Nursing Challenges

Figure 1-6:  The above images show the normal progression of an infant drawing the nipple into the mouth and elongating the nipple.  It also shows the wave motion that the tongue needs to produce to actively express milk from the mother.  The tongue needs to elevate toward the roof of the mouth while the infant maintains a wide open gape or mouth opening.  If the tongue is unable to elevate AND the mouth stay open wide, the infant will close the mouth to bring the tongue closer to the roof of the mouth.  This will lead to a shallow latch, nipple compression, pain and increasing frustrations during nursing.



Connecting all the dots.


Often many questions arise about what exactly is a tongue tie or lip tie is and why it occurs, how it impacts feeding in the infant and growth and development of a person over the course of their life and how can it be resolved.  A major goal of this website is to help educate and allow individuals to more fully understand the implications of proper development from a very early age (as a newborn) and how proper development, growth guidance and usage of the tongue and other orofacial muscles can have a lifelong positive impact on a person.  On the contrary, the non-ideal positioning and usage of the tongue and other orofacial muscles can negatively impact growth and development of the head and neck and impact the entire body. 


The maxillary frenulum or lip tie rarely is a cause for nursing difficulties ALONE.  The lip tie is very easy to see and diagnose, but that does not mean it is the causative factor for the nursing discomfort or problems.  The tongue must groove, extend out and draw the nipple into the mouth.  Once in the mouth the tongue must elevate to form the bottom half of a tube and the roof of the mouth or palate from the top of the tube.  When this tube is formed a closed system is in place and the tongue should make a wave motion to propel milk out of the elongated nipple.  If the infant is unable to elevate the tongue, they will close the mouth down so the tongue comes in closer proximity to the roof of the mouth.  With the closing of the mouth, the initial wide gape or opening will close and the baby will slide down the areola and towards the end of the nipple.  This is ineffective in milk transfer, painful for the mother and will cause the mouth to purse down to maintain an external seal.  This external seal is secondary to the internal or primary seal made by the tongue.  As the depth of the latch deteriorates and becomes shallower the infant will tighten the facial muscles to hold a seal and these muscle will contract.  This lip contraction on the areola and nipple can lead to very sore and irritated nipples and sucking blisters and callous on the babies lips.  These are not necessarily caused by a lip tie, but they are a result of a poor latch from compromised tongue function.  The lip should have the ability to flange or roll back close to the nares or nostril openings with minimal resistance.  The lip DOES NOT need to flange the entire way back to the tip of the nose, because the infant must be able to breathe during breastfeeding.