Tongue ties occur when the frenulum (the string of tissue attaching your tongue to the floor of your mouth) is too short, thick, or tight, therefore impacting the overall function of the tongue. Impaired tongue function can contribute to difficulties in breastfeeding and bottle feeding in babies. If left untreated, impaired tongue function could also contribute to difficulties with swallowing, speech, and breathing.

What are Lip-Ties and Buccal-Ties? 

A lip-tie or buccal (cheek) tie occurs when the labial or buccal frenula are too short, thick, or tight, or insert low into the gumline, impacting function of the mouth. Impaired lip-tie and buccal-ties can also contribute to difficulties with feeding. If a tongue-tie tie is present, it is increases the likelihood there will be a lip-tie or buccal-tie. 

Tongue-Ties in Babies

Ties are often undiagnosed so it is important to be aware of the signs so you can seek professional advice on how to proceed. Most commonly, ties show signs of dysfunction when the baby is young and having difficulty with breast or bottle feeding. Both mom and baby could show signs of ties, which are outlined below.

Baby Signs:

• Shallow latch
• Clamping or chomping on bottle or breast
• Clicking sounds at bottle or breast
• Decreased milk transfer, or poor weight gain
• Coughing/gulping during feeds
• Frequent feedings or long feedings (> 40 min.)
• Reflux, frequent spit-ups, or GI discomfort
• Sliding or popping off breast
• Fussiness or arching away from breast/nipple
• Gagging
• Baby lip blisters
• Loss of liquid during feeds from baby
• Milk tongue (white coating)

Mom Signs:

• Maternal nipple pain
• Misshapen nipples after nursing
• Recurrent breast engorgement or mastitis 
• Decreased milk supply

Tongue Ties in Infants

A baby may not show signs of ties until they become an infant and start eating solids. This could manifest in what looks like picky eating,  physiological problems or oral motor skill deficiencies. A baby may have also gone undiagnosed with ties and may have a history of breast or bottle feeding difficulties. Below is an outline of signs of ties to look for in infants.

Physiological Signs:

• Poor weight gain
• Constipation
• Gi discomfort 

Picky Eating Signs:

• Food refusal of certain textures
• Disinterest in trying new foods 
• Preference for only dry and crunchy foods 

Oral Motor Signs:

• Frequent coughing or choking 
• Drooling 
• Poor lip closure/anterior food loss
• Mashing foods anteriorly with a munching pattern vs chewing on molar surface 
• Difficulty transitioning to age appropriate food textures 
• Food pocketing 

Tongue-Ties in Older Children

Furthermore, if ties continue to go undiagnosed into toddlerhood, there may be signs of breathing difficulty, swallowing , or dental complications. In addition they could contribute to speech difficulties, which is outlined below.

Speech Signs:

• Poor articulation
• Interferes with speech sounds
• Sibilants and lingual sounds
• Pronouncing certain letters

It’s important to get ties looked at by a specialist so they can help with treatments and referrals. Seek advice on how to move forward before struggling with feeding for too long and the problems get worse for baby and Mom. It is important to keep feeding experiences positive from the very beginning of life to build a good foundation.

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Where to Start:

If you have a baby and are experiencing breastfeeding difficulties or pain when nursing, it would be most beneficial to first see a lactation consultant (IBCLC). An IBCLC can work on latch, positioning, stretches, pumping and many other breastfeeding needs. If you have an infant having feeding difficulties with a bottle or starting solids,  schedule an assessment with oral motor specialist, which would be an occupational therapist (OT) or speech therapist (SLP). Oral motor specialists can work on gag reflex, chewing, lip closure, tongue lateralization and many other mouth functions needed for feeding.

Pre and Post Procedural Care:

If one of the above practitioners or yourself suspects a tongue, lip and or buccal-ties, I’d suggest seeing one or more than of the bodywork specialists which could help address the tightness in the body’s mouth. Chiropractors can help with bone and nerve alignment to increase range of motion. Osteopathic doctors can help with tongue-tie through gentle manipulation to help relieve tension in the neck and jaw. In addition, occupational therapist, physical therapists or lactation consultants could be trained in bodywork treatments that could include  Cranialsacral Facial Therapy (CSF), Cranialsacral Therapy (CST) or Myofacial Release can also help with stretching the releasing restrictions in the body. 

If a Frenectomy is Needed:

Once it is identified that a release of the connective frenulum frenectomy could be beneficial, a consultation could be set up with an airway centric dentist or ear nose and throat doctor (ENT).

To Review, the specialists in each area are outlined below. 

Frenectomy:

• Airway centric dentist 
• Ear nose and throat doctor (ENT)

Bodywork:

• Occupational therapist (OT)
• Physical therapist (PT)
• Lactation consultant (IBCLC) 
• Chiropractor (DC)
• Osteopathic doctor (DO)

Oral Motor Therapists:

• Occupational therapist (OT)
• Speech and language specialist (SLP)

Lactation Support:

• International board certified lactation consultant (IBCLC)

The post I Think My Baby Has a Tongue-Tie. Now What? appeared first on Feeling Yum.