By Kate Zachary, IBCLC~

As an International Board Certified Lactation Consultant (IBCLC) I hear these same complaints on a daily basis with both my private practice clients and at the very busy hospital I work at in Los Angeles:

“My nipples are cracked/bleeding/so sore I don’t know if I can continue beastfeeding.”

“My baby eats all day long, but isn’t gaining weight and never seems satisfied.”

“My first baby needed formula supplementation at three months because my supply suddenly tanked” 

“My baby has reflux, but the meds don’t seem to be helping him, so I am eliminating every delicious food I can think of because maybe it’s a food sensitivity….?”

And each time I hear this I ask, “Has your baby had a proper assessment for tongue tie?”  and most of the time the response is, “Yes, my pediatrician looked inside their mouth and said they didn’t see one.”

tongue tie

Let me stop here for a moment and give a few disclaimers so there is no confusion:

  •  I love pediatricians!  I have one for my daughter that I adore.  I work with them at the hospital and they are collaborative and crazy smart!  I could never do all that they do.
  • Diagnosing a tongue tie is outside the scope of practice for an IBCLC.  Have I gone through many trainings to assess for them?  YES.  Yes, I have.  Do I diagnose them?  No, I still don’t diagnose them.  I refer to someone who is an expert in mouths to do the diagnosing and release.
  • Pediatricians have A LOT to do and A LOT to keep track of.  The baby’s mouth is NOT their primary area of expertise.  And although there are some who have gone the extra mile to become trained in proper assessment and maybe even release, most have not, and in the event that you can’t find this unicorn Pediatrician, you’ll want to seek an expert in the area of the mouth: a Pediatric Dentist or an Ear, Nose and Throat (ENT) doctor.

tongue tie

With all that said, if you are experiencing symptoms of tongue tie during your breastfeeding relationship with your baby, please reach out to an IBCLC to have the latch and position assessed.  We will work with you to come up with a plan of care that will help lessen the discomfort, protect your milk supply, and ensure that baby is getting all that they need.  We can also assess for lip and tongue tie and give you a referral to a Pediatric Dentist or ENT (or the aforementioned unicorn Pediatrician) to have it diagnosed and treated.

Like Pediatricians, not all IBCLC’s have gone through training to properly assess for tongue tie, so before you book with one, ask about their experience and comfort with this.

Here are some of the symptoms mom may be facing if her baby has a tongue and/or lip tie:tongue tie

  • Pain when nursing- the kind of pain that doesn’t get better after a little time and position improvement. The kind of pain that makes you question whether you can do this or not.
  • Nipples that look flat after coming out of baby’s mouth
  • Recurrent and frequent plugged ducts and mastitis
  • Low milk supply, or milk supply that plummets around 3 months for seemingly no reason

Here are some symptoms baby may be facing if he/she has a tongue and/or lip tie:

  • Poor latch
  • Baby tires out quickly at the breast, but always seems hungry
  • Poor weight gain
  • Symptoms of reflux that are not remedied by medications. This is often due to baby taking in a lot of air and not being able to control flow of milk due to the poor latch and tired tongue
  • Clicking sound that persist through the feeding no matter what position you use

tongue tie


If some of this is resonating with you, please reach out for support and check out these resources to learn more:

Mommypotamus Blog:

Dr. Ghaheri:

Dr. Chelsea Pinto:

Dr. Elias:

And now a short story:

On July 30th, 2017 at 2:39am my daughter was born in the water at home.  Around 2:45am my midwife and fellow IBCLC and I looked into my daughter’s mouth as she cried and exclaimed “Yay!  No obvious tongue tie!”

Twenty- four hours later my nipples were scabbed and my heart dreaded to assess her for the posterior tongue-tie I knew was there.  Knowing what I know about the pain and complications with supply that come along with tongue-tie, I began pumping once a day and my husband would syringe feed her my milk to ensure she was getting enough, and to give my torn up nipples a break.

One week later we had her posterior tongue tie and very thick lip tie released.  Two weeks later, I was still in a lot of pain, although my nipples were healed, and I was in a dark place emotionally.  I wondered if I was going to be able to continue breastfeeding and I was terrified.  I called many of my lactation consultant friends and colleagues and asked them to talk me off the ledge.  I’ve helped hundreds of women through this exact challenge, and I could not find the answers for myself.  I needed help, I asked for it, and after about a month of struggling through, one day…it wasn’t that bad…I wasn’t staring at the clock wondering how much longer until I could take her off.  And the next day I had forgotten to brace myself for her latch, and it didn’t hurt.  And a few days later I fell asleep side lying nursing with her.  This was huge to me!  Prior to this a friend was telling me how awesome side lying nursing was because you could just sleep through it!  I remember thinking at the time: “I can feel every move her piranha mouth is making!  How in the world does a person sleep through that???”  And then I did.  We had turned the corner.

That first month felt like a lifetime, but of course looking back now, it seems like a blink.  I joke that in that first month I wondered if I would be able to keep going, and now at 20 months I am not sure she will ever stop nursing!

I share this story because I need you to know that you are not alone, and that even Lactation Consultants struggle.  At the end of the day we are all doing the very best we can and there is no wrong way to feed our babies.

tongue tie


Kate Zachary is an IBCLC living in Los Angeles with her 20 month old daughter and husband.  She has 8 years of experience working with families as a Birth and Postpartum Doula, Midwife’s Assistant, Childbirth and Lactation Educator.  She enjoys eating ice cream, laying in her hammock, and making her daughter laugh.  She can be found online at

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