Tongue & Lip Tie

Tongue -tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia. Lip-tie is a condition where the upper lip has restricted mobility and function. As we develop in the womb, a tight string of tissue called a frenum is supposed to recede and thin under the tongue and lip. The frenum is visible and easily felt if you look in the mirror under the tongue and lip. Everyone has a frenum, but in some people a frenum fails to recede and is too tight, thick, or short and causes mobility problems.

The tongue and lip are a complex group of muscles and are important for all oral functions. For this reason, having a tongue-tie can lead to nursing, bottle feeding, dental, speech, sleep, and solid feeding issues.

Baby’s issues

• Poor latch
• Poor weight gain
• Reflux or spitting up often
• Clicking or smacking noises
• Gassy or fussy often
• Milk dribbles out of mouth
• Baby is frustrated when eating
• Unable to hold a pacifier
• Prolonged nursing sessions.

Mother’s issues

• Painful nursing
• Creased or flattened nipples
• Blistered or cut nipples
• Incomplete breast drainage
• Plugged ducts or mastitis
• Using a nipple shield

A new baby with a too tight tongue and /or lip frenum can have trouble sucking and may have poor weight gain. If they cannot make a good seal on the nipple, they may swallow air causing gas, colic and reflux or spitting up. You may hear clicking noises when the baby is taking the breast or a bottle. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for a tongue and lip-tie. It can also cause thrush, mastitis, nipple blanching, bleeding or cracking in the mother or inability to hold a pacifier.

Sometimes a tongue-tie can be “hidden” or “posterior “and can be difficult to diagnose but still cause the same issues as a more visible to the lip-tie. A tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect’s a child’s weight gain but also lead many mothers to abandon breastfeeding altogether. Many times, after releasing the tongue and/or lip, mother’s report immediate relief of pain and a deeper latch. The symptoms of reflux, gassiness and colic may also disappear and wait gain may occur rapidly.

Some children are able to compensate and have no noticeable speech errors due to tongue-tie, but many struggle to adapt. Tongue -tied children often struggle with R,L,S,TH,SH,Z sounds. Some children with a tongue tie may have a lisp, talk softly (mumble) or slowly, or even have a speech delay. Evaluation by a speech therapist should be considered if your child is trying to talk to you or other, but is difficult to understand.

Tongue-tie can also cause difficultly chewing and swallowing food and liquids. Inefficient eating behaviors such as chocking, gagging, packing food in the cheeks or spitting out food can indicate the presence of a tongue-tie. The child may eat slowly or be picky with textures such as meats or mashed potatoes. Even a “hidden” posterior tongue tie can cause these some speech and feeding issues in children, which often resolve after a release.

Some children may sleep restlessly and wake easily or snore from a tongue tie. Often after treatment children sleep more peacefully, snore less, and feel more rested.

Physical appearance of frenum is not always an indication of what symptoms may arise later in life. The ability to stick tongue out does not rule out the presence of a tongue- tie. However, some physical characteristics are commonly associated with speech, feeding and sleep issues.

These include:

Inability to elevate the tongue to the palate with mouth open wide.

Heart shaped tip of the tongue

A thick or tight string under the tongue.

Difficulty moving the tongue from side to side.

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Tongue and lip tie release procedure

Tongue-tie and lip-tie release is a simple procedure with minimal complications when using a laser with good techniques. The laser allows for excellent visualization and precision during the procedure to achieve a full release of all the fibers which typically does not happen with scissors. The procedure may be performed as early as a couple of days after birth and can be performed into adult hood. Typically, once a problem with a tongue-tie, or lip-tie has been discovered, the sooner it is addressed the better the procedure will work and the less issues the child will have.

The procedure can be performed in our office with numbing jelly. Dr Abraham uses the highest quality, state of the art CO2 laser to perform the release. Older children who understand the procedure receive some numbing medicine and laughing gas, and often report no pain at all during the procedure. Younger children and babies usually cry more due to us working in their mouth than the pain.

The laser gently removes the tight tissue with typically minimal bleeding, no stitches and no sedation or general anesthesia. Most of the time the release procedure only takes about few minutes or less. The baby can nurse immediately after the procedure, and older children often notice an immediate difference in mobility of the tongue. Often speech is improved within a few minutes to a few weeks, but speech therapy is required to achieve optimal results.

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Results

One of the most important things to understand when your child has a tongue and/ or lip-tie released is that improvement is a team effort. The release of the frenum is just one piece of the puzzle. Your child will need some time to figure out what to do with the new mobility of their tongue and lip so support from other professionals like lactation consultants, speech therapists and myofunctional therapists is key to the success of the treatment. The tongue is a muscle, and it becomes used to functioning in a certain way just like any other muscle in the body. When tongue function is restricted by a tongue -tie, the body adapts. It takes time for the brain to figure out how to use their tongue effectively once the tie is released. For infants, often the mother notices a difference immediately, but it is also normal to not notice much difference in nursing right afterward. Sometimes there may even be a little regression in sucking (things get worse instead of better) for a day or two as your child’s brain tries to sort out how to use their tongue now that the restriction is gone. Some babies may need chiropractic care, physical therapy, or occupational therapy to address other issues such as torticollis (tight neck muscles) that can affect nursing. If you have any questions or which to schedule an appointment, please contact us at 469-669-0222