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