05/06/2022
Riding the letdown
There are specific situations that come up where a child with a tongue tie may seemingly not have many symptoms. Weight gain can be quite good and mom can have no ni**le pain, even when a significant tongue tie may be present. A common clinical scenario where this occurs is when mom has a significant oversupply and/or overactive letdown (OALD).
I will speak more about OALD than consistent oversupply in this post. Admittedly, I am not a lactation consultant, but my experience in treating thousands of infants allows me to piece together how OALD can positively (or negatively) affect the baby. A few points to consider:
1) When a baby doesn’t have to do any actual work and the flow is plentiful, it would make sense that weight gain is good and there’s no pain. But if I see a baby who is just passively feeding, I consider that to be a pathological process. It doesn’t mandate treatment - it does mean that parents should be told about it.
2) Often, in this situation a baby can present for tongue tie release later - either the milk supply dwindles OR the baby’s caloric demands outpace what the OALD can give them OR something else changes and the baby can’t compensate anymore. The issue is that the good weight gain takes the stress/urgency off of parents for immediately doing something ASAP after birth. Sometimes, they don’t realize until years later that a tie was present the whole time - the oversupply is masking the problem and for some, the oversupply never diminishes.
3) Sometimes, the letdown can be forceful but after that letdown ends, the baby can’t feed (their tongue tie prevents active extraction of milk). This can manifest as either the baby falling asleep (no flow = no stimulation) or the baby getting royally ticked off.
4) For particularly forceful letdowns, babies with ties can often cough, choke, and pull away because they have difficulty organizing the flow of milk from the mouth into the throat. Like waterboarding. Milkboarding. Yeah, milkboarding. I claim that phrase now.
5) Working with an IBCLC is critical - optimizing your positioning (laid back positioning can help, for instance) and managing the letdown (some recommend pumping beforehand or catching the letdown in a towel or Haakaa) can help some of the problems.
There's obviously much more that I didn't touch on. I'm curious to hear the management of the IBCLCs in the audience.
