Motherhood is all consuming.

Having babies, nursing, feeling the fear of loving someone that much, and there's this baby on your chest, and boom, your entire life has changed.

It's a privilege of being your child's safest space and watching your heart walk around outside of your body.

The truth is, I can be having the best time being a mom one minute, and then the next time questioning.

My life choices.

I'm Lo Mansfield, your host of the Lo and Behold podcast, mama of four Littles, former labor and postpartum RN, CLC, and your new best friend in the messy middle space of all the choices you are making in pregnancy, birth, and motherhood.

If there is one thing I know after years of delivering babies at the bedside and then having, and now raising those four of my own, it is that there is no such thing as a best way to do any of this, and we're leaning into that truth here.

With the mix of real life and what the textbook says, expert Insights and Practical Applications.

Each week we're making our way towards stories that we participate in, stories that we are honest about, and stories that are ours.

This is the lo and behold podcast.

One of the things that has been most surprising to me, I think as a mom, and then also as you know, nurse educator, influencer, whatever title you wanna put in front of me when it comes to my work in this space and working with families in births and breastfeeding and postpartum, is how divisive things can be that I just never thought or realized were going to be divisive.

Now, I'm not saying that they should be divisive, but there are certainly a ton of topics, as I'm sure you are already familiar with.

This kind of being a mom and stepping into the mothering world that really are so divisive.

So our guest today, Lisa Paladino, she is someone who is very familiar with this divisiveness that I'm talking about because she is someone who works in the world of tongue ties.

Lisa Paladino is a CNM.

She's an I-B-C-L-C.

She's an internationally recognized lactation consultant, midwife, and educator.

She's got over 35 years of experience and she has dedicated herself really her life, I would say, to improving infant health through breastfeeding support and airway development education.

Lisa is also the founder of Tongue Tie experts where she leads a thriving online community.

She produces the Tongue Tie Experts podcast and she creates educational content for both parents and professionals inside of Lisa's courses, her lectures, and then via her social media outreach.

Lisa also can empower you, healthcare providers, especially, to recognize and manage tongue tie and it's related feeding challenges.

My goal for you with this conversation, as with mostly all of our conversations, right, is that you are getting information that empowers you and makes you feel really comfortable and confident making choices in your story and the story of your baby.

I do not want this topic to feel divisive to you.

I just want you to feel knowledge about it so that if or when you run into an issue, especially one related to tongue tie, that you know where to go, who to listen to, what to do next, and what feels right for you and your family.

So if you take anything from this combo today, I hope that it is that.

Lisa, thank you so much for being here with me.

Why don't you go ahead and say hey and introduce yourself and then we'll get going.

Hi.

So first of all, lo, thank you so much for having me.

I am thrilled to be a part of this podcast.

I love your podcast.

Name number one.

I think that's adorable.

Me too.

And perfect.

And I know you probably have an official intro for me, but.

I just like to say I'm a mom, I'm a grandma, I'm a midwife, I'm a nurse.

I'm an I-B-C-L-C.

I know a lot about babies, and in the last, like 10 to 12, almost a little longer now years, my specialty has become tongue tie and I'm known as the tongue Tie expert because of all of my honing in and learning and, experience with babies with tongue tie.

So.

That's who I am, and I'm thrilled to be here.

Perfect.

Thank you.

I'm, I'm actually glad you like, went through all the things again because my first question really is, is how did you go from mom or let's say nurse to now this, because I love when nurses, midwives.

Are also lcs I-B-C-L-C.

I just think like when that all comes together, it is the most incredible thing, but it doesn't really happen that often.

'cause in theory you had your nurse career, you could have stopped there, then you did midwife, you could have stopped there.

Then you add on I-B-C-L-C.

Yeah.

So how'd you go from that and I to where you are and I had a couple

of other certifications in between.

I'm also a functional medicine.

You do medicine provider.

I've taken herbal medicine certification.

I am.

My problem or curse or joy is that I'm a lifetime learner and I always wanna know the next.

Thing.

So that's, that's what's been happening.

I started as an rn, I was frustrated with my bedside role as an rn, and I didn't quite at the time understand the depth of why I was frustrated.

Mm-hmm.

Now, now looking back, I see a little PTSD about, you know, traumatic births that I was a part of.

By no fault of my own, just my own education, whatever at the time.

That, that's a story for a whole nother day.

But, what happened was I just knew that there were some midwives that were my, I like to say like my heroes who started working at the hospital and they inspired me.

So I had to get my bachelor's degree and then my master's, I got my master's in midwifery and did a research project in the meantime on skin to Skin.

Okay.

Which skin to Skin right now is something that, oh, everybody just does it.

Well, I was one of the pioneers in my area getting that put into place.

So, trying to in implement that as part of the baby friendly 10 steps in my own hospital.

I was involved with the New York City.

Breastfeeding initiative.

Representing my hospital as the only lactation consultant at the place I worked for 38 years.

Oh wow.

Yeah, not, not 38, 28 years.

I'm sorry.

I'm, I'm extending that still.

Oh, wow.

Yeah.

I've been a nurse with, yeah, whatever.

I've been a nurse for 38 years.

But, so, it all sort of came together at once and at that time.

'cause people always say, well, where?

Why?

Tongue tie?

Right?

At the time what happened was I learned a little about tongue tie and nobody else knew anything.

So I felt the awesome responsibility of if people are gonna be sending me their babies that they're challenged with because they think there's tongue tie, I better learn more.

So that's what I did.

I just deep dive into every education every.

Collaborative.

You know, there were a couple of different conferences and groups that put on conferences and that's what I started doing and reading all the research.

Not too much, but all the research that was there and, doing mentorships with.

Providers that are in the field and well known at the time, they were al almost the only ones, the pioneers.

Yeah.

So here I am, all these years later and, I just ran with it because I was getting better results than anyone else I knew and I wasn't afraid to keep learning about it.

So that's always the key is just keep learning.

Yeah.

Okay.

Well then let's just jump right into off of that point.

Thank you for that.

Mm-hmm.

That idea of keep learning and changing and shifting because I think obviously the perinatal landscape does change.

We have some things that feel universally true or things that will be kind of true forever.

Right.

Maybe about our bodies or things that happen, but also there has to be this humility when you're a provider or an educator and recognize like.

Things change.

Evidence changes.

Mm-hmm.

Or we finally get the study that hadn't been done and it's blows your mind because it is or isn't what you expected.

And so last, we were talking about this before we jumped on, but like a year or two ago, there was that huge article that came out about tongue ties and I personally felt like, or tongue TTI treatment I'll say as well.

And I personally felt like this article.

Was kind of negative towards, essentially like laser treatment of tongue ties and cutting snippet.

I know there's different words that people use, but treating a tongue tie and kind of scared a lot of people and families away from that treatment or made it seem like this is.

Like absolutely the worst thing you could do, you know, et cetera, et cetera.

We can get into it.

Mm-hmm.

And so I wanted you to kind of speak to us, speak to my, my mom's here in this community about that.

Let's start first with like a really basic, can you just tell us like what a tongue tie is, what kind of.

The treatments are, and then we can get into the nuance of that discussion too.

Yes,

absolutely.

The first thing I wanna say though is that shame on the New York Times for being so divisive.

It was because the person who was interviewed is one of my mentors and very good friend, and it's Dr.

Scott Siegel and Dr. Siegel opened his office.

Full disclosure, let them come in, see everything, showed them the research that he's a part of, and then they made it look like he was just a sham doctor doing something for money with no, no evidence behind it.

So shame on the New York Times, and I did a whole response to them.

I have a whole podcast in response to them, my own, and it's on my website.

And also we can link it.

Yeah, I interviewed Dr. Siegel in response to it because Okay.

It was just, it was, it was sad.

It was sad.

Yeah.

Because this is a man who has dedicated his life to helping families, and he's the nicest man you'd ever wanna know, like mm-hmm.

You know, and everyone gets his personal phone number, so it's not even like he's not.

For what people say.

He could do anything.

He's a trauma surgeon, he could be doing anything.

And this is what he is dedicated his life to.

So enough of that, what is a tongue tie?

That's okay.

Thanks.

So a tongue tie is you got you got my, you got me going.

I know.

I mean, it was super divisive.

You, you felt that right away.

Yes.

And it's like, and there is no black and white.

There is no black and white in any of these fields.

Right.

So, but it.

Sometimes we're like, put in a position where we should take sides and I don't like to, I, I don't like to take sides on anything anymore.

You know, it just, it just, it's not good too.

But what I do take sides for is empowering families to learn as much as they can.

Yeah.

About everything that they're dealing with.

That's, and make their own decisions, following their own instincts and the education that they, they have.

Taken in, you know, so right.

A tongue tie is a functional diagnosis.

It's not something you can look at and say, this baby has a tongue tie.

Because a tongue tie is something where the position of the frenum or the length of the frenum, which is the piece of skin under the tongue or under the lip in, in the sense of a lip tie, is causing.

Preventing functional movement of the tongue.

So for a newborn, the functional movement of the tongue is comfortable and efficient.

Breastfeeding, right?

Mm-hmm.

So if that can't happen and the cause is the frenum, then it's a tongue tie.

Now where we run into problems is when it looks like it's a tie, but there's something else going on.

Mm-hmm.

So now you have that.

Kind of over-diagnosis overtreatment, somebody who says, oh, this looks like a tongue tie.

You have nipple pain.

Let's snip the tongue tie and everything will be better.

Mm-hmm.

And sometimes it will, but sometimes it won't.

And in those cases when it won't, that's where we get a bad wrap on tongue tie treatment.

Mm-hmm.

So

that's, that's in a nutshell what is going on in some places.

Without having a functional evaluation, which in the case of a breastfeeding baby, it's with an I-B-C-L-C who has had.

Very good education and understands how the tongue is supposed to function, how the muscles work, how the face works, how it's connected to other things.

It can be an I-B-C-L-C, sometimes it's just speech language pathologist with feeding therapy, experience.

You know, it's always someone who has had more training than we learned in school, you know?

Mm-hmm.

As an rn, if you took tongue tie courses, yes.

You are more qualified.

Than even A CLC who didn't take tongue tie courses.

So the label itself, people may hear, parents may hear different labels and get all confused.

Always ask, have you learned about functional tongue tie?

Have you learned about functional movement of the tongue and how it can be affected?

So.

Are you

saying that's a question for parents?

Yes.

To ask a provider?

Yes.

Who is assessing and looking?

Yes.

Okay.

Yes.

And you can never diagnose a tongue tie or assess a tongue tie without watching the function.

Mm-hmm.

So if somebody is not evaluating your feeding, then they cannot diagnose a tongue tie.

I would.

For someone to say, oh yeah, it's a tongue tie.

I could see it and clip it, or whatever.

So you want to be absolutely sure.

So in that sense, there is over-diagnosis and overtreatment, which lends this feel to a bad name.

So you have to be really careful.

The other thing that I wanna make everyone understand is pH otomy or the cutting of that frenum or the clipping.

Sometimes it's called pH otomy.

Ectomy.

Yeah.

Here call a release a revision.

Yeah.

Which it's not really a revision.

Revision is the second time you do something.

So it's, it's a release.

That's not the only treatment and it's never, almost, never the first treatment.

So the, the treatment can be full body.

You, you wanna think about that?

Frenum is a piece of fascia, which, you know, without going into a bio lesson, fascia lines all of our insides of our body.

It's the lining of the insides of all the tissues in our body, and everything is connected.

So if there is tightness under the tongue.

There may be tightness elsewhere, or if there's tightness elsewhere, it might be causing tightness under the tongue.

And, so we wanna look at the whole structure of the face, the neck, the cervical spine, the hips, believe it or not, are connected to the how the jaw is working.

Just as an example, my, I have a brand new granddaughter and she went to an osteopath for treatment.

That was our first treatment for her.

Tongue tie was going to the osteopath, and he noted that her hips were very tight and asymmetrically, meaning not the same on each side.

So adjusting her hips helped her latch.

Mm-hmm.

So we're all connected.

Right?

So think of that makes me think of

what, sorry.

That makes me think of labor and how we're like your jaw is connected to your pelvic the floor.

Yes.

It's true for our babies, it's true for human beings.

Like we carry stuff like from head to toe.

We do carry like tension or whatever.

There are these really?

Yeah.

I think people think sometimes, oh, this is like all woo woo.

You know, these connect.

It's like, no, it's not like from birth we can see this.

Right?

Baby's carrying tension tort, like things where they're twisted or whatever certain ways and the impacts it can have.

Yep.

On their whole little body or their breastfeeding.

These are so real.

This is not some kind of wonky thing that we're trying to sell.

Yeah.

And another connection, trying to sell, this is a

little off topic, but I have to mention it 'cause it's about breastfeeding.

You know how you say in labor we say the hips and the, and the jaw.

Right.

Yeah, are connected.

The pelvis and the jaw.

The, yeah.

Yeah.

So also the baby's head, right?

So we think about how sore the mom's bottom is.

Think about, I always like to say, because I always tell moms not to touch the baby's head when they're trying to latch.

Mm-hmm.

And I say, think about how sore that baby's head probably is.

Like how tender, not to say the baby's in pain.

No.

Yeah, but that's tender, right?

Yeah.

That baby's head was the one pounding against your parents for hours for days.

Yeah.

Right, right.

Yeah.

Yeah.

So like be gentle.

'cause if you know it's a reflex, if you touch the baby's head, they tuck their head in and that's the good for latching.

Right?

Right.

It works for birth, but it doesn't work for latching.

True.

So be very sensitive when you're trying to latch.

Sometimes all we have to do is take our hands off the baby's head, support them.

Beneath the neck and let them extend their neck.

Yeah.

And they can latch deeper.

Yeah.

Which brings me into the other treatment for tongue tie and making sure, or the treatment for symptoms that may mimic tongue tie is making sure having that good lactation evaluation where you make sure you're using positions that favor a deep latch that you and BA baby are, are in the best position for you and that baby.

And that could change.

In consequent babies, right?

Mm-hmm.

If you've had two babies, they may have liked or did well in a certain position, but maybe with this baby, this baby needs something different.

Mm-hmm.

So that kind of thing, making sure the mouth is open, the chin is in the nose, is out.

Often just a millimeter change in the baby's mouth can change a lot of difference in what it feels like on the mom, right?

Yeah.

So we wanna do all the lactation things.

We want to make sure there's no body work tension.

We want to make sure that mom's got milk supply going.

We wanna rule out anything else that could be causing the symptom.

Mm-hmm.

So, you know, we don't wanna just say, oh, this baby is a tongue tied, let's fix it and everything will be better.

Because if, if the tongue tie wasn't the thing causing the symptom, fixing the tongue tie is not gonna make everything better.

Right, right, right, right.

So for example, say Mom has never watched another mother breastfeed and I. I've met a lot of women that they were the first in their generation, none of their friends breastfed.

She has no idea how to hold a baby to breastfeed.

Yep.

I have made, I've brought women to tears, just showing them the proper way to hold their baby, you know, often off that silly pillow.

'cause I hate, I'm, I'm not a fan of breastfeeding pillows and getting them close and on their body and in a good position and helping them relax.

And all of a sudden the baby can nurse and it doesn't hurt and there's milk transfer.

Mm-hmm.

So it can be a simple fix.

Maybe there is a tight frenum, but let's get breastfeeding going first.

Yeah.

Let's see, let's test out the feeding.

Let the baby uncurl, which is a very, unprofessional way of me describing babies needing body work.

Right?

Yeah.

Because I feel like they're born all curled up and they're going to uncurl and we want that to happen.

In a symmetric, like the same on both sides and be able to move side to side, put their heads back comfortably, do some tummy time, lift their heads all on their own comfortably.

All of that contributes to breastfeeding.

All of those motions that newborns make are for the ultimate goal of breastfeeding 'cause that's how we survive biologically as a, as a species, and also breathing with their mouths.

Closed breathing through their noses because a baby needs to breathe through their nose in order to.

You know, suck and swallow efficiently.

Mm-hmm.

Or they're going, there's gonna be some choking and sputtering and gagging and stuff like that.

So we wanna make sure all of that stuff is going good or well.

And, before we consider release in most cases.

Also, something that nobody seems to bring into mind, and I have a whole course on this for, for professionals, is making sure the mother is considered in, what is she ready for?

Right.

So if you are a parent who's listening to this and you just had a baby and you Google tongue tie and this came up and everybody's throwing all this stuff at you and you just had a traumatic birth, you may be anemic.

You haven't slept yet, you're bleeding, you're in pain.

You don't want somebody to tell you your baby needs surgery.

Mm-hmm.

Right?

And frenotomy is a simple procedure, but it's still to a new mom sounds like, oh my God, there's something wrong and my baby needs surgery.

I want everybody to take a deep breath, step back and consider the mom, consider her mental state, her physical state.

Has she recovered what's going on with the rest of her family?

All those things before we consider a surgical procedure if possible.

Yeah.

Yeah.

Oh, Lisa, you know, that's a lot.

I have like 10,000 questions a good way.

Like, Hey, let's talk about this more.

Yeah.

Yeah.

Okay.

I wanna bring this down to like the mom that you just talked about, or let's say my 37 week mom who's like, good Lord.

Another thing to worry about, right when it comes to breastfeeding, because we were talking about this before we started, but.

I just had an episode go up about demer, which when I was talking about it, that too, I was like, I hate putting another thing in front of you related to breastfeeding that you might have to worry about.

But like you said, people deserve to have this information so that they can then, you know, you get to choose what to do with it, but we don't, we don't like withhold just to protect moms feelings, right?

Like Right.

They deserve to have this info.

So anyway, so that mom, let's say that pregnant mom.

Okay.

Here's another thing to kind of add to the list.

Maybe it's already on the list 'cause.

People know what tongue tis are at this point.

What should they be thinking about, like right now prenatally in regards to, I don't wanna say just basic breastfeeding prep.

I mean, a lot of us probably know some of that, but like even thinking about tongue tie or a way to just kind of know what would I do next if I'm gonna run mm-hmm.

Into some of these issues, like Right.

What would you say to her?

Right.

So, the first thing I would suggest for everyone who is.

Even if, if you have a 10% inkling that you want to breastfeed,

mm-hmm.

Make a relationship or find an I-B-C-L-C, most IBCLCs will do a prenatal visit virtually or in person so that you have that connection.

Not just about tongue tie, but about anything, any questions that come up.

Because if I tell you.

More than half of the people that call me in the first couple of days, and I get the messages, you know, I just had a baby and this is going on.

I answer them and then I never hear from them again.

Mm-hmm.

Because, not 'cause they don't like me, it's because they are just so overwhelmed Yeah.

With so many things.

Yeah.

And they're not sleeping and they don't even remember who they called.

And it's, and, and I don't mean this to insult anyone I've had brain and you know, it's real.

I know what that's like.

Right.

So, if you have someone in your corner already.

Then when it, when or if there's a problem, or even just a simple question, which there will be questions, there will be questions there.

Lot of those, because you cannot plan for what this is going to.

Feel like what your baby's gonna be.

You can't plan.

Nope.

But you can plan to know what to expect in general, what's normal.

And this is what I do in a prenatal, right?

So it's, it's more like, so for those who don't know, prenatal means a visit with the lactation consultant before the baby comes.

This works really well for second babies too, because mm-hmm.

If you had any, bumps along the road in the beginning of your first breastfeeding or even along the way.

I like to go back and say, well, what happened and what could we do differently?

Mm-hmm.

Or what would've happened that would've been more support for you at that point, you know?

Mm-hmm.

So we plan through the problems, and I am a doom and gloom prenatal appointment.

I go through everything that could go wrong because if you're a first time mom, you probably have this like fantasy of this perfect birth and you know, all the things.

And so I go, I go in and go, well, if.

I know you don't wanna have an iv, but what if you have an IV or Yeah, you know, I know you don't wanna, you know, have a C-section, but what if you do, this is what you should do.

You know, so that's what I like to do.

And a lot of lactation consultants work the same way as I do in the prenatal appointment.

And a lot of us have like a package.

So you get that prenatal appointment and appointment within the first week so that you can, make sure that everything is going how you want it to and optimize things.

Yeah.

You know, optimize things before it gets to be a problem.

Where that comes in with tongue tie is, first of all, you already have a. A connection and a relationship with someone that hopefully you've built some trust with them and they know you, right?

So you're not going to them upset with a problem right away.

You're going to them with, this is what's going on, what do you think it is, kind of thing.

And you get to have time instead of making all the relationship stuff you can get right down to, well, this is what I think, this is what I think you should learn about instead of starting from scratch when you first meet the first time.

Does that make sense?

You know?

Yeah.

No, absolutely.

Yeah.

And I talked before about what we do, what we try to do to avoid immediate tongue tie release.

That doesn't mean that there aren't some people that do need it.

There are some babies that cannot latch.

There are some babies that are so tight and tied that even though they're going to need different and more therapies, if they don't get that release, they're not gonna nurse at all.

So there is sometimes immediate release.

I just wanted to throw that in there because I don't want anyone to say, she's saying, baby never needs a release in the first week.

Okay,

so let's jump to that actually.

Yes.

Let's fast forward.

So let's say this mom does or doesn't have a relationship with someone.

Mm-hmm.

But now this baby is born is in her arms.

Pretty standard what happens in the hospital.

And this is gonna, this is what happened to me with my third and so I'll just share, this is a personal story, but pediatricians round on your baby, like once after birth in a hospital.

Mm-hmm.

And then usually like once a day until discharge.

Mm-hmm.

And the pediatrician has to discharge your baby, the OB or CNM discharges the mom.

And then, so both of those providers see you kind of once a day until whenever it is that you're supposed to go home.

So the pediatrician comes, they typically the first.

Time they see your baby usually a few hours after birth unless you delivered in the middle of the night or whatever.

They come by and they do like a head to toe assessment on baby, and that usually includes, you know, some oral assessment as well.

Most of them not always aren't well, and I would say most of it supposed to.

It's supposed to,

yes.

Well, and most of them aren't trained in lactation either, so I'm always kind of like that.

But even without lactation.

This is the thing should be looking, I don't want anyone to assume that somebody felt inside their baby's mouth because Well, that's what I'm gonna bring up.

We've had, forget about tongue tie, I've had

palates mixed like palate.

Yeah, yeah, yeah.

'cause they just haven't, don't even look at the mouth.

Yeah.

Yeah.

So don't assume.

Ask Yeah.

And, and talk to the pediatrician.

That's, that's number one.

Talk to the pediatrician.

But go ahead.

I

interrupted you.

No, you're good.

No, that's fine.

That's helpful.

And so she walks in with my third baby and granted, you know, I'm nurse, I know.

I'm gonna say I know what's going on pretty well at this point.

But she walks it in and she assesses my son who had been latching well for, you know, the first few hours and things were going great.

And she does this little assessment and she, I think she sticks her finger in his mouth and has him suck for a minute, and then assesses with a little, you know, pin light, flashlight, whatever, and peeking inside.

And then she's kind of like, he has a little bit of a tie.

Just, you know, pay attention to that and then kind of, you know, wipes her hands and walks out type thing.

And I was like, whatever.

I'm not worried about like, because I mean, I re I know what you said, this is about function and how I feel.

Mm-hmm.

And milk and all this other stuff.

Mm-hmm.

But I was so annoyed at her as well.

'cause I'm like.

A first time mom or an anxious mom, you cannot just drop, oh, there's a little bit of a tie, like, eh, on a parent and walk outta the room.

Right?

And so what do you say maybe to that mom, right?

If you know, I just ignored it and we were fine and there was no tie.

Right?

If there was, it was totally functional, right?

Like I never saw or felt anything.

But what do you say to that mom who then they walk out and they're like, wait, what?

Yeah.

Is there a tie?

What do I do now?

Like, what's that?

So, so first of all

that that person who assessed that.

Doesn't have tongue T tie education.

It's obvious.

No, she doesn't.

I know the doctor say there's a little bit of a tie.

Yeah.

That's like saying you're a little pregnant.

It either.

It either works or it doesn't.

There is no like, you know, maybe it's short, maybe it's not so tight.

Okay.

Wait,

I wanna ask you.

Yeah.

Can sticking your finger in their mouth and having the baby suck on it, is that a true assessment of function?

No.

No.

Right.

No.

So even when a provider's doing that, it's like that's not as I can

what They're looking towards the extreme of baby can't suck on your finger.

Can't even like lift their, yeah.

Yeah.

So.

If you are trained to tell which part of the tongue is lifting Yeah.

Along with the visual exam and other muscle testing you, you can know that's part of the exam.

Yeah.

But that's not it.

You know, that's not the full exam.

And then what the baby does on Hi on your finger may be different than what they do with the breast.

On the breast.

Yeah.

So a full functional exam involves observing a breastfeeding.

Yeah.

Yeah.

You can't do it without that.

Yeah.

So there's that.

And then, there's no such thing as a slight tie or a little tie.

And what I would say to that mom is don't even bother getting this.

Sounds terrible, but don't bother getting more information from that doctor.

Yeah.

Get that information.

Find out the signs and symptoms of tongue tie, and then find a provider who understands it, not an emergency.

If everything's going fine like it was with you, it's definitely not an emergency.

Yeah.

But you do.

I do this thing and we learned as nurses anticipatory guidance, like you give the information.

That the person may need in the future, right?

So if I saw you at that point and everything was going fine, I would go through the list of what else can develop down the road.

Like if all of a sudden you keep getting repeat mastitis or the baby gets reflux.

'cause honestly, the first three days.

Isn't always a telltale sign of what's gonna go on for the rest of your breastfeeding relationship.

Yeah.

You know, are you developing pain?

Do you get lump, you know, a lot of breast lumps and clogged ducks.

Do you get nipple blebs is the baby, refluxing is the baby nursing all day long at, you know, four weeks old and never falling into a routine where they have restful, satisfied times.

Mm-hmm.

There's a few different, you know, there's a whole list and I have a list of the symptoms and we could put that in in the show notes.

Yeah.

If you want, you know, can go to ti experts.net is my website and there's information for parents that they can download a list of signs and symptoms for free.

Mm-hmm.

Think about the next thing, because often there's compensations, babies are smart, they need to eat to survive, right?

So I've seen compensations.

Now my daughter is on her second baby, so I mean, I've had lots of.

Lots of experience with this with patients, but when it's your own family, you get to see the behind the scenes.

Right.

And my daughter has a copious milk supply and my grandson, you know that baby that you said, you stuck your finger in their mouth and they can't even suck on your finger.

That was my grandson.

Hmm.

But he gained like a champ.

He.

Tortured my poor daughter's nipples.

Yeah, but he gained like a champ.

So if anybody says to you, oh, your baby doesn't have a tongue tie, 'cause they're gaining fine, that's all that matters, eh?

Walk the other way.

'cause that's not all that matters.

There's a lot that matters.

And the other thing that sometimes sounds scary to parents, and again, like you don't wanna be like doom and gloom.

But a lot of times this is not a quick fix.

Mm-hmm.

And there, so if you do have the tongue tie release and things don't get better, it doesn't mean that there wasn't a tongue tie.

It means there could be other underlying things.

Like, for an example, for my grandson, he had a very high narrow palette.

He was born very asynclitic, meaning his, his head shape was totally crooked.

His whole face and jaw was crooked.

He had a lot of structural things going on.

He's healthy and well, and beautiful and perfect, but anybody who examined him would be like, wow, he's so, he's like, so crooked is the lay person way to say it, right?

Yeah.

So.

We had to make sure he was in very specific positions.

And the position that would've given my daughter comfort was almost impossible for him.

So it was, it was a challenge even with every, you know, I have a huge network of provider friends and colleagues, and she had every treatment, more than any treatment that I ever prescribed for any other baby that in my care.

And still, it was a, it was a struggle for 18 months to nurse him.

Yeah.

But she did it and I'm very proud of her.

Yeah.

Yeah.

Now she has a new baby, this baby, completely different.

And I promised her I was not going to examine the baby and treat the baby like a patient until at least day three.

I made her that promise.

She just gave her three days.

Got it.

Okay.

Because she was like, mom, just let me do this.

Yeah.

I want you to be there, but I want to enjoy my baby without you starting to be, you know, whatever.

Yeah.

So, okay.

Fair.

But I did stick my finger in her mouth a little bit, just playing with her and realized her palette was gorgeous.

And, and that's a very professional way of saying like, I was like so excited that her palette was even, it was nice and broad.

I called my friends who I, I network with who's an ot, and I was like, guess what?

She's got a great palette compared up, right?

So.

But this baby's got, of course, she's got a tongue tie and she is got B buckle ties, meaning like her cheeks are very tight.

Mm-hmm.

And she may need that released.

But now she's going on four weeks.

She has not had the release yet.

We're doing all kinds of body work with her.

She's two pounds above her earth.

At three weeks old, she was two pounds above her birth weight.

So any pediatrician who used weight gain as a criteria would've been like, oh, she's fine.

Mm-hmm.

You know, and your nipples aren't bleeding, so let's go.

You know?

Mm-hmm.

So, no, it's not about that.

It's about, she's refluxing, she's, she's getting a lot of milk and she's spitting up, she can't lift her tongue to control the milk flow.

Mm-hmm.

So she is taking more than she needs.

She's taking milk really fast because my, my daughter has is blessed with an overactive or very copious milk supply, especially in the beginning of her postpartum time.

This is her pattern now, and the baby doesn't need to work hard.

But if we let this go in three or four months.

When that hormonal drive of milk supply goes down, if the baby isn't using her mouth efficiently to stimulate the breast, her milk supply is necessarily gonna go down unless she started pumping.

And you know who need, you know, if you don't need to pump, let's not.

You know?

Right.

We don't want her to have to pump to keep up her supply because the baby has a tongue tie.

Right.

So that's where we are with that, and that's what I recommend.

You know, if you're not gonna do the release right away don't ignore it.

Learn about it.

Learn what other things can happen.

And go with that.

The other thing that I say going down the line too is this isn't just about breastfeeding.

So if you have any inkling that your baby had a struggle with oral restriction and you do not release it, or you do not get other therapies for it, and down the line, things develop like difficulty with solids.

Bottle refusal a lot of times is the first sign of an oral restriction that parents recognize.

Because, you know, now we start giving a bottle and they can't take a bottle, which my grandson couldn't take a bottle because he couldn't lift his tongue at all, right?

And he couldn't suck that way.

So.

A lot of oral motor work was needed.

A lot of, you know, what we call suck training, and that happens in a lot of babies that you know, a lot of times the bottle refusal difficulty chewing and swallowing because you need to start using those muscles that of the tongue that may not work right down the road.

Speech issues are possible from a tongue tie, so you wanna just let parents know that that's a possibility not to.

Release a tongue tie when there's no problem to prevent future problems.

'cause we don't have enough research to say that.

But at least to be aware that these are possible repercussions of oral restrictions that babies may compensate for early on, that may show up later.

Right, right.

Okay.

So that mom, I'm gonna track her through this story.

Okay.

Track so that mom who has just been.

Like your daughter, like how this baby maybe has this history actually really quick genetic component to tongue ties, yes or no?

What do you think?

Can you say that really quickly?

I'd

like to say it could, I believe it's epigenetic, meaning uhhuh, it's genetic, but it's seeming to be running in every family.

So how could that be?

Right?

So it's really, it's rare that you have.

No.

A family with no tongue tie, so, right.

I don't, I don't fall for the folic acid, idea.

If you've heard that, if any parents have heard that?

I haven't

uhuh

You haven't heard about that?

No.

That, oh, it's because of folic acid and the mt H that causes the tie R gene mutation.

You haven't heard that?

Well, I know this whole related to tongue tie, that's No, that's a theory.

Okay.

And it's, and people who believe it are very passionate about that.

But just in my own family, I do not have the MTHR mutation.

Neither do my two daughters.

They both have tongue tie.

I have one daughter that was born with a cleft lip.

Okay.

And she doesn't have the M-T-H-F-R mutation.

Okay.

So, and I took folic acid, not folate with her just in case.

Did all the right things.

Yeah.

It's either.

Environmental toxin exposure.

Mm-hmm.

Or generations who did not breastfeed.

Mm-hmm.

Affecting our genes.

So like it.

Yeah.

And that's gonna be genetic changes.

Yeah.

That's what I believe.

But again, I'm a lifetime learner.

I'll go with the flow.

If somebody presented me with a lot of good research that said it was related to that gene and our ex, you know, and folic acid, I would believe it.

But there's a lot of.

Correlation, not causation studies.

Mm-hmm.

About that.

Like, oh, this baby had this and had that.

There's not enough research.

Okay.

Okay.

Thanks.

Which is terrible.

Thanks.

I wish it was, this is helpful.

But then again, then again, the increase in tongue tie can be related to the awareness of breastfeeding in this generation.

Mm-hmm.

You know, even just like 30 years ago when I was starting out, it was rare that a mom just breasted.

Right.

So Right.

Giving a bottle is easy.

Babies didn't have to work very hard.

We didn't see as much difficulty with feeding.

If we did, there was a severe problem.

Yeah.

And in school, as healthcare providers, we only learn about the anterior really restricted right heart shaped tongue type of tongue tie.

Right.

Right.

And there's obviously more, you've mentioned different ties throughout this episode.

Yeah.

Yeah.

So there's more, I also think, like going back to how I mentioned I talked about demer, but the more we know and the more we're aware.

More, we're gonna have diagnoses of things because we're simply paying attention more too sometimes.

Right.

You know what I mean?

Like it's not like, I do not think that Demer did not exist in the seventies.

Right, right.

We just didn't have a name for it.

Right.

So it's not like demer is suddenly off the charts.

Why do we all have Demer now?

Right.

It was there 50 years ago.

Right.

We just didn't know that that's what it was.

Or maybe it had a different name or maybe people just referred to it as something else.

'cause there wasn't this more kind of clinical understanding yet.

The diagnosis of tongue tie goes back to biblical times.

There are, there are comments in the Bible, you know, whether you're religious or not.

The Bible is still a book that was written how many thousands of, you know, centuries ago, whatever.

And they referred to, he cut his tongue and then he spoke.

Mm-hmm.

And

there are, there are, archeological.

Pictures of tools that were used for tongue tie release.

So that's been there.

Yeah.

But going back to what you just said, like 50 years ago, if a mom tried to breastfeed and it didn't work, that was the dawn of formula.

Mm-hmm.

So it was, oh, it doesn't matter that much.

We got this formula.

So nobody investigated, why isn't it working?

Mm-hmm.

And so many mothers were blamed, oh, it's your nipple shape.

Your breasts aren't good, your milk is bad.

Right.

Meantime, most of the time it's the baby's issue.

Yeah.

Causing the problem, you know?

Yeah.

So it it, it was a lot of mother shaming in our paternalistic formula.

Company driven society and you know, don't go after me and not against formula, you need it.

But there's a lot of history there with why we, you know, why I wasn't breastfed, you know, neither was I, you know?

Yeah.

Because of my mom was knocked out from my birth.

Yeah.

She was given scopolamine.

Mm-hmm.

From my mine and my two siblings.

That's so wild.

And she was frowning with my brother when she was knocked out.

So she never experienced birth until she came to my, my own daughter's third birth was her first experience at birth.

It's so wild.

And it was so healing for her.

But anyway, yeah.

Yeah,

it's a different society, thank goodness.

But we have a long way to go as shown by how we started out talking about that article that wants to divide us.

You

know, because that's how we get ratings.

We, we divide people.

Yeah.

Well it's like click Beatty and all that, right?

Yeah.

But what, it has such serious implications, right?

Because there are real moms, real dads, real families reading this.

And so maybe you got the clicks and the views and the shares, but did it.

Yeah.

It's just like, well, what then?

What did you do next?

Mm-hmm.

Because now we have all these parents who don't know what to do.

Right.

When their

baby has a tie and you, so you know what?

This can be a very serious thing.

I have a friend who works with babies who were so unable to feed that they.

Got tube, feet tubes inserted.

Mm-hmm.

Mm-hmm.

And are living with tubes.

And she goes around the world, she's a speech language pathologist, feeding therapist.

She goes around the world and does intensives with these babies.

And one of the first things she does is assess for tongue tie.

She gets their tongue ties released, and lo and behold, now they can swallow.

Yeah.

Now they can suck and swallow.

They can eat food.

Right.

You know, so there, you know, and, and I. Often think that if my grandson was not born to someone who planned to breastfeed, that would be where he would've wound up because he could not take food any other way.

Then by at the breast.

That was like literally a water fountain for him because Right at a breast

with some oversupply, which ended up being really helpful.

Yes.

Like I don't have oversupply, so if that had been my child Right, we probably would've run into issues.

Or if you didn't

plan to breastfeed, say you didn't plan to, she didn't plan to breastfeed.

Her milk dried up.

Her baby's in the hospital not taking bottles.

That's gonna be the failure to thrive BB that are eventually Yeah.

Gets a tube because they don't know what else to do with them.

Yeah.

And there are really, there are kids around the world that this is part of their problem of why they're, they're not sucking and swallowing.

Mm-hmm.

And it can lead to.

Things down the road.

So this isn't just a, you know, a choice, a selfish choice for moms who want to breastfeed.

Mm-hmm.

Nobody thinks that, you know?

No.

Well, there are people that think that and Yeah.

Probably don't.

And if you wanted to really don't get inflamed, you would go down the comments in that New York Times article.

Yeah.

And some of the stuff that was said made me really just, I just cried and I stopped reading.

It's sad.

Yep.

It was just, it is, it's really sad.

How people were calling mothers selfish for doing something to their baby.

So I would like to reframe it and say we do something for our baby.

Mm-hmm.

Nobody wants their baby to have a procedure.

Mm-hmm.

But if it's going to help and make life easier for the mother, which matters,

it does matter.

And the baby.

Yes, then you're not doing something to them.

You're doing something for them, and it's

also for them, because we're talking about the continuation of a breastfeeding relationship, which serves the baby for every day that you're continuing and doing that and moving forward.

So Well, you and I believe that.

Yeah.

Not everybody believes

that because again, the propaganda we've been fed.

Since Formula was developed, you know, I mean, my mom was also told not to stop smoking and not to Dr. Not to stop drinking.

Yeah.

Yeah.

Well, things seriously change.

Right.

Seriously, because they didn't want her to gain too much weight.

Yeah.

'cause she was a little obese.

Mm-hmm.

She was 140 pounds.

They called her obese.

Right.

This was, this was the sixties.

It was like a poop show.

Yeah, let's just put it back.

So that's why I'm only four 11 'cause my mother wasn't allowed to gimme any nutrients while she was pregnant.

We can have a different episode about that.

Okay, guys?

Yeah.

Yeah, yeah.

Okay.

I wanna summarize this.

Really quickly and you can say, yeah, that sounds right, or, or tweak whatever I say.

But essentially, I feel like as you're approaching birth and the desire to breastfeed, the idea is find that lactation support prenatally for tongue tie, and for everything else that is going to come up in the questions you're gonna have in those immediate days after the hosp or in the hospital breastfeeding.

Make sure you're taking kind of a holistic view of, Hey, how's mom doing?

How's she feeling?

What's the support like?

As well as knowing kind of the fullness of signs and symptoms of mm-hmm.

Ties.

And I wanna just include one more time that the mother's comfort is part of that functional Yes.

Assessment.

Because I think going back to the idea of people are like, why would you do this to their baby?

But if a mom is hurting.

The entire time she's breastfeeding and it's possibly related to Ty that matters.

And so just I want you to know that's like, that's a sign and a symptom as well.

And then once, let's say you are worried or you do think there's something going on, to understand that there are specific providers who can diagnose this and treat this, I would say often a second opinion or like an additional, you kind of, this occur into this duality of providers who are maybe supporting you through this is valuable.

And then I think.

The ultimate kind of is knowing, yes.

Tongue tie, release, or whatever you wanna call it, is not the only option, but it is a viable, helpful option.

That should be part of a conversation while we also talk about some of these other things you're talking about, like body work and.

What is it?

Like myofacial massage and tension work and stuff like that.

Mm-hmm.

Does that sound good?

Like for some Yes, absolutely.

Okay.

And, and the other thing I want, you know, going back to the pain.

Yeah.

Pain is the number one reason why breastfeeding is stopped.

Mm-hmm.

And it's also the only.

Well, the best research we have about tongue tie treatment is that maternal pain decreases after Yes, I know

what you're talking about.

Yeah.

It's not even about like function for the baby, it's that the mom feels better and that matters.

Of course it matters.

Yeah.

'cause

how can someone just do something?

This is, can I get a little crass?

I don't say, how could imagine if a man was doing something eight to 12 times a day that was gonna hurt his penis?

Yeah.

We'd be finding a solution for that really quick.

Yeah.

Right.

Yeah.

They, they wouldn't be signing up for that, would they?

No, no.

And wanting it and like, wanting it so badly.

Right.

And smiling and taking pictures about it.

Yeah.

Yeah.

So, yeah.

So we should not be in pain.

We do not deserve to suffer.

We should reach out for help.

Yep.

Part of the sooner rather than leader.

Yeah.

And, educate yourself, empower yourself, and follow your instincts.

My message is always, if you feel like something isn't right, listen to your instincts.

Don't be gaslit by any provider that tells you, mm-hmm.

Everything is fine.

If it's not, and that that goes for breastfeeding or tongue tie, or anything in your life, all of it.

If you feel like something isn't right, it probably isn't.

Mm-hmm.

And follow those instincts.

Trust yourself.

It's perfect.

Absolutely.

It's perfect.

It was a great place to stop.

Yeah.

Okay.

I do have two follow up, like just end of combo questions.

One, where can people find you?

I know you mentioned a couple resources that you have available for parents, so Yes, that's one.

Yeah, go ahead.

So people

can find me on my website, t it's tongue tai experts.net, or Instagram at Tongue Experts.

Facebook.

For those of you who are old like me, we still on Facebook.

Tongue tied experts or uhhuh.

I have a great support group that's peers and professionals, so parents and professionals can join it, and they help each other.

It's called breastfeeding, tongue tied babies, and that's on.

On Facebook.

Unfortunately, I love Instagram, but it's so much easier to support each other on Facebook.

So I keep that thing going.

Yeah.

Yeah.

And the Tongue Tie Experts Podcast has lots of interviews with different professionals.

Mm-hmm.

And me talking about all these issues in depth that we, we covered quickly today.

Yeah.

And, by the time you publish this, I hope to have a link for parents for a quick tongue tie guide, something easy to digest with a summary of everything they need to know if they're suspecting tongue tie in their baby.

Perfect.

We'll link all of these things she's talking about for you guys in show notes.

Excellent too.

If you wanna follow up.

Okay.

Last question.

What's one thing in your life that's just sparking joy right now?

Or just bringing you ton of delight?

Is it your grandbaby?

My, my, like both of

my grand babies.

Definitely both of my grand babies, especially My new Little Joy honey is Sage Georgiana.

Georgiana was my mom's name.

And love that, she's just.

She's perfect.

I just hold her when I get to hold her, when my daughter will let her go for a second, and I just put her in my arms and I just breathe her and snip, you know, are you obsessed with the smell of a newborn's head like I am?

I just like, yeah.

I mean, I'm weird.

I, I already can't wait to have grandkids and I just had a baby turn one, but it's like, ugh,

let the baby.

So that's my joy and that's what keeps me going.

And, yeah, that's it.

It's beautiful.

Perfect.

Beautiful.

Well, thanks

Lisa so much.

Thank you,

lo, this is super helpful.

Thanks.

All right.

You take care.

You too.

Thank you so much for listening to the Lo and Behold podcast.

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