We noticed a lip-tie on my daughter, Alana, a few days after she was born. What is a lip-tie? It’s when the frenulum (the string of tissue connecting the lip to the gum) is low and keeps the lip held very tight against the gum. You can see it when you flip the lip up or when you sweep you finger under the lip and run it along the gum until it feels like your finger hits a wall. You can also have nuchal (cheek)-ties or tongue-ties. 

Signs that a lip-tie might need intervention is when it impacts the function of feeding. With Alana, she fed well the first couple weeks but then I started getting some nipple blisters and callouses, indicating Alana had a tight latch. This showed that her lip-tie was most likely starting to impact function.

My husband and I decided to visit an airway centric dentist who releases ties with a laser procedure, which would provide Alana with increased lip mobility. This would help her flare the upper lip on the breast to create a tighter seal and deeper latch. During the dental consult, I was hesitant about following through with the procedure because the dentist was saying the procedure was not absolutely necessary. However, I was very happy my husband was there to push for the procedure being done. During the week following the procedure, breastfeeding created no more blisters or pain!

However, Alana’s latch started to return to her shallow habits about a week after the procedure. Fortunately, I had followed the dentist’s recommendation to follow up with a lactation consultant to help with the latch, positioning, and stretches post-procedure. I’m sharing with you six oral motor exercises and two holding positions I learned during these visits that have been very helpful with maintaining an effective latch during Alana’s feedings.

I also want to note that these exercises can be done prior to a lip-tie release to help prep the baby with stretches or in prevention of getting a release. However, it’s always critical to find a practitioner, such as a lactation consultant, you can work with you to address your unique circumstance. 

Oral Motor Exercises: 

1. Fishy face: Using your thumb and forefinger, place one on either side of your baby’s face. Gently squeeze the cheeks while pulling the cheeks forward to make a “fishy face.” This helps to gently stretch the cheeks and lips. Repeat 3 times.
2. TMJ massage: starting at the temporomandibilar joint (where the jaw meets the ear), make circular massage motions and continue down the jawline until you reach the chin. This helps release tension in the jaw and encourages the jaw to drop open. 
3. Upper and bottom lip massage: place your forefinger on the upper lip where a mustache would go and make a back and forth motion to a count to three. Repeat on the lower lip.  This brings stimulation and awareness to the muscles that will make a seal on the nipple of the breast or bottle. Using two thumbs, make strokes downward under nostrils and from crease of the nose to stretch the muscles.
4. Hip hop gapes: using your fingertip, slide your finger down from the tip of the nose, to the top lip and then to the chin to encourage your baby to use their gape reflex to open their mouth wide. Repeat 5 times.
5. Cheek sweeps: using your forefinger and thumb, make circular motions to stretch and massage the cheek from the inside. Finish by gently pinching and sweep the fingers forward and out of the mouth.
6. Pterygoid stretch: place your finger in the mouth along the gum line and allow your baby to chew 12-15 times each side. This helps stretch the pterygoid area (jaw muscle used for chewing). It also helps guide the tongue to follow the finger for it to practice lateralizing to the sides of the mouth. In addition, this exercise helps desensitize the gag reflex. 

Positions: 

1. Head hangs: lay your baby across your lap with the head extending over your thigh. Allow your baby to arch backwards and look left to right. The oral motor exercises can be done in this position. You can gently rest your palm on the baby’s chest, or support their head if needed, during this exercise.
2. Koala hold: seat the baby upright on your lap straddling your thigh. Use a hand to support the baby’s neck and between the shoulders. You can then lean back to open your chest towards the baby. 

The post 6 Oral Motor Exercises for Baby for Shallow Latch appeared first on Feeling Yum.

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.

The post Does My Child Have a Tongue-Tie? appeared first on Feeling Yum.

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.