Tongue & Lip Ties

I started doing more research on Tongue and Lip Ties a few years ago and quickly learned that no one in my small town was concerned or addressing oral restrictions in babies. I could never understand the black cloud that seemed to loom over the topic. There were concerns about overdiagnosing or chatter that this was a "fad" and we should ignore it until it went away.

But it didn't go away.

Families were being tossed around to different providers, often with no help or diagnosis, and commonly ending up exclusively pumping, formula feeding, and feeling unheard. It made me delve into the taboo topic; searching for online studies, books, in-person conferences, and hands-on training.

So let's delve in!

In this blog, I will address Tongue and Lip Ties as "oral restriction" (also called Ankyloglossia). It is described as "an embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement." Retrieved from - International Affiliation of Tongue Tie Professionals

(I am not going to delve into classes of restriction, different kinds of ties etc. There are great blogs and more information from leading specialists, I like Dr. Ghaheri's blog posts!)

Click here for more information on Lip Ties.

Everyone has a Frenulum!

Yes! Everyone has a frenulum under their tongue and lip, the problem is when it becomes restricted and function of the tongue or lip is impaired.

Often times we will see these symptoms in the feeding parent:

• Painful Nursing/ poor latch

• Cracked, creased ,flattened nipples

• Bleeding nipples

• Low milk supply

• Plugged ducts, reoccurring mastitis

• Thrush

• The need to use a nipple shield

Infant symptoms may include:

• Poor or shallow latch

• Long feedings often falling asleep at the breast

• Slips on and off nipple during feeds

• Reflux and or colic symptoms

• Clicking noises while feeding

• Poor weight gain

• Chewing or gumming the nipple

• Inability to flange to the lips on the breast or bottle

• Milk dribbling out of the mouth when feeding

There are other symptoms not necessarily associated with feeding that we attribute to tongue and lip ties as well. These include:

• A strong gag reflex

• Unable to keep a pacifier in the mouth

• Mouth Breathing

• Congested nose

• Frustration at the breast or bottle

Often an IBCLC (International Board Lactation Consultant) will notice the restricted frenulum/ function.

Why?

Well, oral anatomy is on our radar. If you are having feeding issues, an oral assessment with the infant should be part of your consultation with an IBCLC. We examine the tissue under the lip and tongue as well as observe a feed to assess function. We may even use a scoring tool to see how the tongue moves, cups, suckles, and elevates.

My IBCLC thinks my baby may have a tongue or lip tie, now what?

Your IBCLC should be able to give you some referrals for 1. Bodywork and 2. A diagnosis and revision.

Did you know that a Lactation Consultant cannot diagnose oral restriction? This needs to be done by a Doctor. Most commonly a Pediatric Dentist or ENT.

What is Bodywork?

Bodywork is extremely important in regards to assisting the restriction from releasing. According to Bodyworkers of Ankyloglossia:

"Practitioners use hands-on assessment to locate areas of decreased mobility, tightness or restriction and gently help to mobilize the area using gentle experienced touch. Bodywork helps baby with body awareness and maximizes baby’s access to postural reflexes and natural movement inclinations through the nervous system."

For optimal results, bodywork should be done before and after a revision. I am so lucky to work closely with a Chiropractor and a Licensed Massage Therapist who both specialize in infants and Cranial Sacral Therapy. Your IBCLC should make a referral for bodywork as soon as possible so you can get a session in before the revision.

Here is a list of the Types of Providers regarding Bodywork someone could work with regarding oral restriction.

Treatment

Your IBCLC will refer you to a specialist (Pediatric Dentist or ENT) who will diagnose and release the oral restriction. Meet with the provider and make sure they have experience, you feel comfortable, and they have a post-revision care policy in place (stretches/lifts to do at home and a referral resource list; any good provider will know local resources! Sending you home with an uncomfortable baby and no aftercare is a red flag.)

A frenectomy uses a laser or scissors to remove the tissue. There is no general anesthesia needed (for more on why this is, click here). The baby is typically gently swaddled, the frenulum may be numbed, a groove director tool can be used to lift the tongue, and then the revision is done by laser or scissors. The procedure is very quick, complications are rare, and the baby will have the opportunity to breastfeed or bottle-feed right away.

The ideal provider also has an IBCLC and a Bodyworker on staff. This team approach addresses the whole

Baby and leaves you with a complete care plan for the best results post-release. An IBCLC will continue to work on latch and overall feeding goals, even if you are bottle-feeding your infant may need suck training to learn how to reuse and strengthen his/her tongue. The Bodyworker will help improve tongue movements, jaw and neck tension, and overall oral function.

After the revision, your provider will send you home with some stretches to do. These are very important to avoid reattachment because oral wounds heal quickly and cells like to migrate and heal together. Each provider has different goals in mind for these stretches as well as medicinal and comfort management recommendations. You will also need ongoing follow-up with lactation and bodywork once or multiple times depending on your situation after a revision.

It is also helpful to know some non-pharmacological options for pain management. Babies are typically the fussiest around day 3 and 4 after the release. Lots of skin-to-skin, on-demand feeding, and baby-wearing are helpful to calm baby and parent. Infant massage, co-bathing, and music therapy are also soothing for the baby.

Is A Frenectomy Our Only Option?

The frenulum does not get more elastic over time. Some parents like to work with bodywork and take a "wait and see" approach. This is great if your IBCLC and your diagnosing provider give you a borderline diagnosis. Bodywork can target the surrounding tissues and muscles to relieve tension around the frenulum, but the frenulum itself can never stretch out or become more flexible. You may notice after a few sessions with your bodyworker that things are not improving, indicating that it is time for a revision.

Sometimes, even babies with extreme Ankyloglossia will not exhibit many symptoms and will have adapted to the anatomy they were born with. They may nurse well, gain weight properly, and be content little bundles of joy. However, there are other concerns associated with untreated oral restriction, such as dental/orthodontic issues, potential airway and oral facial problems, speech concerns, eating and swallowing difficulties, social/emotional concerns, as well as other concerns that may persist into adulthood.

Only you and your partner know what approach you will take. I encourage all my clients to do their own research and whatever decision they make I will be available to help them reach their feeding goals.

In the past few years there has been more research on this topic and I see the black cloud being lifted. I love that more parents are becoming more empowered to do their own research and find answers in their community. I love that there are more resources for families and collaboration between providers. More awareness means a better outcome for families!

If you are local to Eastern North Carolina and need to connect with Tongue Tie Resources please click here.