Tongue Ties and Colic/Fussy/High Needs Baby's

Tongue Ties causing Colic/Fussy/High Needs Baby's

Infant colic is a common but poorly defined and understood clinical entity and, while several causative factors have been suggested, a unifying theory of its pathogenesis is still required. A definition that I have begun to adopt is one where stimulus irritates the baby and gets to a place where the caregiver is no longer interacting positively with the baby.
Parents go on an endless quest to sort out baby's colic/wind/reflux/random discomfort. Conflicting and numerous advice is given across a range of health care professionals and well meaning support systems. A large focus of this conflicting advice is around feeding and winding. Mom has an inherent instinct to nourish her child, and a disruption in that desire, coupled with conflicting advice can have a profound impact on mother and the mother/infant relationship. One of the most basic human instincts of the baby is the need to breastfeed, demonstrated by the breastcrawl soon after birth. When this is disrupted, it can effect how the baby feeds, and cortisol level studies suggest that the baby suffers stress.
One of the reasons for this disruption could be a Tongue Tie. The medical term for this is Ankyloglossia. It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and too tight, causing movement of the tongue to be restricted. There are many signs and symptoms that point you in this direction, which is why always a good idea to consult with a certified lactation consultant SACLC or IBCLC if you are having concerns. I am just going to focus on the fussing/windy/colic baby.
The Tongue Tie baby will try to latch on the breast with a "small mouth". They don't open widely, and that narrow opening allows small amount of the breast tissue into the oral cavity. This results in a shallow latch that can predispose the mom to significant pain and inefficient milk intake by the infant, leading to a cascade of problems. When you are told to get the baby to open the mouth wider, may need to investigate why baby is not opening wide. If there is indeed a restriction, a wide latch can cause baby discomfort and tension and possibly migraine, the baby responds by closing the mouth until the tension dissipates. The shallow latch leads to a high needs fussy baby; and excessive air swallowing due to the poor latch and seal can lead to reflux.
This is leading into our definition of colic/fussy/high needs baby: Fussing, windy, reflux, constantly on the breast, appearing to be in pain, irritable. A baby with colic may experience hyperalgesia, previously described in infants subjected to procedural pain due to routine medical care such as heel pricks. This can lead to something like a wind being unbearable, causing long inconsolable bouts of crying. Parents overtired, feeling inadequate, painful breastfeeding and no longer having positive relationship with the baby. These parents seek help from various health care professionals. Paediatrician may treat the reflux with PPI and often putting bandaid on the issue by suggesting formula, chiropractors, physiotherapists, sleep trainers, dieticians, clinic sisters, pharmacists etc. each doing best to help the parents and the baby. This all comes at a financial cost, putting parents under strain as well.
Tongue ties are not always obvious, especially posterior tongue ties. It takes training, reading and practice in diagnosing tongue ties. This is why it is ideal if you are having feeding issues to consult a lactation specialist. May help get a clear reason as to why baby has colic and direct the efforts of health care team, paediatrician to do frenotomy, lactation specialist assist post frenotomy exercises and breastfeeding post frenotomy, chiropractor / physiotherapist assist with body work. This helps to avoid uneccessary medications, unfocused consultations, stopping breastfeeding and all comes with it.

Samantha Crompton RN SACLC

References:

1. Update on infantile colic and management options. Curr opin Investig Drugs, Nov;8(11):92-6.
2. Dr Michael Marinus presentation. Abbot Nutritional Forum. 18/08/2016.
3. Dr Bob Ghaheri. www.drghaheri.com
4. Breastfeeding basics: Tongue Tie. www.breastfeedingbasics.com
5. Born to breastfeed Born to be Breastfed. Hettie Grove. 2016. p114-116.
6. Influence of repeated painful procedures and sucrose analgesia on the development of hyperalgesia in newborn infants. A. Taddio. www.yorkspace.library.yorku.ca KAT107.
7. Dr Michael Marinus Easy Baby Podcast Episode 3. www.marinuschiropratic.co.za. August 23 2015.