12/29/2022
Pay attention to compensations
I think a lot of people misunderstand how tongue tie causes problems when it comes to breastfeeding. Can tongue tie directly cause issues like air ingestion that leads to reflux? Definitely (there are 7 papers that show this).
But many other symptoms aren’t caused by tongue tie directly. Instead, the symptoms are a downstream problem caused by the baby’s compensation to the tongue tie. So if mom is experiencing significant ni**le pain, it’s not technically the tongue tie causing the pain. Because the baby uses the jaw/gums/lips to hold on instead of the tongue (when they’re tied), the latch is invariably shallow. That’s the source of the pain.
If mom needs a ni**le shield to help baby latch on or to avoid severe pain, that’s totally cool. Is it a solution? No. It’s a compensation and should be used temporarily until the reason that shield use is needed is determined.
If you’re supplementing with a bottle or SNS because nursing isn’t going well, that’s awesome. But that’s a compensation you’re making on the baby’s behalf if your goal is to breastfeed exclusively.
If you’re a lactation consultant evaluating the symptoms, don’t just explain them away. Don’t give the baby credit for “deciding” on doing things that are just instinctive on their part. Try to figure out the source of the compensation that’s causing the problems. Poor hold, poor latch, muscle tension, tongue tie, lip tie etc - these can all cause different compensations. The secret to improving the dyad’s symptoms is sleuthing your way through the problems.