Tongue Tie Resources 

Tongue Ties cause difficulty with the ability to freely move the tongue, which is vital for babies feeding at the breast, bottle, and for eating solid foods. For proper function in feeding and swallowing, the tongue must be able to move up, and down to form a negative pressure to adequetly remove milk from the  breast, and move in a wave-like motion to swallow. The lips need to be able to flange easily around the nipple,while the tongue has to extend beyond the gum line to prevent the bite reflex, and to assist in achieving a deep latch. 

When tongue function is restricted by a tie, the tongue may not extend beyond the gums, causing baby to have a chewy latch.  A baby with a lip or tongue restriction may have a shallow latch, tend to grab on mostly to the nipple, while not taking in much of the areola. This compresses the nipple onto the hard palate in the baby’s mouth, and can cause pinched nipples, nipple pain, as well as skin breakdown. A tongue-tie often accompanies a high palate, which also decreases the suction, and further reduces milk transfer.

Babies with ties may take shorter feeds, others feed for long periods becoming sleepy from their latch challenges.  Some babies pop on and off the breast, or click while feeding at the breast. Others may remain attached to the breast for long periods of time, falling asleep, and comfort nursing without taking in a full feeding. Some infants are able to compensate for poor tongue function by feeding mostly during the milk ejection reflex, or “let-down” when the milk ejects more freely, however they may choke on the fast flow. 

An infant’s breastfeeding challenges often results in the end of a breastfeeding journey, exclusively pumping and bottle feeding, or a loss in milk supply. Some babies with oral restrictions also have difficulty gaining enough weight,  and need to supplement. 

Many babies with a tongue-tie, also have an abnormally tight membrane attaching their upper lip to their gums (lip-tie).  Babies with a lip-tie often have difficulty flanging their lips to create a good seal around the breast or bottle. They tend to have suck blisters especially on the top lip but can be on all lip surfaces. Because air leaks in at the corners of the mouth during sucking, they swallow more air. This air in the stomach causes more spit up (reflux), gas pain and a fussy baby.

There is some research linking lip-ties with improper jaw development and spaces between the permanent teeth.

Baby Symptoms:

• Poor latch, shallow latch

• Noisy sucking or clicking

• Coughing, gagging

• Gumming, chewing the breast

• Popping on and off the breast, frustrated

• Sleepy, tired baby on the breast

• Long feedings, lasting up to an hour, frequent feedings

• Baby always hungry

• Lip blisters

• Milk leaking on the sides of the mouth

• Fussy baby, colic, gassy

• Reflux, frequent spitting up

• Poor weight gain

• Unable to hold pacifier

• Poor bottle feeding

• Noisy breathing, snoring while sleeping

• Thrush in the mouth

Symptoms for the Lactating Parent: 

• Poor milk supply

• Oversupply

• Severe pain when breastfeeding

• Bleeding, cracked or blanched nipples

• Nipple vasospasms

• Clogged ducts

• Mastitis

• Nipple thrush

• Frustration and anxiety associated with breastfeeding

• Problems bonding with the baby

Tongue-tie releases are called frenectomies, Frenectomies  remove the tissue, or tight frenulum under the tongue or upper lip to allow the tongue and lip to have better mobility. Frenectomies can be performed with scissors, lasers, and electrocautery. Trained providers that can do frenectomies include doctors (ENTs or Pediatricians), dentists, midwives, and nurse practitioners.  I highly recommend laser frenectomies because laser cauterizes as it cuts, reducing the risk of bleeding and infection. It also minimizes pain and swelling, making the procedure more comfortable for your child. Secondly, a laser frenectomy is extremely quick – often completed in just a few minutes, the procedure usually requires no stitches. 

STRETCHES

Wash your hands well prior to starting stretches. Gloves are not necessary, however can be used if you prefer them. Use a small amount of coconut oil on your fingers when you do the stretches. Swaddle your little one well, to prevent them from getting their hands in the way while you do the stretches.  It is normal for a small amount of bleeding to occur when you do the stretches.  

Timing: 

The first set of stretches should be done the morning after the  procedure. Do 4 stretching sessions per day for 4 weeks, roughly every 6 hours. It is important to be sure the sessions are spread out throughout the day, with no longer than six hours in between stretches.  One session should be in the middle of the night. This stretch is the most important, because it helps prevent the body from having too much healing time between exercises, which can allow the wound to heal inappropriately.  Many parents find it convient to do these just before diaper changes. Some babies will cry with the stretches, however the typically settle when fed afterward.  

Lip Stretches:

The Upper Lip is often the easier of the 2 sites to stretch. If your baby had a lip tie revised, I recommend starting with the lip stretch.  Starting with the lip allows you to get under the tongue easier if the baby starts to cry. For the upper lip stretch, place your finger under the lip, stretch the lip up towards the nose,  moving it up as high as it will go until you get resistance. Then gently sweep your finger from side to side along the wound for 1 second, repeating this three times. 

Tongue Stretches:

The Tongue should be your second area to stretch. Insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Put your thumbs on the baby’s forehead and your middle fingers on the chin. Then use both index fingers to dive under the tongue and pick it up, towards the roof of baby's mouth. The tongue needs three separate stretching motions:

1. Once you have your fingers under the tongue, lift the tongue up with your index fingers, lifting as high as it will go towards the roof of the baby's mouth. Hold the tongue up for 2 seconds, then allow it to relax. Repeat this 3 times. Pushing your index fingers together can help prevent them from separating.  Next, push at the top of the diamond, pushing the tongue up, and back towards the tonsils. 

2. Using your index finger, make a J along the diamond incision, starting at the bottom of the diamond, and going up, push up on the tongue while making the J. Use a lifting motion while sweeping through the wound.  This is a gentle stretch, not forecful.

3. Use a little pressure to massage on either side of the floor of the mouth, outside the diamond, to loosen up the muscles on the floor of mouth. 

Here are some exmple videos of stretches:

Lip Stretch

Tongue stretch

Bodywork can be beneficial before, and after a frenectomy, or tongue tie release.  It helps to improve surgical success, restore functionality, and promote proper development.

Bodywork before a frenectomy can help release tension, and reorganize a baby's soft tissues, which can improve surgical success, and foster proper development of the face, jaw, and airway.

Bodywork after a frenectomy can help reduce discomfort, promote blood circulation, and optimize tissue healing. It can also help improve range of motion, mobility, and function throughout the body. Bodywork can also help retrain the oral and facial muscles to rest, and function properly. For example, gentle massaging under the tongue can help reduce scar tissue buildup, and get the tongue used to moving with less restriction.

Bodywork that has been shown to be beneficial includes infant massage, chiropractic care,craniosacral therapy and tummy time.