. I'm the 'oral specialist' in the room watching this chaotic 'first feed take place. Nobody but me has looked inside this baby's mouth.

Why would you not do a 'suck test' and feel that her tongue cannot extend to latch into the nipple? I'm not a lactation consultant or a midwife but I can feel the power of those gums grabbing my finger and can tell that's not a baby who will latch.

So I ask, 'will anybody check this baby for oral restrictions?'. Blank stares all round. Three midwives, two of which just look away and the third tells me, "oh, the paediatrician will do that tomorrow". Tomorrow. Tomorrow?! After a whole sleepless night with a baby who cannot latch and no feeding specialist in sight?

Tomorrow came and the paediatrician said, "there's no ties, she just needs to learn to feed". Confusion starts right here. The SPECIALIST said there's no ties, my sister chose to hear what he said because her baby's health is in his hands. He knows all about babies right? He's a paediatrician, baby doctor, they know everything about babies right? Then there's the midwives, they are all helping my sister, they now have 'a plan' to feed this baby. This is the plan;
1. Express every couple of hours attach a hospital grade breast pump for 10 minutes on each breast, then 5 minutes on each breast.
2. Give the baby 40mls of formula to keep her belly full and so she doesn't get 'too upset' when we try to latch her onto the breast.
3. Give her the 1ml of colostrum that the 30 minutes of being attached to the pump produced, then compensate again with formula.
4. We'll only do this until 'my milk supply gets better', and by then baby should have learnt how to attach to the breast.

If I'm confused by this 'plan', how must my 30 hour old niece feel? What does her little brain make of the 'difficult to attach to the breast', but oh so easy to down 40mls of formula from the bottle, do to her? How do her Orofacial muscles know what to do?

Sucking from a breast and sucking from a bottle require VERY different muscle movements. Sucking from a breast, without oral restrictions, is how the perfect symphony of Orofacial development begins. Sucking from a bottle, COMPENSATING, is how DYSFUNCTION begins.

I'm the oral specialist but I usually only get a say once dysfunction has occurred. People bring their dysfunctional children to me for rehabilitation. Adults come to me for oral rehabilitation. People on the verge of suicide come to me for Orofacial rehabilitation, because THAT muscle dysfunction that began at birth, has impacted their whole life and caused pain in their heads that NOBODY could 'fix' until they came to me.....to US....I'm not the surgeon, the surgeon is another oral specialist, a dentist with a piece of equipment that cost over $100k. A laser that removes a lip tie or a tongue tie in 30 seconds without a drop of blood. A 'surgery' that requires no anaesthetic on a 26 hour old baby. A 'surgery' that ALLOWS that baby to attach uninhibited to the breast so she can suck in a functional manner.
Her palate can now grow to the shape of an unrestricted tongue that can latch freely to her mothers nipple. A lip that can flange to allow the breast to be tightly sealed so that she doesn't gulp air whilst feeding, causing 'reflux' or 'colic'.

Accountable. Who is accountable for the hundreds of thousands of undiagnosed babies that are thrown to COMPENSATION so soon after their births? Why is there no 'oral specialist' involved in this primal instinct to feed? Why do we get baby after baby who is 'failing to thrive'? Who is responsible for the path of muscle dysfunction that occurs at birth?

I'm upset. I'm angry. I'm frustrated. I'm the oral specialist and it's my niece that it's now happening to.

Paediatricians need to be educated in tethered oral tissues. They need to be accountable for this path of dysfunction and the ongoing lifelong effects. They are the 'gods' to these vulnerable young mothers. They need to become oral specialists if they are given this power to change the trajectory of a humans growth, a humans lifelong journey to the path of dysfunction, malocclusion, muscle imbalance, chronic pain.

This is my specialty. This is the reality I see every day and it's become personal now. I see the path my sister will travel because she's been given poor advice from someone, from many professionals, who are not oral specialists.

Postnatal depression, anxiety, the days, weeks and months of grief because nobody identified an oral restriction that could have been released in 30 seconds. I have the right to be mad because I'm the oral specialist but nobody is listening to me.

Palate issues in tied babies

Palate issues in newborns with tongue tie.

My observations as are as follows;

Babies born with any type of TT appear to have a 'high', 'bubble' or 'nook' palate.

I will use the term 'nook' because it seems to best describe what is going on.

Upon examination, I notice these babies have a little or large nook directly behind the upper gum line. That is the spot that is most comfortable for babies to put everything that goes into their little mouths! Be it a breast, bottle, paci or finger.

I think their tongues have rested there for their whole gestation helping to make the nook! This is their 'default' position and place for everything! This is why we hear the words 'pinching', 'biting', 'squeezing', 'painful', 'my baby takes over an hour to feed and is still hungry' and we see cracked, sore or bleeding nipples. We also see lots of crying.....

These are the poor moms who are told OVER AND OVER again that, "Everything looks good” because the latch LOOKS good but if you listen with a stethoscope, the pattern is suck, suck, suck swallow. Because really, it is bite, bite, bite swallow. The latch is REALLY very shallow and the mom is visibly upset by pain, frustration and lack of validation :-).

These are the babies who never relax at the breast, they fight to latch, they cry and fuss, they pop on and off lots, they will fall asleep at the breast but not stay asleep,  they either sleep too much or not enough. These babies would be described as 'unhappy, tense or colicky'

Often seen issues with this problem are; reflux, gas, green (frothy/mucous poops and or excessive hiccoughs. Until these babies have a proper latch/suck/swallow/seal, the ability to suck and swallow is not learned. These dyads suffer in many ways.

Once the tongue issue is resolved, these babies are ABLE to bypass their little default nook but we need to help them learn how.

In order to establish and maintain a proper suck/swallow/seal, the tip of the nipple, bottle, finger must be at the junction of the hard and soft palate (you can feel your own right now with your tongue). Then and only then will proper, efficient transference of milk begin. When training with a finger, you can FEEL the back of the throat, you can FEEL the change in the suck from bite to suck, you can FEEL the suction change and you can feel/SEE the jaw motion change to a nice deep suck swallow. You can SEE the baby relax right in front of your eyes. It is amazing and heartwarming and often times, more tears.

It is my observation that until these babies learn the proper way to transfer milk, to where there is a rhythmic suck swallow, suck swallow, suck swallow, suck swallow; pause, they will NOT produce the proper gastric juices needed to properly digest breast milk or formula and later solids.

Often times, these are the babies who never seem full, they will always eat. Often times, once the issues ARE resolved, they seemingly 'overeat' but, if you were an 8 pound baby and needed 20 ounces of milk in a 24 hour period but you were only getting 16 or 18 ounces per 24 hours for, let's say 10 days, that would be 20- 40 ounces of food you didn't get that you needed/deserved. Who among us wouldn't try to make up for that?

Suck training is relatively easy once the issues are resolved. I teach suck training with;

An INDEX FINGER placed at the soft palate with OCCASIONAL gentle/rhythmic downward pressure on the tongue until the tongue learns to DRAW milk out and the tongue rests FORWARD of the gum line. I like teaching this technique because this is often the moment at which the mom totally understands what it takes to suck/swallow. This is a powerful moment! Suddenly, it all makes sense!

NIPPLE SHIELD (large) as this forces the baby's mouth to open wider and makes it harder to push the nipple into the nook! Weaning from the shield is fairly easy once suck/swallow is established.
I already know all the 'stories' about nipple shields! (I love shields, have always used them, will always use them. Sometimes they don't work but they are a great addition to any LC'S bag of tricks.

These mommies and babies deserve our (IBCLC's, HCP's, LC's and support people of ANY kind) unwavering help and dedication. It is my hope these determined mommies are HEARD. If both mommy and baby are miserable about feeding let's give or get help. Even if it means admitting we don't know what's going on and we have to refer them to someone else, they deserve the best!

Annie VerSteeg IBCLC, RLC

Sleep issues resolved immediately!!!

My 3 year old was never able to sleep through the night. Mouth breather, snoring in the back of the throat, soak beds with drool, thrash around like a drunk ninja, and sweat ALL night long, even if sleeping with just a diaper, he would wake hair soaked in the morning. Instantly gone after revision. He was revised at 5:00 in the evening. That night he did not snore, sweat, or move. My husband and I stared at him in disbelief for several nights. Looking back it's very worrisome to me that babies sleep like that, it doesn't seem safe. I bed share with my babes and there was noway I even thought about him sleeping away from me. This procedure could have changed him completely. It boggles my mind because he even had an anterior tie, how did no one, me included see that! ~ Amy Miller Barry