Heather Rae El Moussa's son has surgery for tongue-tie: What parents should know

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American actress and TV personality Heather Rae El Moussa has shared that her son recently underwent what she called a tongue-tie revision.

The "Selling Sunset" star shared a photo of her four-month-old son Tristan Jay to her Instagram story on Tuesday.

She first opened up about her son’s condition and the impact it had on breastfeeding in February.

"I had many tearful nights in the beginning because I'd be up at 3 a.m. trying to feed him [and] felt so defeated," El Moussa wrote in an Instagram post.

"I thought... I'll just pop him on my boob and feed him anytime. [Yeah] no!"

She confessed her son had cheek-tie, lip-tie and jaundice — in addition to tongue-tie — which was caught early on by her lactation specialist. After the tongue tie revision, El Moussa said her baby was "latching so well."

Read on for everything you need to know about tongue tie.

What is tongue-tie?

According to the International Breastfeeding Center (IBC), during pregnancy "the developing tongue separates from the floor of the mouth. Sometimes this process is incomplete and some of the tissue remains – this is called a frenulum.”

If the frenulum makes it difficult for the baby's tongue to move or function normally, then it is called an ankyloglossia, or "tongue tie," according to the Toronto-based center.

The Canadian Paediatric Society estimates about 4.2 to 10 per cent of newborns have tongue-tie.

Nancy Harmon, a lactation consultant and registered nurse in N.S., says in some of her sessions where a tongue tie is suspected, she checks to see if the tongue of the baby is moving in a way that’s good for breastfeeding.

"The tongue typically should be able to be able to lift, it should be able to go left and right… and it should be able to curl around the breast," Harmon explained.

She herself cannot diagnose as a lactation consultant, but can help refer families to a pediatric specialist when needed. Harmon said tongue-tie is sometimes diagnosed during a baby's newborn physical examination, but many times it's missed.

"Many times there are untrained staff, or they may be trained but they may not have someone on staff who can actually do the (tongue-tie division)," she said.

According to the U.K.'s NHS, the condition is not always easy to spot and it may not be obvious until the baby has problems feeding.

How does it impact breastfeeding?

For painless and effective breastfeeding, the IBC said "the baby must latch on deeply onto the breast with mouth wide open and the tongue forward." But, if the baby can’t do that because of tongue-tie, that may lead to slow flow of milk from mother to baby.

"If the baby is not removing enough milk, then sometimes they’re not gaining enough weight… and if the baby’s not removing the milk, then the mother’s milk supply can be low and it’s just a whole circle of misery," said Harmon.

She also added the condition can contribute to nipple soreness or damage.

"Mothers can have really sore nipples because the babies are off and on the breast and the baby can't stay on and hold the suck."

How is tongue-tie resolved?

If the tongue tie is not severe, Harmon said babies who have it can grow up and be "quite fine."

But, some end up having a tongue-tie division due to the speech impediment or breastfeeding difficulties.

A tongue-tie division "involves cutting the short, tight piece of skin connecting the underside of the tongue to the bottom of the mouth."

Harmon said sometimes it needs to be done several times — like suspected in Heather El Moussa's case.

"The word revision is kind of a misnomer… a tongue-tie revision means that it’s a procedure that’s done after the original," Harmon explained.

"If, for instance, the baby does have a tongue-tie release… and after a month or so… it has grown back, then they would have it revised."

Harmon said the correct terms for a tongue-tie division is a frenectomy or frenotomy.

In babies who are a few months old, the procedure is usually done without anesthetic or with a local anesthetic that numbs the tongue. But in older babies with teeth, they’re put under general anesthetic.

"The baby's head is held securely while sharp, sterile scissors with blunt ends are used to cut the skin… It only takes a few seconds, and you can start feeding your baby immediately afterwards," according to the NHS.

Nurse Harmon said the procedure can also be done using a laser that cuts through the skin.

"If you’re working with someone with breastfeeding problems and if you do all the other things, like helping them with positioning and getting a deeper latch… and after a week or so things are still not good," she explained, "you might reconsider having more done."

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