Tongue Ties, Lip Ties, Tethered Oral Tissues
You have likely already heard many different opinions about infant oral ties, but are still curious or undecided. Let’s start with the basics. We all have connective tissue throughout our bodies called fascia. It’s visible in the mouth, connecting the lips to the gums and the tongue to the floor of the mouth. We call those points of connection frenulums – and everyone has frenulums. When they are tight and restrictive, when they keep the lip and tongue (and sometimes the cheeks) from moving as much as they should, we call them “ties.”
Not all oral issues are a tie, though! There can be tension in the fascial network in the mouth, neck, and body that can result in poor tongue movement. It’s important to check for these things and work on them first.
When a breastfeeding baby has oral restrictions mother, baby, or both may experience symptoms. The breastfeeding parent may experience:
- Pain while nursing
- Cracked, bleeding, or bruised nipples
- Pinched or “lipstick” shaped nipples after feeding
- Nipples that turn while or purple after feeding
- Frequent blocked ducts
- Frequent mastitis
- Low milk supply
The breastfeeding baby may experience:
- Difficulty latching to the breast
- Difficulty staying latched
- Twisting or pushing away during feedings
- Coughing, sputtering, choking at the breast
- Lip blisters that don’t go away
- Lips that turn white while breastfeeding
- Feedings that never seem to end, baby never seems satisfied
- Cluster feeding that goes on all day
- Signs of reflux – grunting, nasal congestion, frequent spit up
- Excessive spit up
- Excessive or uncomfortable gassiness
Do All Ties Require Surgery?
Frenotomy, the procedure to release the tight frenulum, is not required, but can allow significant improvement in infant oral function. It is only one step in the process, though! Just getting a procedure is not enough. If a provider tells you that, it is a reason to take caution. Read: It’s a process, not a procedure.
The tie is keeping the tongue from moving to it’s full range – the tongue has never had a chance to fully move and develop the strength and coordination needed to latch and feed well. There are also other issues that can be going on. Since babies are smart, they compensate. They use other muscles to help them feed and get into different positions. This can cause discomfort and tension on top of what is already going on. While the procedure will release the restriction, we still need to address the strength and coordination of the tongue and oral muscles.
What if we don’t want to have a tongue tie procedure (frenotomy/frenectomy)?
You do not have to. There are many reasons parents choose not to seek a procedure for their infant. They may not be comfortable with the procedure, or they may not feel comfortable with the after care that is required.
Your IBCLC will give you their clinical observations and respect the choice of the parents, as they are the experts on their baby. Your baby’s care plan will be tailored to oprimize baby’s function and come up with the best way to protect mom’s milk supply.
Continuing to work with baby’s mouth both at home and with your IBCLC is essential, as is continuing with body work. Although there is no way to “stretch” or “fix” a true tie with oral and body work, there are many ways to optimize function if a procedure is not a possibility.
What is the best way to treat a lip or tongue tie?
- Get a full feeding assessment with a skilled IBCLC. If you’re in the Baton Rouge, Louisiana area, that’s Magnolia Lactation. It’s important that both mom and baby are assessed – the breastfeeding parent is not a bottle, but a full human requiring expert care.
- Begin working with baby! Your IBCLC will instruct you on exercises to begin in order to start helping oral function.
- Address any body issues. Your baby is more than a mouth. At Magnolia Lactation, we are assessing the whole baby and identifying any areas of tightness, tension, or asymmetry. We will refer you to a skilled body worker in order to address these issues. Babies love body work, and it helps a great deal in calming and comforting them.
- Consult with a skilled frenotomy provider to assess the structure and learn about the risks and benefits – we will discuss local providers and help you find the best fit. While it can be tempting to schedule a procedure first thing, the best results come when you have worked with your IBCLC first and learned about the best release provider for your specific situation.
- The parents decide the next step. Working with positioning and feeding, with oral exercises, and body work should help your baby and you should see some improvements. Your IBCLC will let you know the goals of the pre-procedure therapy. The final decision of whether or not to schedule a frenotomy is going to be with the parents. Does this feel like the next right step? Are they prepared to do the site care afterwards?
What happens after a tongue tie release?
You will have set your follow up appointment for 1-3 days after procedure with your Magnolia Lactation IBCLC. You will begin care of the sites (often referred to as “stretches”) in order to allow them to heal in the proper way. You’ll learn about this care before your procedure and your IBCLC will guide you through it after. This will be daily care that will need to continue for 4 weeks.
That’s the site care, but we’re also going to take this time to work on the oral strength and coordination. Babies practice swallowing before they are even born. Babies with ties have never been able to practice with a full range of movement! Once the tongue is released, it needs time to get stronger and learn how to move well. Magnolia Lactation is skilled and experienced in infant oral habilitation and will guide you through this process to increase strength and function.
How do we find the right provider for a tongue tie procedure?
Talk with your IBCLC first. It is important to have a full functional exam and address any oral and body tensions *before* making an appointment with a release provider. A provider who will offer to “clip” or cut the tie without any preparatory assessment and work is one you do not want to choose. A provider who tells you there is no aftercare needed is also a red flag.
If we’re not having any problems, should we still seek a frenotomy?
If there is full function of the tongue and there are no signs or symptoms of any issues then no.
Are tongue ties a fad?
Tongue ties have been around for a long time. Many of us as adults still have them. Thankfully, we have had alternative ways to feed babies when their ties kept them from breastfeeding well. More recently we are assessing and addressing the ties in order to give babies full functional movement. More families are choosing to address the restrictions in order to continue breastfeeding as much as they desire. In addition, we are learning how the tongue affects palate and airway development and parents are choosing to address those issues earlier than later.
Should I find a provider on the tongue tie facebook group?
It’s great to get feedback from other parents about their experiences and local parent groups are a great way to do that. We strongly urge caution in using “tongue tie support” facebook groups. Some of these groups collect personal information from members and share it in other groups without consent. Many of the recommended providers are not recommended for their skill and continued education, but because they have some sort of personal or fincancial relationship with the person running the group. Many of the provider lists are created by those who do not have the education to properly vet the providers, or by those who are biased due to personal or financial reasons. We do not currently have a group for Louisiana that properly vets providers. Please be careful.
Always keep in mind that each person sharing their experience has a different situation. No two babies or families are the same. Care should always be given based on YOUR baby and YOUR family. The care plan, exercises, or procedure that worked for another baby may not be the best plan for your baby.
Can any provider fix a tie?
There are many different ways to perform a frenotomy/frenectomy. Some providers will offer a “snip” or “clip” and release just the front part of the tie. In order to gain full function, a complete and precise release is needed. It is imperative to find a provider who will collaborate with your IBCLC and perform the release needed to address the functional issues that your baby is having.
My pediatrician says the tie is mild, what else can we do?
If you are noticing symptoms or seeing that your baby is struggling the question is: then what is causing these issues and what is your plan of care? As healthcare providers, we are here to give your our assessment and plan of care. You as the parents are the experts on your baby and you get to decide what plan will work the best for your family.
So where do we start again?
Start with an appointment with a skilled IBCLC. For the Baton Rouge, Louisiana area, that’s Magnolia Lactation. You and your baby are unique and deserve an individualized care plan for the best results.