Tongue tie is such a controversial subject. Trust me -- I know.
Sir G clicked with every nurse: suck/click/swallow/breathe was his wonky rhythm. I checked and rechecked and latched and unlatched and relatched and couldn’t figure out what was wrong… till he was 2 months old, and it occurred to my tired mommy brain to check inside his mouth. Oh. A tongue tie.
I had the tie released by a local ENT, but the clicking never went away (at the time, I blamed it on the fact that he’d nursed the wrong way for so long), and he was a long, skinny baby till he started solids (which was quite shocking as my twins were round chubbers).
When my next baby, Sir S, was clicking shortly after birth, I resolved to release it right away this time. The day after his bris, we were at the ENT’s office.
“It’s not so bad,” he told me. But he clipped it, and we came back home… and the clicking continued.
It wasn’t till his weight started to slide down on the charts (from the 80th-90th percentiles, to below the 20th) when he was 3 months old that I realized something was wrong.
Well, it’s been quite a journey since, and I’ve seen just how controversial the lip tie/tongue tie debate is -- and saw how much it can impact a baby when it’s not dealt with correctly. But I’ve also learned that it’s not just nursing babies. And it’s not even just babies.
There is so much more to tongue tie than the “it’s controversial” people even know...
So first: what are tongue and lip ties?
The tongue and lip are connected, respectively, to the base of the mouth and the upper gum with a piece of tissue called frenula (frenulum is singular).
The frenula should keep the range of motion of both the lip and tongue slightly limited (not bouncing all over the place), but allow for proper motion to enable normal oral function to occur. For the tongue, that means easily reaching the upper palate; for the lip, that means allowing it to flange upwards properly.
A “tie” is when that frenulum is too tight to allow for proper movement.
Tongue and lip ties are most commonly discussed around breastfeeding.
Quick lesson on how the mechanics of breastfeeding work: in order for your baby to efficiently transfer milk (which is fancy-shmancy LC talk for “get milk out of your breast and into his tummy”), his tongue needs to create a vacuum seal. A proper seal is created by his tongue cupping the breast and “holding on” with the back of his tongue.
Tension from tongue tie keeps the back of the tongue tied down, and the baby is forced to use his lips to hold on to the breast. As they move back and forth, that friction will often cause a nursing blister on your baby’s lip.
So now that we’ve settled what tongue and lip ties are, here’s what you need to know about them.
The first thing you need to know is that, when it comes to tongue tie, there are two “types” of ties: anterior and posterior.
An anterior tie is pretty easy to see -- if you try to lift the baby’s tongue, you’ll see a membrane that goes all the way, or nearly all the way, to the tip of the tongue.
Many doctors (including the ENT who saw my boys) “only believe in” anterior ties - they believe that only anterior (visible) ties are the ones that can restrict the movement of the tongue and cause problems.
But that’s not actually the case.
One doctor who releases ties uses the analogy of a sailboat: if you’re trying to fit a sail boat under a bridge, and the sail is too high, taking the sail down won’t resolve your problem -- the mast is still there!
Just because the sail, or the anterior membrane, is not visible, doesn’t mean that there is no tie.
A posterior tie, which may be present alone or together with an anterior tie, will also restrict movement -- when a baby with a class 4 posterior tie cries, you won’t see any membrane, but you will see the sides of the tongue elevate, but the mid-tongue will stay down, restricted by the tension of the posterior tie.
At the end of the day, it doesn’t really matter whether or not your baby presents with a membrane holding the tongue down. What matters is: can that tongue move the way it should or is there tension?
When I got Sir G’s tongue tie released, I was just happy to get in with a top pediatric ENT. Little did I know that I was hardly doing anything for him.
Many ENTs and pediatricians don’t know much about tongue tie -- and being a top ENT or amazing pediatrician doesn’t mean they have all the information. In fact, the top ENT that we saw both for Sir G’s only release and Sir S’s first release didn’t even tell me to do any sort of stretches (stretches manage wound healing so that the tongue doesn’t reattach), until I asked after Sir G’s release.
Find someone in your area who is an expert in the field of tongue tie releases. In my area, it’s the pediatric dentists and notthe ENTs who have familiarity in this field. Do your homework, and find out who’s really knowledgeable about tongue ties in your area -- it may be a pediatric dentist, an ENT or even a periodontist!
(You can contact me and I’m happy to reach out to the specialist in my area and connect you with a specialist in your area).
The earlier you release, the easier your baby’s transition will be - they won’t get a chance to learn to nurse wrong, or to allow tension to build up from that tie.
That being said, it’s never too late to release. (The pediatric dentist that did Sir G’s second release -- the best of the best in the Chicago area -- said he’s released children up to age 18, and adults as old as in the 90s have been released!)
If the tie is causing problems (more on that below), get it released.
Once the release is done, make the most of what this specialist has done for you with follow up: do your stretches, work with a lactation consultant to make sure latch looks good (if baby is still breastfeeding), and be sure to get body work (such as craniosacral therapy) done to release the tension or misalignment that can build up as a result of an unresolved tie.
Most people tend to think of tongue tie a problem exclusively for breastfed babies. After all, so long as the baby isn’t hurting mom or struggling to get the milk he needs, then it’s not a problem, right?
Proper latch on a bottle is important, too. Any clicking, gulping or dimpling of the cheek when taking a bottle means that your baby is taking in excess air.
That can cause big gas bubbles (tummy discomfort!) and lots of spitting up if that burp comes up with milk or formula on top of it.
And, on top of that, it can impact your baby’s orofacial development even if he’s bottle fed (see below for more on that).
If your bottle fed baby has a tongue tie that’s preventing a proper latch on the bottle, it’s best to get that released.
Fact #5 Not just nursing -- also solids + speech
But the effects of tongue tie can follow your child beyond the stage of exclusive liquid nutrition.
As any good speech therapist will tell you, we use our tongue for more than just sucking!
Tongue tie can also affect your baby’s ability to eat solid foods. Restricted movement of the tongue will make it difficult for them to move the food around the mouth to chew, and to the back of the mouth to swallow.
And let’s not forget about the major role the tongue plays in speech! All that oral muscle movement is super important to properly and clearly shape sounds.
“The toe bone’s connected to the foot bone / The foot bone’s connected to the ankle bone…”
Nothing exists in a bubble, and every piece of our body is interconnected - and the tongue is no different. It’s connected to the bones of the face -- the jaw, the hyoid, the palate -- and to other muscles in the area.
Toss some tension to the tongue, and the tongue’ll do its part by passing that tension on to those it’s connected to. Which will pass the tension on to those they’re connected to, which can cause lots of tension in places nowhere near the tongue.
That means that tongue tie can cause a high arched palate (the muscles that connect from the tongue to the back of the mouth can pull the bone out of place), causing even more difficulty in properly nursing, as well as a longer, narrower face.
Tongue tie can also restrict arm motion or posture, or inhibit comfortable movement, and can even - crazy as it may sound! - affect your posture.
And, of course, sleep.
Yes, tongue tie can affect sleep -- which, by extension, means it can affect all aspects of your or your child’s day-to-day living.
In order for us to get the deep sleep we need, we need to be nose-breathing. Nose breathing is deeper and more invigorating, allowing us to get the oxygen we need.
In order for that amazing nose breathing to happen, we need to:
Tension in the tongue can cause facial changes that can result in narrower nasal passages, making nose breathing more difficult in general. On top of that, the restricted tongue movement caused by the tie may make it difficult or impossible for the tongue to properly seal off the mouth to move the breathing over to the nose.
Which means that unreleased tongue tie can, quite literally, make your child’s sleep less restful, and cause a whole host of issues from sleep deprivation.
So that’s the rundown on Tongue Tie. Did you learn something new here? If so, let us know in the comments below.
This article was reviewed for accuracy by Patricia Berg-Drazin, IBCLC and diplomate certified as a craniosacral therapist. Patricia has been a practicing IBCLC since 1990, and as a CST since 1997, specializing in working with mothers and babies, and is particularly experienced in the area of tongue ties. She has published articles in the Journal of Human Lactation and Birth Issues and has reviewed books for the Journal of Human Lactation since 1991.
You can contact Patricia at [email protected]