What is a Tongue Tie and Why is it a Big Deal?

Nikki Imes, CD(DONA), Monitrice (OMA)

I am on a mission in my local birth and breastfeeding community: I am working to raise awareness about tongue-tie, its impact on breastfeeding, and the quality of life of the mothers and babies affected!

I come at this issue from a unique perspective. I am not a breastfeeding mom nor am I a Lactation Consultant. I am a birth doula, intern midwife and CranioSacral (CST) therapist. However, within the last year, I have been presented with a score of babies who have/had tongue-tie and have seen the negative impact this can have on new families.

As a birth professional, I was already vaguely “aware” of tongue-tie. However, once I began working on babies as a CranioSacral therapist, my awareness grew and things began to snowball. Now, I rarely go a week without either meeting a new tongue-tied client or working on a previously tied baby as part of continued CST care. 

So, what is tongue-tie?

“Ankyloglossia” or “tongue-tie” is defined in Dorland's Pocket Medical Dictionary as “abnormal shortness of the frenum of the tongue, interfering with its motion”. Sound simple, right? Sadly, not it isn't as simple as it sounds.

I am learning, as expressed in Alison Hazelbaker's book “Tongue-Tie; Morphogenesis, Impact, Assessment and Treatment”, there has long been a controversy amongst healthcare professionals about what tongue-tie is and if it has an impact on breastfeeding, speech, swallowing and other parts of everyday life for infants and adults. However, parents (and especially breastfeeding mothers) are much less conflicted about the negative effect of tongue-tie, even if they are not quite able to distinguish the various degrees of ties.

The classic anterior tie is the tongue-tie most healthcare professionals are familiar with. It is is characterized by the frenum (the “string” on the underside of the tongue) that is attached very far forward on the tongue, sometimes even to the tip. Signs that parents can to look for include a heart-shape to tip of tongue, a tongue that cannot extend over the lower lip and/or a tongue that truly looks “tied down” when baby cries. This can prevent babies from extending their tongue properly to achieve a good latch when breastfeeding and, in future, can lead to speech impediments (along with many other dental issues).

A posterior tongue-tie is quite a bit sneakier. The frenum is not visible in most cases, because the mucosa on the floor of the baby's mouth has enveloped it and causes an even tighter restriction of the tongue. Often, these babies are able to extend their tongue past their lower lip, but they are unable to lift their tongue very far upwards in their mouth. The tongue often makes a U shape when crying, instead of reaching towards palate. By being unable to press the breast tissue towards the roof of their mouth, they have extra difficulty transferring milk out of the breast.

Lip-tie, too...

To add insult to injury, often babies who have tongue-tie also have a lip-tie, as well. Dr. Kotlow of Albany, New York describes lip-ties as “continued attachment of the upper lip to the upper jaw tissue”. As a breastfeeding hurdle, lip-tie can prevent top lip flange, which also causes latch difficulties. Long-term, lip-ties (along with tongue-ties) can cause tooth decay, due to the lip never fully moving away from the base of the upper teeth and the tongue being unable to clear all food debris away from the teeth. Lip-ties also cause the “cute” gaping of teeth that is adorable in toddlers and a financial nightmare for parents with teens who require orthodontia.

Symptoms?

If you are looking inside your little one's mouth and are uncertain if they have a tie, the following symptoms may be helpful for you to determine if you are headed in the right direction:

l  Low milk supply (depending on the severity of the tie a baby may not be able to stimulate milk production through vigorous nursing or transfer the milk efficiently)

l  Creased/flat/blanched nipples after nursing

·      Painful nursing including cracked and bleeding nipples

·      Early weaning because child gets frustrated at the breast

·      Tooth Decay – Improper tongue mobility may prevent babies from clearing milk from their mouth, causing decay (especially on the top front teeth)

·      Colic, gassiness (inability to maintain suction at the breast means baby swallows a lot of extra air)

·      Slow weight gain (baby may actually be burning more calories than he is taking in, due to inefficient milk transfer)

·      Excessively long nursing sessions, with a baby that still acts hungry after leaving the breast (Occasional seasons where baby wants to nurse non-stop are often growth spurts and some babies just have a leisurely pace when nursing. However, tongue-tied babies often want to nurse non-stop because, as stated before, they burn more energy than they are taking in.)

·      Reflux

·      Sleep apnea

·      Abnormal sleep patterns (Waking often to feed because they are unable to fully drain the breast and therefore always hungry. )

·      Speech difficulties

·      Gap between teeth/jaw issues ( Tight tissues can prevent normal development in many areas of the mouth, not just the tongue.)

·      Thrush/mastitis due to inefficient milk transfer

·      Plugged ducts

So, what's a parent to do?

For an anterior tie, there are some pediatricians, midwives, ENTs, and dentists trained to clip them with  sterile scissors. It is a relatively minor procedure that can offer freedom from the restriction of the frenum tie.

For posterior ties and lip-ties, I highly recommend finding a healthcare professional trained to use a laser to release the mucosa under the tongue and the tissue holding down the lip. This is usually a dentist, believe it or not. They see the long-term effects of tongue-tie on the health of the mouth and can offer their patients relief from many symptoms by revising the ties. Laser revision is also very non-invasive and much preferred to what used to be the only option for posterior ties: scalpel incisions and sutures to restructure the tissue under the tongue.

Resources!

Here are some care providers trained in laser revision:

·        Lawrence Kotlow, DDS, PC – Albany, New York

·      Hugh Oser, DDS – Keller, Texas

·      Stacy Cole, DDS (Holistic Dentistry) – Fort Worth, Texas

·      Dr. James Jesse is a friend of Dr. Kotlow’s that has been recommended by several mamas. He is in San Bernadino, California.

·      Lindsey from Crunchy Savings went to Dr. Notestine  in Dayton Ohio

·      Dr. Martin Kaplan of Kid Care Dental in Stoughton, MA. was trained by Dr. Kotlow

(Credit goes to Heather at the Mommypotamus blog for compiling this list)

Other web resources include:

http://tonguetie.net/

The section on Dr. Kotlow's site with his articles, most of which are regarding tongue and lip-tie. Many of them also have great pictures of various types ties.

The Tongue-Tie Babies Support Group on Facebook, which is an international group of parents and professionals working to help support families through tongue and lip-tie revisions with all the questions and concerns they may have.

If you are local to the Oklahoma City metro area, I am always happy to help talk to parents about babies with suspected ties. You can find my contact info on my website.

 Also, one of the very first people who brought posterior tongue-tie to my attention, Margaret Back, is an IBCLC apart of the Lactation Services department at Integris Baptist in Oklahoma City. I highly recommend getting in touch with her for questions about whether posterior tongue-tie could be the culprit in certain breastfeeding situations.

My goal

My goal, as a birth professional supporting new families,  is to empower parents, lactation consultants, doulas, pediatricians, breastfeeding educators, La Leche League leaders, midwives, doctors and the public at large with the information regarding tongue-tie. Many families are suffering needlessly and in an age of instant access to info, this doesn't need to be the case!