THE TONGUE AND LIP TIE
A tongue is an extremely complex muscular organ which is essential for sucking, swallowing, breathing, speech, eating, drinking, chewing, tooth and gum and digestive health.
A baby’s mouth is designed to breastfeed effectively and any loss of normal breastfeeding experience either by the mother or the baby must be evaluated or treated as early as possible to avoid future problems and more importantly from premature weaning.
A tongue and lip tie is tightness in the normal tissue that attaches the tongue to the floor of the mouth and gums of the baby respectively. This prevents normal range of movements of tongue preventing important functions of the tongue.
Some of the symptoms may involve :
Inability to latch or shallow latching at mother’s breast
Repeated unlatching during feed
Choking or spluttering milk
Prolonged and very frequent breastfeeding
Colicky and gassy baby
Mouth breathing and snoring
Difficulty in handling solids
Disturbed and Inadequate sleep
Excessive or inadequate weight gain
Nipple pain while breastfeeding
Thrush or episodes of mastitis and abscess
Frenotomy is a small procedure which is essential for release of a tie and is the first step to restoring normal tongue and lip function. Rehabilitation of the tongue motor function is an important follow up treatment after the procedure with tongue exercises and sucking.
This procedure requires no anesthesia and the rehabilitation period is sometimes longer for older babies and children. Therefore it is best done in infancy as early as possible. Most importantly this protects an important experience of breastfeeding for the mother and her baby.
What is a tongue & lip tie?
Tongue tie or Ankyloglossia is defined as a congenital structural abnormality of the lingual frenum, The cord that stretches from under the tongue to the floor of the mouth is called the frenum and this can sometimes be tight. When the frenum is normal, it is elastic and initiates sucking, eating, clearing food off the teeth in preparation for swallowing and of course in speech. When it is short, thick, tight or broad it has an adverse effect on feeding, breathing and speech among other whole body functions.
A similar frenum attachment that is tight seen under the lip where the lip attaches with the gum area is called a lip tie. This is a congenital midline anomaly cannot be outgrown as baby grows and not known to be corrected by a non-surgical treatment.
WHY IT HAPPENS ?
The development of the tongue and the lip tie takes place during the embryonic state in the mother's womb. In the first three months of life, as the face becomes differentiated into its various parts, the frenum, which is the left over of the tissues disappear as the oral areas are formed. If not then it would lead to webbing, as it is sometimes called and can occur between upper or lower lips and gums, cheeks and gums as well as under the tongue.
SYMPTOMS IN A BABY
Some of the symptoms seen in a baby may include:
Inability to achieve latch or loses deep latch during breastfeeding
Choking, grasping, gagging or frequent nasal congestion
Constantly feeding round the clock with no signs of satisfaction.
Falls asleep often at the mother’s breast only to wake up often crying to feed.
Not gaining weight despite frequent feeding or failure to thrive.
Refusal or fighting the breast
Arching the back and pushing the breast away.
Re-flux or frequent spit ups
‘Colicky’ or gassiness
Milk dribbling or spilling from baby mouth while breastfeeding.
Audible noises while feeding called ‘Stridor’
Loss of suction in latch resulting in ‘Clicking’ sounds.
HOW IS IT DIAGNOSED ?
Lactation experts take a closer look at the problem and must do a detailed oral motor assessment to check for any abnormalities. Also they must check on the capability of the baby to suck. Often babies with problems like tongue tie and lip tie bite and not suck.
Determination of a tongue/ lip Tie involves:
A thorough detailed history intake related to pregnancy, birth and breastfeeding by a knowledgeable International Board Certified Lactation Consultant
A thorough Oral motor assessment and whole-body Assessment of baby
A thorough observation of a full feed assessment at breast/bottle
Scaling on a reviewed/verified tongue tie assessment tool which will determine structural and functional assessment to conclude a recommendation of treatment of tongue tie.
SYMPTOMS IN A MOTHER
Nipple trauma – Soreness, bleeding or cracked open wounds
Excruciating pain during breastfeeding despite good positioning
Distorted shape of the nipples after feeding.
Low milk supply, severe engorgement, mastitis and/or abscess
Recurrent plug ducts or thrush
Sometimes no noticeable symptom.
HOW IS IT TREATED?
Once the severity of the condition is established. For a severe tongue tie a frenetomy is often advised, a surgical procedure to clip the frenum and free the tongue. A similar procedure is done for the lip also.
Treatment is shown to be highly effective when it is integrative and comprehensive which involves:
Advanced clinical lactation protocol to support feeding challenges
Frenotomy surgical procedure
Craniosacral Biodynamic treatment and/or other supportive body work
RISKS OF UNTREATED TONGUE & LIP TIE
Other probable issues seen during the growing years of a baby if it remains untreated are :
Difficulty in accepting solids or chewing.
Restricted normal oral development and dental issues such as tooth decay, crowded teeth or gaps between the teeth.
Delayed or impaired speech development.
Sinus issues or persistent digestion issues.
Related other pain or stiffness in joints and muscles in the body such as TMJ disorder (Temporo Mandibular Joint disorder)
Bed wetting
Snoring, sleep apnea, obesity leading to later cardiovascular diseases & hypertension.
FREQUENTLY ASKED QUESTIONS (FAQ)
FREQUENTLY ASKED QUESTIONS (FAQ)
The answers are based on current global evidenced based knowledge available on this subject. The approach and protocol may differ sometimes depending on where you choose to do the treatment.
Q. How does one determine my baby has a tongue tie?
A. Determination of a tongue/Lip Tie involves:
A thorough detailed history intake related to pregnancy, birth and breastfeeding by a knowledgeable International Board Certified Lactation Consultant
A thorough Oral and whole-body Assessment of baby
A thorough observation of a full feed assessment at breast/bottle
Scaling on a reviewed/verified tongue tie assessment tool which will determine structural and functional assessment to conclude a recommendation of treatment of tongue tie.
Q. My baby is able to stick her tongue out of her/his mouth. Wouldn't tongue tie make this difficult?
A. A baby not being able to stick out the tongue out of the mouth is perhaps one sign of possible tongue tie , however this criterion is outdated and insufficient to evaluate tongue tie as per international standards currently followed. Evidence based current approach is a comprehensive functional assessment of the tongue.
Q. Wouldn't tongue tie make it difficult for baby to use the bottle nipple as well and my baby is able to feed from a bottle easily?
A. Bottle feeding and breastfeeding mechanics are entirely different and cannot and must not be compared. Bottle feeding is passive feeding for baby which utilizes automatic sucking reflex of the baby which gets elicited as soon a long artificial nipple touches the soft and hard palate junction in the baby's mouth cavity and fails to elicit all muscles in action to control and regulate milk which is essential for normal development of muscle action, sucking, swallowing, breathing, digestion and elimination along with cranial nerve development of the baby.
Breastfeeding is a normal activity for a baby and therefore must be the normal yardstick for understanding feeding efficiency for a baby rather than the bottle feeding being considered a norm for assessment. Besides this, it helps to understand that there is a loss of partial or complete breastfeeding.
A tongue tie can cause challenges in bottle feeding as well except that it is not recognizable such as abnormal breathing patterns, spillage of milk from the corners of the mouth, mild to severe milk reflux, feeding stress cues, finishing feeding either very quickly in a short time or taking a long time, nasal congestion often mistaken as cold, noisy breathing sometimes and many other symptoms which are often ignored as normal. Effects of bottle feeding on the development of cranial bones, muscles and bones is matter of concern. Ask your lactation consultant/doctor to elaborate on the effects.
Q. What does the tongue tie correction treatment involve?
A. Treatment is shown to be highly effective when it is integrative and comprehensive which involves:
Advanced clinical lactation protocol to support feeding challenges
Frenotomy surgical procedure
Craniosacral Biodynamic treatment and/or other supportive body work
Q. Is the procedure safe for the baby? Does the procedure have side effects?
A. Treatment surgery is minimally invasive, simple and known to be safe for the baby. The laser procedure has shown to have no side effects and in fact the only side effect of the procedure which are undertaken in our clinic is better and improved breast/bottle feeding.
Q. Does this procedure require a local anesthesia?
A. No anesthetic is required for the procedure as the procedure is often less than a minute.
Pain management post procedure is supported using remedies and craniosacral treatment.
Q. Will there be bleeding?
A. With laser treatment we often see no bleeding at all and sometimes a drop or two which coagulates almost immediately.
If your baby has a rare blood disorder which is established after birth do keep your tongue tie treatment team informed about the same.
Q. Are there any medications or antibiotics that baby will have to take after the procedure?
A. There is absolutely no requirement of antibiotic however we recommend natural and safe remedies to help provide ease and comfortable for the baby.
Q. How soon can my baby feed after the procedure?
A. Feeding can be resumed almost immediately with no delay.
Q. Baby has to take a few vaccinations scheduled. Doing the procedure and taking vaccinations in such close proximity to each other cause problems?
A. As per the procedure guidelines there is no disturbances on the schedule of the vaccinations around the procedure time however as I discuss with most parents who have proceeded to do the frenotomy understand when I mention that vaccinations are uncomfortable and so is the procedure as well and in order to provide baby as comfortable support, most parents see wisdom in rescheduling the vaccinations spaced out by 1 week to 10 days after the procedure.
Most also see the wisdom in giving priority to frenotomy over the vaccinations in terms scheduling time since establishing breastfeeding and overcoming feeding challenges would be primary if scheduling the procedure can be facilitated.
Q. Have you seen any cases where this procedure has not made any difference?
A. The clinical data based on our client database is currently showing 98% significant improvement in feeding after comprehensive treatment which includes advanced clinical lactation protocol, frenotomy surgical procedure and Craniosacral Biodynamic treatment. It has been noted that the families who have marked ‘no’ to little improvement on the research survey have shown to be due to following reasons:
Family’s significant delay in decision for treatment (based on individual severity of the breastfeeding issue)
Limited or no craniosacral biodynamic treatment as chosen by the family.
Baby has grown into a certain muscular behavior over a period of time and/or Significant other reasons such as growth spurts occurring during treatment such as teething, etc... starting solids making it difficult to influence change in muscular behavior.
Mother unable to keep up with weaning process from bottle to breast and expression/pumping of milk.
Q. How much does the procedure cost?
A. Cost of the procedure is best understood by the clinic where the procedure is done since it may depend on if you will choose laser or a traditional scissors procedure.