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LIP AND TONGUE TIES

Here at Bodo Chiropractic, we are passionate about breastfeeding and we want to help make your journey as smooth as possible. One of things that we find to be impeding the ability to breastfeed, other then musculosketal restraints are called tethered oral tissues (TOTs) or more commonly known as, tongue tie (TT). 

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Early intervention is important. If you are struggling with breastfeeding or think your baby has a tongue tie, let us help you with diagnosis and management. Read on to learn about tongue ties and how we can help. 

DOES YOUR BABY HAVE ANY OF THESE SYMPTOMS?

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  • Reflux

  • Colic or extreme fussiness 

  • Blisters on their lips

  • Gagging 

  • Clicking at breast

  • Using lips or cheeks to nurse 

  • Stiff or arching their back

  • Inability to latch or maintain latch (pops off nipple)  

  • Nipple pain for mom

    • trauma or pain throughout feeding is abnormal 

    • pain upon latching that diminishes is usually normal  

  • Misshapen nipples after nursing 

  • Weight loss, or issues with weight gain

  • Mastitis or clogged ducts 

  • Head tilt preference to one side (Torticollis)

  • Does baby fall asleep at the breast

  • Inefficient nursing sessions - seemingly endless feeds 

  • White tongue 

  • Poor milk transfer (leaking)

  • Upper lip folds in 

  • Blanching of upper lip when latched 

  • Decrease in milk supply 

  • Doesn’t like car seat 

  • Airway issues - open mouth posture, seems like they are always have a stuffy nose 

  • Resting tongue posture - tongue not at roof of mouth 

  • Early head control (not a “normal” milestone)

  • Inability to keep pacifier in mouth 

  • Sleep issues

We know this could be exhausting and frustrating but we want you to know that you are not alone. There is a biological need to breastfeed and we want to help you fulfill that need. Even if you are not breastfeeding, tongue tie can also cause complications for the future and the baby should be evaluated.

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Your baby could be fine and nursing well, but are they thriving?

If there are multiple symptoms, the baby might have a tongue tie. So,what is it?

Ankyloglossia AKA tongue tie (TT) 

Ankyloglossia a condition where the tongue is tethered to the bottom of the mouth by a short or thick lingual frenulum (tissue under tongue). The tie could be anterior (frenulum attaches too far forward), posterior (connective tissue under the tongue causes tension and inability for full tongue movement), lip, or buccal (cheek). 

 

This can be difficult to diagnose by yourself. The tongue tie can be a embryologic remnant where the tissue did not fully change as expected or forms left over tissue

 

More information on TT: Dr. Ghaheri, Dr. Zoghby, Tongue tied (By Richard Baxter), Chelsea Pinto

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Image: https://www.tonguetielife.com/

What happens if we leave the tie untreated? 

Breastfeeding could continue to be difficult. Baby could continue to be uncomfortable and exhausted. According to Ricke (2005), untreated tongue-tied babies were more likely to be exclusively bottle fed at 1 week of age.​ The longer a tongue tie is left untreated, likelihood of breastfeeding abandonment will increase significantly; Donati-Bourne, et al (2015)

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Getting the tongue tie release involves 6 weeks of stretches and body work at a minimum (pre and post). Body tension needs to be addressed before a release is considered. There is an increased likelihood of reattachment if tension is not addressed. We don’t want muscle tension around the wound because it can cause more scarring and potential for a revision. If a baby is compensating, breastfeeding, doing fine, and they are gaining weight, this does not mean you shouldn’t act on the TOT.

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Not getting the tongue tie released usually involves:

 

 Body work at least 2 times a week, stretches every day, oral Myofunctional therapy as a kid/adult. Potentially leading to other issues down the line such as; speech issues, airway issues, poor jaw development, headaches, TMJD, chronic pain in neck and back, sleep apnea, mouth breathing, snoring, teeth crowding, bed wetting, poor oral health/dental issues, day time fatigue, frequent tonsil and adenoid issues, behavioral concerns and difficulty concentrating.  

So my baby has a tongue tie, what's next?​​

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Body work (chiropractic/craniosacral therapy). If body work doesn’t seem to help with symptoms, a release is generally advised followed by a referral to a pediatric dentist for a consultation on whether or not a release is necessary.  

 

You will want a team of specialists to guide you through this process 

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Once revision and body work have been completed, you can expect all the symptoms of TT to resolve. See section Does your baby have any of these symptoms for a complete list.

Why does it seem to be increasing in

awareness And Diagnoses? 

There are a few thoughts on this:

 

It’s not necessarily a matter of increased prevalence, it's that we are more aware of the signs and symptoms. Especially the ones that were never released or recognized. American academy of Pediatrics - published an article on breastfeeding about 20 years ago where they identified anterior, posterior, buccal and lip ties - (it's not a new thing)

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Other causes are:

 

  • Increase in folic acid and fortified foods causing to much midline closing during development in utero.

  • Social media presence, sharing information more readily which causes an increase in diagnoses, increase in research = increase in awareness.

  • We have more information now, prior generations were misinformed and all about convenience - breastfeeding was not convenient and formula was “better” and tongue ties went undiagnosed.

myths and misconceptions of tongue tie

I can stick my tongue out so I don’t have a tie - FALSE  

 

My baby is gaining weight just fine so there is no tie - FALSE

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I can’t see a tie so there must not be one - FALSE

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My baby has acid reflux, not a tongue tie, so a revision is not needed - FALSE

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  • 7 studies suggest reflux improvement following frenotomy (Siegel 2016, Ghaheri 2017, Ghaheri 2018, Slagter 2020,  Hand 2020, hill 2022, Ghaheri 2022) â€‹

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It has to be released - FALSE

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  • Depending on severity and symptoms, body work might be all they need

  • Release is generally recommended if baby is having continuous symptoms

Why was I told that my baby doesn’t have a tongue tie? 

Providers typically don’t have very much training unless they seek it out. Medical school only has a brief section on tongue tie. If a provider wants to be more educated in the subject they must seek out continuing education courses on TT.  

 

Generally TTs are looked for in the hospital after birth but are commonly missed due to lack of information, TTs must be felt and assessed on a functional basis, not just by looking under the tongue. 

 

​Ways to explain what a tongue tie is like for a baby/child/adult:

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  • Syndactyly is a condition where a person is born with one or more of their fingers fused together. They can do most things fine, but they most likely won’t ever be a famous piano player (everything is possible - this is just for explanation purposes). Just with a tongue tie, patient’s will likely be able to do most things without issue but there will most likely be underlying conditions that could have been helped if the TT was diagnosed and properly managed.    
  • Another way to think about it is always having your shoes tied together, you will find a way to walk, it might be slower and more careful but you will still have issues when it comes to running. If you were born that way, (e.g. with a tongue tie) you will never know the difference and you will come up with ways to compensate.  â€‹

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we are here to educate you to make the best decision for you and your baby

For more information on TTs, we have attached a list of research articles below and the book Tongue Tied by Richard Baxter (available in paper and audio);

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