Lessons in Lip Ties & Tongue Ties

A few months back, we were hanging out with my brother, sister-in-law and nephew. Somehow, we got onto the subject of lip ties—I think because they suspected that Bryce (2 years old) has one. At the time, their pediatrician and dentist had both said it was nothing to worry about, but I had happened to read a Bower Power blog post not long before that about frenulums (lip ties) that I passed on to Marie.

Since then, Vivienne’s two top front teeth came in, and one day, as I was examining the new pearly whites, I noticed what I was pretty darn sure was a lip tie.

See how her upper lip is “tethered” to her gums with that little string of flesh? We all have it, but in “normal” mouths, this piece of flesh extends upward toward the top of the gums, not toward the teeth.

At Vivienne’s 1-year pediatrician appointment a few weeks ago, I asked about it. Our doctor took a quick look at it and dismissed it, saying it wasn’t a big deal if it wasn’t bleeding. I shrugged it off.

Then, late last week, I got a text out of the blue from Tyler and Marie saying that Bryce’s mouth had been evaluated by an otolaryngologist (ENT) and she had determined that Bryce has a Class IV lip tie (the most severe), and an “off the charts” tongue tie (meaning it was worse than the worst they typically see). The ENT said that Bryce needs to have oral surgery in order to ensure he doesn’t have any lasting problems with his teeth or speech.

Here’s Bryce’s mouth:

As you can see, the gap between Bryce’s two front teeth is pretty significant, and you can see how the tie extends down his gums, and there is a strip of thicker flesh going between his front teeth.

Upon seeing this and hearing the verdict of their evaluation, I started to get really curious about Vivienne’s again. Looking at the pics side by side, Marie and I thought that Vivienne’s might look even a little worse than Bryce’s—the fleshy tie seems to come further down between Vivienne’s teeth.

Marie told me a lot of what she’s learned so far, and I started to do some research of my own. It’s pretty amazing the research that’s out there about how these ties can affect babies. Now, I never had any nursing problems with Vivienne, which is one of the most common signs of a problem. But did you know that lip ties can cause reflux? It has to do with baby’s latch and suckling motion being off, and them ingesting more air than normal, which can cause reflux. You may remember we struggled with it (which included massive projectile vomiting) in Vivienne’s younger days.

For reference, here’s a photo of Bryce’s tongue:

This was the best Marie could do (it’s hard to get pics of the inside of little ones’ mouths, you know!), but you can see that the little piece of flesh extends up and attaches itself to the tip of his tongue. He can’t even really lift his tongue up or stick it out in order to show us the underside of it anyway, because the tie is so severe. You can even see how the tie is making the tip of his tongue slightly “heart shaped,” which is caused by the tongue being pulled back by the tie. Crazy, isn’t it?

I am amazed (AMAZED!) that Marie was able to breastfeed this child for more than a year. She did have some problems with a poor latch, and he was slow to gain weight, but their pediatrician never even mentioned or looked for the possibility of a tongue tie, much less a lip tie! Hindsight is 20/20, of course, but it’s disappointing to think about how things could’ve been easier on them back then if someone had noticed.

Here are a couple of helpful articles and blog posts I came across on the subject of babies, breastfeeding, and lip/tongue ties:

• Mommypotamus: A Step-by-Step Guide to Diagnosing Tongue/Lip Ties
• Infant Reflux and Aerophagia Associated with the Maxillary Lip-tie and Ankyloglossia (Tongue-tie)
• Feed the Baby LLC: Tongue-Tie and Lip-Tie
• Dr. Ghaheri: How to Examine a Baby for Tongue-Tie or Lip-Tie
• Bower Power: Frenulums

After all of this, I decided to call the ENT—same practice that saw Bryce, and the same one that put Nora’s ear tubes in—to see if they thought it would be worth having Vivienne evaluated. I called, they were willing to set up an appointment, and happened to have an opening for the next day. We went today and had the doctor take a look at Viv.

The doctor said that Vivienne’s lip tie wraps around her gums toward the inside of her mouth, which indicates a Class IV tongue tie. Having looked at lots of pics, though, I think she’s on the fence between a Class III and Class IV (in my not-so-expert opinion). He also said she has a minor, posterior tongue tie, which is basically a “hidden” tongue tie (from my research, seems to be the least problematic of tongue ties). Based on the fact that we didn’t have problems nursing, her teeth appear to be relatively unaffected, and she has no problems eating or drinking, he said there is no action necessary at this time. Basically, we watch it as she grows and see if anything changes.

We saw a different doctor in the practice than Bryce did, and I actually wonder if the conclusion would’ve been different if we had seen the same one he did. I’m happy with the “diagnosis” and recommendation to wait things out, as I’m in no hurry to put my baby under anesthesia for something that, at this point, is… cosmetic? I’m not even sure how to classify it. But one thing I’ve learned from searching and reading and seeing moms talk about their experiences with lip and tongue ties is that there are many, many doctors—pediatricians, dentists, ENTs, you name it—who miss the opportunity to diagnose these problems. Whether they are uneducated or uninformed, or if they just don’t fully understand the impact they can have, I’m not sure.

Anyway, Bryce is scheduled for surgery in October, and it’s not an easy decision for Tyler and Marie to make. The ENT said it needs to be corrected because of his teeth and speech, but even so, they are second guessing themselves and considering a second opinion.

And we’re waiting it out.

As a mom, now I just want to encourage other moms to take a gander inside of their babies’ mouths. If you’re having trouble nursing, if your baby is extremely irritable, if there are issues with reflux… check out baby’s upper lip and under his or her tongue. If something doesn’t look right, ask about it. And if you don’t get the guidance you’re looking for, find a different doctor to ask. Follow your instinct. Listen to your gut. I’ve already seen a lot of stories out there about moms who advocated for themselves and their babies and once the tie(s) were corrected, they saw improvement.

Are there any moms out there with experience with tongue and/or lip ties? Were your kids diagnosed in infancy, or not until they were older? Did the diagnosis come easily or was it a bit of a battle? How did you come to your decision to do the revision, or leave it be?