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Tongue Tied: A Tale of Blood, Lasers and Tears

There’s nothing worse than seeing your baby screaming in pain. It’s quite another thing to watch his mouth fill with blood as well.

That’s what we experienced yesterday, and it was fairly traumatic for all involved.

But before I explain how and why this happened, we need to go back to Jasper’s birth, and the discovery of a little thing called ankyloglossia, or tongue-tie. It’s when the strip of skin connecting the baby’s tongue to the floor of their mouth is shorter than usual, restricting its movement. It can be a problem for breast feeding because if the tongue-tie is bad, the baby can’t stick its tongue out to get a good latch, or lift the tongue up to the roof of its mouth, which is essential for good sucking.

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A tongue-tie (not Jasper’s)

Jasper had a pretty bad tongue-tie, pretty much like what you see in this photo. Usually with this sort of thing you want to get it dealt with right away, and we did. Less than 12 hours after he was born, a nurse at the maternity unit came along with a big pair of scissors and snipped it. It wasn’t very pleasant but it wasn’t too bad, either. It didn’t bleed too much and Jasper stopped crying after a couple of minutes. We thought that was the end of it.

But no. When our midwife was at our house one day she noticed he had a lip tie as well. This is where the top lip connects to the top gum, restricting movement of the top lip, which is important for a good latch. She didn’t think it was affecting his feeding , but said some parents like to remove them to stop kids from getting a gap in their teeth later in life. The decision was up to us and there was no rush to decide. We decided to wait until the school holidays to get it sorted. We made the booking for the Hamilton clinic because it is a third of the price of the procedure in Auckland and has a great reputation.

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A lip-tie (also not Jasper)

We thought that was that but then a couple of weeks ago at his regular Plunket check the nurse also noticed his tongue was still a little heart-shaped at the tip (a classic sign of tongue-tie), and advised we get that checked out again as it may have re-attached.

So Wednesday was the day – two days ago.  We get there about 11:30am and fill out some forms before the nurse comes to get us. She sits us down in her office and takes a look at Jasper’s mouth and confirms he has the worst level of lip tie, which may have contributed to his complications with breastfeeding. (She also confirmed his tongue tie had come back and we should get that cut again, too). This hit Liv a bit hard . She had to stop breastfeeding a couple of weeks ago because she stopped making milk.  Liv thinks maybe if this was picked up on and fixed earlier Jasper would have been sucking better, and therefore the supply would have been greater.

Now, I should point out here that the jury is still out on whether lip and tongue ties are actually that big of a problem for breastfeeding. Some people are convinced they contribute to poor feeding, while others think it’s just another medical fad that serves no real purpose, like circumcision. Up to 10% of babies have tongue ties, and about eight percent are getting them cut, a huge increase from a decade ago.

In New Zealand, though, it seems the general advice is to get them cut if they’re at least a little bit bad, so that’s the advice we took. It’s more than just breastfeeding, too – sometimes lip ties can cause people to have a large gap in between their front teeth if it’s not fixed, and other dental problems that may require braces to fix. We figured that while that’s not life or death, it seems quick and easy just to get it fixed now and avoid all that.

Anyway, the nurse took us through the procedure. It’s pretty simple – they use a water laser to cut the strip of flesh on both the lip and tongue. It’s painless and takes about 30 seconds in total, she said. Sounds good, we thought.

Then the dentist came in and had a look in Jasper’s mouth. He wondered why we were there if Liv had stopped breastfeeding. We told him we just wanted to avoid any dental or speech issues later (tongue-ties can cause speech impediments because children can’t move their tongue’s like they should be able to).

Finally they were ready for Jasper. They kept us in the nurse’s office and they whisked him away. It’s better if we’re not there for the procedure, they said. We believed them, and were glad to be excused, quite frankly.

While they were doing it, Liv and I watched a two-minute video about how to care for the wounds once we got Jasper home. It seemed straight-forward enough – you just massage the cut site with your fingers for a few seconds several times day to stop it healing over.

As soon as the video was over, we heard this faint cry and knew it was our boy. They brought him back in to the room and he was as red as a beetroot, screaming his little head off. Liv took him and held him close, and he stopped crying after a few minutes. There was a little bit of blood but it stopped bleeding very quickly. The nurse gave us some gauze in case it started bleeding again.

We waited there for a few minutes, just to make sure Jasper was OK, and before long the smiles came out again and we knew he was all right, so we went on our way. We made the most of our little visit to Hamilton and had lunch in town before heading home.

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Jasper happy as can be to be leaving Hamilton

We got home about 3pm and everything seemed OK. Then about 4:30 he woke up screaming and I couldn’t console him, which is unusual, so I gave him some Pamol to calm him down. He was red in the face, screaming for about 25 minutes before he settled. That hasn’t happened before, so I was a little concerned. But eventually he returned to normal, so I thought he must just be hurting a little.

By 6pm, Jasper was happy enough and we just went about our nightly routine: bath, feed, in bed by 7 (that’s Jasper’s routine by the way. I wish it was mine). The night was normal and he didn’t seem to be in pain.

Yesterday morning – the day after – seemed like a normal day, mostly. Jasper was pretty settled and Liv and I were exhausted. About 9am I popped down to school for a bit to do some planning before classes resume next week, leaving Liv at home with Jasper for an hour or so.

When I returned,  Jasper was lying on his play mat on the floor. He seemed happy enough, wriggling and cooing as usual. Liv told me she had done the exercises we were instructed to do and his tongue-tie bled a little bit. Ok, no worries, I thought. But when I got down and looked at him close, there was quite a lot of blood in his mouth. Enough to make me concerned.

About this time he started crying. I’m not sure if he was actually in any pain, but he was becoming distressed. Maybe he was picking up on our anxiety, I don’t know. But as he got more agitated, the bleeding seemed to get worse. When I looked into his mouth there was blood all through it, and it started running out of his mouth. We used some of the gauze the dentist gave us to stop it, but it didn’t work.

We decided to get him down to the doctor right now, just in case the bleeding doesn’t stop. Meanwhile she got on the phone to the dentist who did the procedure – they said she’d call us back. She then called Healthline to ask them what to do. We had him in the car within a minute and were pulling out of the driveway within two. Jasper was screaming. The Healthline nurse – who was incredibly kind and helpful – was still on the phone to Liv but there wasn’t much she could do for us. We just needed someone to look at Jasper.

Luckily we live in Pukekohe where traffic isn’t an issue, so we got to the A&E in five minutes (in Auckland this would have been a 20-minute trip, easy). During the car ride, though, he calmed down. He was still bleeding quite a lot, but he definitely didn’t seem to be in pain. I guess the movement of the car just settled him.

We got into the A&E and went to the counter. Liv was crying, but Jasper was happy enough. We held tissues up to his mouth to catch the blood, which had slowed down a bit at this point. The staff there didn’t seem too concerned – the receptionist handed me a clipboard and told me to fill it out the obligatory form, as we hadn’t been there before. I was thinking, Huh? Shouldn’t someone see him right now? I can’t fill out a form, my son is bleeding!!

Right on cue Jasper did a bit of a vomit that was filled with blood and he and Liv started crying again. Suddenly two nurses came rushing out.  Jasper just grinned at them, with his gummy, bloody mouth. Sure, now he puts on the charm. You should have seen him 10 minutes ago, I thought.

We took Jasper into one of the consulting rooms and he was very calm, definitely not in pain. The nurses gave Liv a piece of gauze and made her put it on his tounge and hold his jaw shut for a few minutes. Jasper screamed throughout but the bleeding slowed and a decent clot was there under his tongue. The nurse said to leave it, as removing it would start the bleeding again.

A doctor came in and took a look. He shrugged apologetically and said there’s not much they can do, but to come back if it starts bleeding heavily again. They stressed though that if the bleeding was bad to call an ambulance straight away. Their advice was to ease up on the exercises for a day or two and let the cut heal a bit more before agitating it.

So they loaded us up with a bit more gauze and sent us on our way. I was just glad Jasper seemed OK. The bleeding had stopped and he was happy.

We got him home and he went straight to sleep. Liv lay next to him almost the entire nap, terrified he was going to choke on the clot or his blood. He didn’t. Later in the afternoon the dentist finally called Liv back, long after we needed any advice. She apologised and said the receptionists had downplayed the seriousness of it. In hindsight, maybe it wasn’t that serious, but it seemed it at the time.

The dentist said this was highly unusual and that they never see this kind of bleeding in children who’ve had lip or tongue ties cut. She put it down to his age – because he could stick his hands in his mouth now, he may have been playing with the cut site and that could have made it worse.

Anyway, since then, there has been no more blood, and we’ve even done the exercises with no complaint from him. So I think we’re over the worst of it.

When we have our next baby, if there’s a sign of a lip or tongue tie, we’re going to get it dealt with straight away. Like, the next day. It’s much less of an ordeal when they’re very little. Although we thought we had done this with Jasper, getting his tongue tie cut hours after his birth, getting the laser treatment done may have been more effective. Also, we weren’t told to do these exercises after that initial one, and that might have been why it came back.

Overall, yesterday was the scariest experience of our parenting so far, but I think we dealt with it well and did the right thing by getting him down to A&E. I’m sure there’ll be plenty more scares to come, but I hope we get a bit of a breather first.

 

 

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