With my first daughter I went through breastfeeding “hell” in the first 6 months. Besides nurses latching her wrong, which resulted in 2 months of sharp pain, I had no clue what was wrong, why she was losing breast, why she never seemed satisfied with nursing, etc. It was 2008, just after the melamine scandal broke in China, and I was terrified of any formula (even though she had to be given formula in the first 24 hours at the hospital), so I bit my lip and suffered through pain and exhaustion in order to make breastfeeding work. And it did. I breastfed her for 2 years and she was weaned 2 weeks after her 2nd birthday.

Only years later, when I had my 3rd child, did I realized that she was lip-tied (her tie broke when she fell down on her face at the age of 2 – I can still see the signs of that fall because when the tie is not surgically cut you can sometimes see the bits of it remaining). And with my 3rd child I knew he was tongue-tied, too, but discovered the tie much later than I should have because I was assured he didn’t have one (thank you, doctors…not)!

It took me over 6 years and some hands-on practice with other moms to be able to determine when the baby has a possible tongue and/or lip-tie.

So below are the signs that should come to your attention first when you feel something is off with your baby’s latch:

1. One very clear sign of the tongue-tie is when the baby lifts or pushes the tongue forward it gets a separation in the middle making it resemble a snake’s tongue. This is definitely a tongue-tie.
2. One of the clear signs of the lip-tie is the tie connecting to the very tip of upper gums stretching towards the tip of the upper lip.
3. Blisters on upper lip indicate poor latch and upper lip-tie.
4. Inability to stick the tongue out indicates poor sucking reflex and a tongue-tie (quite often – a posterior tongue-tie, which needs more serious surgery than the anterior one).
5. Quite often a lip-tie comes with the upper lip curving in during nursing. It can also be a sign of just a poor latch. However, it is always good to take a look and investigate whether it is the former or the latter.
6. Clicking sounds made during nursing indicate that there might be a tongue-tie. The tongue doesn’t stretch properly and doesn’t move as it should, hence it creates sort of a hollow space, so the clicking appears. It can also indicate a poor latch.
7. In over 90% of cases, upper lip-tie comes with posterior tongue-tie (which is what my youngest has).
8. Lip and/or tongue-tie often come with weak sucking reflex (the baby loses the breast, can’t latch properly, gets overwhelmed and tired while nursing or taking the bottle – which is what my youngest had in the first month of his life!). Note: weak sucking reflex can also be a sign of some physiological problems, such as various types of cleft palate, and some other disorders. Please seeks advice of the professionals and don’t dismiss the signs. Your baby may have all of the above plus some. Advocate for yourself and your baby!
9. Baby’s weight gain is poor – less than 500g a month in the first 6 months (I had a tongue-tie and I gained only 300g in 2 months, which alarmed both doctors and my mother; once I had the mini-surgery, I latched properly and my weight gain took off from there on). Note: poor weight gain can also be caused by a number of more serious problems, such as acid reflux, GERD, genetic disorders, food allergies, etc. Please seek the advice of professionals, get second and third opinions, advocate for your baby and don’t dismiss the signs!
10. Mother has frequent blisters, blebs, cracks and clogs. All of those can also indicate a poor latch, yeast infection, mastitis and more; so investigate the causes properly.

Unfortunately, in China lip and tongue-ties are often misdiagnosed and dismissed. Mostly it is due to the fact that formula feeding is preferred over breastfeeding. And since it doesn’t take the same effort and positioning of lips, many doctors simply advise you to drop breastfeeding and just give your baby formula (not even expressed milk).

So what can you do if you suspect your baby has a lip/tongue-tie? Make a visit to a pediatric dentist/orthodontist. If you don’t have one – visit a regular one and do so in a big public hospital (or an International hospital). If you can, find a lactation specialist and discuss your options with her. We lactation specialists are usually capable of identifying the signs and suggesting you the course of actions. Some of us may know breastfeeding-friendly doctors, or can recommend a place to go to in order to confirm the diagnosis. Also, if your baby had a lip-tie/ tongue-tie surgery, the lactation consultant can help you work on the latch – and in some cases – perform the exercise that is needed post lip/tongue-tie surgery.

Wishing you and your baby health!

Varya Sanina

Varya is a contributor to havingababyinchina.com. She is originally from Russia and has been living in China for over a decade. She is a Mom of 3 , an educator (Montessori, Positive Discipline), postpartum doula, baby massage and perinatal fitness trainer, breastfeeding and lactation specialist. She blogs at creativeworldofvarya.com about multiculturalism and life in China.