Have you been hearing about tongue ties, but don’t really know what that is? Is it a big deal or isn’t it? And what do you do about it anyway? Read on to get clear about tongue ties, what they are and what to do about it!
What Is a Tongue Tie?
A tongue-tie is a type of oral restriction, which can occur at any of the 7 frenula in the mouth: under the tongue, the upper lip, the lower lip, the upper cheeks and the lower cheeks. Yes, there are 7 frenula in the mouth and we need them!
The frenula are connective tissue (i.e. fascia) that connect the tongue, lips and cheeks to the jaws. The tongue is the most common oral restriction followed by the upper lip. Restriction of the cheeks and lower lip are less common.
So, what’s the big deal? The big deal is that limited mobility of the tongue, the lips or the cheeks will affect the way your baby can feed now and in the future. This is true for both breastfeeding and bottle feeding.
In addition, human development builds on itself. That means that what is happening developmentally with your baby now will influence the skills that come next. If feeding is hard now, that will lead to challenges with solid food feeding in the future and often speech and language skills as well.
Diagnosis of an oral restriction requires both a visual assessment of the anatomy AND a functional assessment of the mouth (i.e. how do the tongue, lips and cheeks move). If someone has only looked at the tissue and is declaring it a “tie,” beware! An accurate diagnosis is important and is accomplished by a skilled provider with a license to work in a baby’s mouth (ex: occupational therapist, speech therapist, dentist, ENT, nurse practitioner or pediatrician).
Early detection is ideal so that you can alleviate challenges your baby is facing now and to ensure that your baby’s developmental trajectory is as optimal as it can be going into the future. So, how do you know if your baby might have an oral restriction?
Common Signs of a Tongue Tie in Infants
There is what I call a constellation of symptoms that are associated with having an oral restriction. Because that frenulum is made of fascia and our fascia runs through the whole body, when it’s restricted in any one part it can cause trouble in other parts of the body too. Here are some of the most common symptoms for baby:
- Gassiness and/or reflux
- Slow or limited weight gain
- Difficulty latching or staying latched
- Falling asleep when feeding
- Feeding more frequently than every 2 hours after the newborn phase
- Significant restriction in the body such as head turning preferences or head shaping differences
- Generally uncomfortable and fussy or “colicy”
- Clicking and/or coughing/choking when feeding
- Irregular and/or painful bowel movements
Because babies with oral restrictions have difficulty with feeding, there are also common signs of oral restriction that are experienced by the breastfeeding parent:
- Flattened or lipstick shaped nipples after a feed
- Pain experience during or after feeds
- Mastitiis
- Consistent engorgement
- Nipple thrush
- Cracked or creased nipples
If you are noticing these symptoms in your baby or yourself, the next step is to get an accurate diagnosis by a qualified provider who is trained in diagnosing and addressing oral restrictions.
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Best Practice: What to Do if Your Baby Has a Tongue Tie
People often think of getting a frenectomy as “fixing” the tongue tie problem. And there is often a feeling of immediacy to rush and do the release as soon as possible. However… best practice for addressing oral restrictions includes a variety of providers and does not treat a tongue tie as an emergency. In only rare cases does a baby need a frenectomy immediately, like when the feeding challenges are so great that getting any amount of sustenance is extremely difficult.
So, I like to think of a “solution pie” when I talk to families about how to address oral restrictions. This means that there isn’t only 1 solution, but many solutions (like pieces of a pie) that are needed to provide individualized care AND to provide the family with the best support. This includes types of intervention, as well as, education for the family and identifying the ideal timing for release. Generally, the pieces of the pie include oral motor intervention, lactation, a release provider and body work.
Oral motor intervention – This is going to be your occupational therapists and speech therapists. Oral motor intervention is where you get to teach your baby how to use their tongue, lips and cheeks more effectively. Learning new motor patterns is essential and this doesn’t automatically happen from the release alone! Baby has been using compensations very wisely to get the job done, but the only way to learn how to do things differently is to practice, practice, practice. OTs and speech therapists have the strategies to facilitate this learning with your baby, teach you how to keep things progressing at home and to problem solve any challenges that arise.
Lactation – A lactation provider that is trained and skilled in the specialty of oral restrictions will have the know-how and savvy to guide your feeding journey and support you and baby as best as possible. This is the provider families often go to first when having feeding challenges. Therefore, the lactation provider is also essential for offering families excellent education and guidance on what to do next when oral restrictions are the cause of the feeding issues.
Release provider – The release provider is the person who performs the frenectomy or frenotomy. This is often a dentist or ENT. This provider should spend time evaluating and educating you and understanding your baby’s specific challenges. A great release provider will also value the other pieces of the solution pie by either referring you to additional services or collaborating with your current providers.
Body work – This category includes a variety of services that work with the body’s natural healing mechanisms, like craniosacral therapy, chiropractic and Musgatova Neurodevelopmental Reflex Integration (MNRI). Individuals benefit from one or a variety of these services to bolster the nervous system and to facilitate a state of healing and ease in the body.
Each of these providers should be seen, to varying degrees, both pre and post frenectomy. This is to support you where you and baby are at now, to prepare your baby for release, and to monitor the healing process and enhance optimal skill development after the release.
Why Occupational Therapy Can Help
So, how do OTs assess oral motor development?
We are going to look at the postural and oral reflexes of the body, as well as, how your baby is able to move the tongue and what your baby is doing when feeding.
What does all of that mean, exactly? We are going to check skill by skill and reflex by reflex. We are also going to watch your baby feed and feel your baby’s suck. All of this information tells us where exactly your baby needs support to bolster their feeding ability.
In addition, since we are working with the whole body, we will address any other areas that need support. This may be tummy time skills, head rotation, posture, sensory integration, regulation and more.
When to reach out for support?
FAQs About Tongue Tie in Babies
Is tongue tie genetic?
Yes, the presence of oral restrictions are commonly seen from parent to child. However, not every child of a parent with an oral restriction is guaranteed to also have an oral restriction.
Can tongue tie cause reflux?
How much does tongue tie surgery cost?
Does tongue tie cause speech challenges?
Yes, having a tongue tie can contribute to speech development challenges. However, not every child with a retained tongue tie is guaranteed to have speech challenges. And, not every child who has had a frenectomy is free and clear of having speech challenges. If that child did not receive oral motor therapy to optimize the skills of the tongue, then they could be in need of speech therapy as they age.
There are also a number of other potential challenges that a retained tongue tie can contribute to such as disrupted sleep, breathing issues, feeding challenges, and oral-facial growth. Therefore, speech therapy, feeding therapy (with an OT or Speech Therapist) or myofunctional therapy are essential pieces of the “solution pie” in order to address the specific needs of the individual with oral restrictions.
Is tongue tie common?
How Happy Healthy Therapy Can Support You
At Happy & Healthy Therapy I offer OT sessions for infants from birth to the crawling stage for feeding and whole body therapy. I predominantly serve babies with oral restrictions and I incorporate craniosacral therapy and MNRI into my work. The work that I do is gentle and not forced. I am working to facilitate and not manipulate. And therapy is individualized to your baby and your family goals.
The first session is evaluative where I gather information on your and your baby’s journey, assess your baby’s skills and provide my feedback and recommendations. From there, follow up visits are focused on the interventions that will improve your baby’s skills and achieve your family goals.
If you’re noticing signs of a tongue tie in your newborn, don’t wait—reach out to Happy & Healthy Therapy to schedule an evaluation and get support tailored to your baby’s needs.
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Website: www.happyandhealthytherapy.com
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