All about tongue ties…
Oral restrictions, as we call them in the field of lactation, receive news attention and online chatter every so often. Recently there was a New York Times article talking about how many of them are unnecessary, and in my opinion, served to fear monger new parents out of considering the procedures. Of course we need unbiased coverage in the world of medicine - but it did not feel like they considered the families who had very positive experiences with the procedures.
In every medical specialty, there are procedures that are unnecessary or over suggested, or even botched. That does not make them right - but it is not isolated to this specialty. And - in my experience, many families who struggle with nursing due to undiagnosed ties are often brushed off by providers who have little experience with them, confusing everyone and can end up gaslighting parents who have valid concerns.
I have completed the Oral Habilitation MasterClass by Jennifer Tow, which went into depth about ties and care of them. As an IBCLC and RN, I am not allowed to diagnose any oral restrictions. That is outside of my legal scope of practice. However, I can do a functional oral assessment and tell parents what I am noticing.
What should a normal infant mouth do when nursing or bottle feeding?
The breast/chest/bottle touches the hard palate at the roof of the mouth, which triggers the suck reflex (if under 3-4 months of age)
The tongue cups the breast/chest tissue/bottle then moves like a wave (peristalsis)
The lips suction and create a seal that allows the milk to be pulled out without swallowing air
Baby is able to suck, swallow, and breathe at the same time without losing suction or popping off
In the presence of a restricted oral tissue, this process is often interrupted.
This can cause:
Nursing parent experiencing pain when feeding
Nipple damage - bleeding, cracking, bruising
Difficulty with weight gain - either initially or after milk supply regulates (4-6 weeks) as the initial fast flow reduces and baby is not feeding optimally causing a drop in supply
Feels like baby is “constantly feeding” or pops on and off throughout the feed
Other symptoms!
Everyone has a frenulum - it keeps the tongue and lip rooted to the mouth. But sometimes the position of it, or how short/tight it is makes the process of feeding difficult, or even unsafe! If a baby can’t control the flow of milk or suction appropriately, they will opt to protect their airway and pop off. Or maybe they aren’t getting enough, and this can drop milk supply since milk supply is established based on how much is being pulled off.
If something is not right with nursing, or your baby struggles to bottle feed, it is worth finding a IBCLC who can do a functional oral assessment, who is trained to identify the impact of ties, and who can make a recommendation to address all kinds of other issues that might come with it!
Usually, if parents have concerns, and there are signs of restrictions, I’d recommend the following:
Full oral and body assessment to identify tension and impact on feeding
Refer out to body worker who can help reduce overall body tension (craniosacral or chiropractor who is skilled to work with babies)
Work on helping baby suck optimally by doing oral exercises before the procedure
Meet with a DDS who is trained to use a Light Scalpel for revising ties, and who I have worked with before and can communicate with
Ultimately - you are the expert on your baby, and you make the decision! But - it can help to have all the pieces of the puzzle. This is just my approach - every baby and nursing parent couplet is different and each one needs individualized care - in Baltimore or virtually!
