Breastfeeding is supposed to hurt, amirite?

Actually no, there may be some initial soreness, but your baby’s latch should never feel clampy, bitey, chompy or cause injury to your breasts. This may come as a surprise to you. What if I told you that the things that make breastfeeding painful, also have the potential to affect your baby’s brain development?

What I am referring to are something called tethered oral tissues, (TOT), more commonly known as lip, tongue and cheek “ties”. The technical term for these tissues is frenula or frenums. They are part of normal embryologic development. They are supposed to dissolve in utero at about 12 weeks post conceptional age. In some cases, these tissues remain after birth and the restrictions caused by them can create problems with latch, milk transfer, weight gain, reflux, general fussiness, constant hunger, and gassiness to name a few issues. Of highest concern is that a tethered, retracted tongue can obstruct the airway. Breastfeeding mothers may experience pain, breast damage and shame. There is an attitude that you can breastfeed if you just try hard enough. Women who want to breastfeed and have been unsuccessful at the time of their consultation with me report feeling like failures.

There is information online about the ramifications of tethered oral tissues. There is disagreement about their existence and the problems that they can cause.

Once identified, tethered oral tissues can be released by a trained provider, such as a pediatrician, dentist or ENT. It is often a simple procedure done with a laser or scissors. A program of aftercare to prevent reattachment is assigned. Feeding intervention is implemented by an occupational or speech therapist in conjunction with a lactation consultant.

I have been working with infants for over 30 years of my career as an occupational therapist since graduating from The Ohio State University in 1980. I also have advanced training in craniosacral therapy. I was puzzled for years, as to why some feeding treatment sessions worked and other babies were back about two weeks later, with all of the same problems. I learned about tethered oral tissues in 2013. About that same time, babies started coming to me having had their ties already released, or had a session with me, underwent the release surgery and at follow up, everything I did then integrated. I was baffled. I knew at that point that the release of the tethered oral tissues was the common denominator, but I couldn’t make sense out of how or why it made such a difference. Not only did the feeding issues clear up, craniosacral function improved and held. Discussion of the craniosacral system, function and dysfunction are beyond the scope this essay, but suffice to say that it plays a profound role in how the brain functions.

I spent 9 years studying anatomy texts and online resources with the intention of identifying how the tongue relates to skull function. The skull is held together by a set of connective tissues called the intracranial membrane system. One membrane, divides the hemispheres of the brain. Another membrane separates the cerebral hemispheres from the cerebellum. I spent hundreds of hours trying to make sense out of what I was feeling. It turns out that I am the first person in the world to investigate these connections, and thus there is no reference material available about this.

My big break came in January of 2022. I participated in a human dissection class with Todd Garcia, owner of the Laboratory Of Anatomical Enlightenment, and Tom Myers, developer of the Anatomy Trains Model of structure. I learned that the tongue has attachments to a muscle called the “superior pharyngeal constrictor”. The superior pharyngeal constrictor attaches to a bony bump in front of the big hole in the bottom of the skull where the spinal cord exits. This attachment is called the “pharyngeal aponeurosis”. It a short piece of tough tissue that enters the big hole (foramen magnum) and attaches to the inside of bones inside the skull. It’s an obscure, but direct pathway from the tongue into the skull.

Medical research demands empirical data. Empirical data is information that can be measured, recorded and replicated. I found that many infants with tethered oral tissues have small heads (per head circumference measurements recorded on CDC growth chart graphs). Formal data gathering has not yet begun. Informally, increases in head circumference is have been found to change from percentiles as low as 3rd increasing to within normal limits after release of tethered oral tissues. More research is indicated. This is the beginning of scientific inquiry. Anecdotally, I know what I observe and what mothers report. A typical exclamation is “It doesn’t hurt!!” (to feed my baby).

A simple surgery that releases tethered oral tissues can facilitate pain free, effective breastfeeding. Additionally, the baby’s brain may be more free to grow if it has more space in the skull.

In summary, timely identification of TOT has been observed to easily resolve feeding issues. There is no justification for delay of referral to one of the experts for evaluation and treatment. I was taught a screening by one of our local preferred providers. For your information, the top lip should be able to stretch up over the nostrils without blanching and a sweep under the tongue with your finger is how a tongue tie is identified. Being able to stick the tongue out is not a valid indicator.

At what age can surgery to release tethered oral tissues be done? Robin Glass OTR/L asserts that barring other factors, the releases can be done as early as 38 weeks post conceptional age. The rationale is the suck/swallow/synchrony is usually active at 34-35 weeks post conceptional age.

There are numerous Facebook pages devoted to tethered oral tissues. Unfortunately, there is a wealth of controversy and misinformation “out there”.

In the meantime, know that there is hope for you and your baby. Breastfeeding can be a satisfying, nurturing experience for your family. Is breastfeeding supposed to hurt? The short answer is no. Help is available.

Footnote:

This essay is a brief summary of independent research that resulted in the discovery of a novel anatomic pathway connecting the tongue to the brain.

The copyright material on file with the Library of Congress is called “The Ties That Bind: Your Tongue to your Brain, via the Intracranial Membrane system; The Prantl Mechanism.