Are you overwhelmed with the information available about tongue ties and oral restrictions or concerned your baby has ties? Many myths and misinformation are circulating on the topic, which can make it more confusing for parents. Let’s take a deep dive into how the tongue functions during feeding, what happens when it is restricted, and how to navigate the tongue tie release process for best results.
Ankyloglossia is the scientific term for tongue tie. The tongue is made up of a group of eight muscles and is always at work. The tongue is involved in feeding, swallowing, jaw development, and speech and impacts our breathing. Being able to move correctly and without restriction is essential for all its functions to be performed properly. When it can not move freely, it affects our whole system.
The lingual frenulum connects the tongue to the floor of the mouth. The frenulum is a band of tissue which is part of the fascial system. (1) Everyone has a frenulum under their tongue, and it is a normal part of our anatomy. A tongue tie refers to a frenulum that restricts the tongue’s ability to move and properly function.
Did You Know?
The tongue is connected through the fascial system through the body all the way down to the toes. (3) This is very important to understand. It means that if there is a tongue tie, there is likely tightness in other areas of the body that can also impact the baby's ability to comfortably and efficiently nurse.
Fascia is a system of connective tissue below the skin that surrounds and supports muscles, organs, nerves, and bones. When the fascia is tight, it impacts the ability of our body to move freely and comfortably. It is like wearing clothes that are too tight, making it hard to bend and move. We want our fascia to be loose, unrestricted, and able to bend and move with ease. If we pull one part of the fascia tight, like having a tongue tie, the consequence is it pulls on everything else connected to it, causing strain patterns. (4) Breastfeeding is a whole-body experience for your baby and not just about what their latch might look like.
The tongue usually separates from the floor of the mouth in utero. Tongue tie is a birth defect found in 4% - 10% of babies. (2) This percentage may be on the low side because only some practitioners are proficient at assessing ties, and many ties go undiagnosed until later in life. Undiagnosed oral restrictions have led many parents to stop their breastfeeding experience earlier than planned. There are solutions!
Symptoms the parent may experience:
Pain while nursing
Lipstick-shaped nipple after nursing
Plugged ducts or mastitis
Low milk supply
Cracked, bleeding, or damaged nipples
Symptoms the baby may have:
Clicking sound while nursing
Gas and hiccups
Tires quickly while feeding
Low weight gain
Falls asleep quickly at the breast
Difficulty handling milk flow, choking or sputtering
Strong gag reflex
Seems hungry all the time
Difficulty drinking from a bottle
Difficulty with solid food
If you are checking off any of the symptoms above, it is time to find an IBCLC (International Board Certified Lactation Consultant) experienced with oral function and habilitation. Not all lactation providers or pediatric providers have taken the continuing education required to obtain the skill sets needed for assessing and helping to correct the compensations babies and parents make when ties are present. Your IBCLC will recommend, communicate, and coordinate with the other care providers required to resolve the oral restrictions properly, and effects oral restrictions have throughout the rest of the body. The best results in resolving ties come from a team-based approach led by your IBCLC.
The Role of the IBCLC
An IBCLC spends the time to take a complete health history for you, your baby, and your feeding experience. Not everyone experiences the same symptoms with tongue ties, so this information collection is very important for helping determine other areas of the body that are being affected due to the tightness under the tongue. Together, you will develop a care plan that is individualized and specifically designed for you and your baby. An IBCLC is the only provider who considers the dyad when assessing breastfeeding and improving feeding problems. Other care providers on your care team can play a role in the care plan, but it is the IBCLC who should guide the process.
Seeing how your baby nurses and/or bottle feeds and listening to the symptoms you and your baby are experiencing is essential since each parent and baby dyad is unique. An oral assessment can be performed in person or virtually as your IBCLC guides you. An oral assessment includes looking for signs of restriction under the tongue and the other frenum in the mouth: the upper lip (labial), lower lip, and 4 areas of the cheeks (buccal).
Your IBCLC will also assess your baby’s reflexes, observing their whole body to determine where muscle tension and strain patterns are contributing to their feeding challenges. Babies and parents make compensations during positioning and latching for more effective feeding and milk transfer. Although these compensations help to feed the baby, it is not optimal for comfortable and efficient milk removal, milk supply, or the baby's development.
Your IBCLC will give oral and body exercises to begin loosening tension and tight fascia. There is no one-size-fits-all plan, and the exercises may change as you work together.
Bodywork will be a part of the care plan to address structural issues.
Release provider - If the release provider does not require you to work with an IBCLC and have bodywork done before and after the procedure, discuss this with your IBCLC or find a different release provider. It can indicate their lack of understanding of how the whole body matters and lack of preparation can result in an incomplete release or less optimal outcomes.
The preparation done by you at home with instruction from your IBCLC and the bodywork your baby gets allows the release provider, often a pediatric dentist, to do their work more easily. Preparation helps the baby gain as much mobility with their tongue as possible, relax muscles being overworked, and strengthen other muscles needed for better outcomes after the tissue is released. When the prep work is not done, it can result in no change in symptoms, worse symptoms, tissue reattachment, or breast refusal.
"Tongue-tie release is a process, not a procedure."
Jennifer Tow, IBCLC, LMT, CSOM
Your IBCLC will give you information on what to expect during the process of releasing tongue ties and the aftercare involved. When your baby is restricted, it is like having a rubber band that, if we stretch it, may loosen, but the tension is not gone. When the tie is released, oral exercises and bodywork therapy continue. The tongue muscle learns how to move properly with its full range of motion. The body has more freedom of movement with less tightness, making positioning at the breast more comfortable.
Symptoms in older children & adults
Tongue tie symptoms extend beyond breastfeeding. If restrictions and strain patterns exist, they can be maintained but will only go away by addressing the cause. Some parents experience no pain during feeding, and their baby gains weight just fine. Symptoms may not be recognized until later in life. (6)
Difficulty with solid foods
Gag on foods or throwing up after eating
Difficulty forming certain sounds
Chronic sinus infections
Enlarged adenoids or tonsils
Chronic neck and shoulder pain
Myths about tongue tie
Your baby will outgrow the tongue tie
Tongue ties stretch over time
You have to wait until your child is 1 - 2 years old to release a tie
Lip ties don’t affect feeding
If your baby is gaining weight, there is no need to release a tongue tie
If the baby can stick their tongue out over their bottom gum line, they aren’t tongue-tied
Posterior tongue tie doesn’t exist
Treating tongue ties is just a new fad
Buccal ties do not impact breastfeeding
Buccal ties should not be released in babies
Many myths and misinformation are given to parents about tongue ties and oral restrictions. Understanding how the tongue works and its connection to the rest of the body can help connect the dots of symptoms experienced by the parent and baby if you suspect a tongue tie. Remember, not all providers have the same continuing education or skill sets for proper assessment. If you recognize symptoms of ties affecting you and your baby, step one is to call an IBCLC who has experience in oral function. Correcting a tongue tie with the proper preparation and follow-up care can lead to better overall growth, development, and wellness.