Here at Tampa Breastfeeding Center, our IBCLC’s (feeding specialist) have advanced training and education on identifying and managing tongue and lip ties, aftercare, and oral habilitation (oral retraining), which also includes providing holistic support to the family. This encompasses a comprehensive approach to feeding, offering both practical and emotional support for parents, and ensuring that any medical interventions are well-explained and coordinated. If a frenotomy is needed, we will make appropriate referrals that best suit our families needs.

What is Tongue and Lip Tie?

Infant tongue tie, also known as ankyloglossia, is a condition where the thin piece of tissue (the frenulum) that connects the underside of the baby’s tongue to the floor of their mouth is shorter or tighter than normal. This restriction can limit the movement of the tongue.

Tongue Tied

Signs of tongue tie in a newborn:

  1. Feeding difficulties:
    • Trouble latching onto the breast or bottle properly.
    • Inconsistent or weak suckling, leading to poor milk transfer.
    • Difficulty maintaining suction, causing the baby to frequently pull off the nipple.
    • Short or ineffective feeding sessions.
    • Poor weight gain or weight loss
    • Milk leaking from sides of the mouth
    • Difficulty with bottle
  2. Mother’s symptoms:
    • Nipple pain, cracking, or bleeding due to a poor latch.
    • Engorgement, as the baby may not be emptying the breast effectively.
    • Low milk supply due to ineffective breastfeeding.
  3. Other potential signs:
    • Clicking noises while nursing.
    • Excessive drooling.
    • Trouble sticking out the tongue or moving it from side to side.
    • Tongue not resting at the roof of the mouth
    • Sleeping with the mouth open
    • Reflux
    • Gagging or exaggerated gag reflex
    • Choking when feeding (breast or bottle)
    • Stressful feedings
    • Structural (body tightness) (ie) torticollis
    • Infant dysregulation

Potential long-term effects of untreated tongue tie:

  1. Feeding Difficulties
    • Poor latch: Babies with tongue tie often have difficulty latching onto the breast or taking the bottle properly, leading to poor milk transfer. This can result in insufficient nourishment and frustration for both the baby and the mother.
    • Nipple pain and damage: Mothers may experience painful breastfeeding due to an ineffective latch, leading to sore, cracked, or bleeding nipples.
    • Low milk supply: An inefficient latch may result in reduced milk production because the breast isn’t being adequately emptied during feedings.
  2. Speech and Language Delays
    • Articulation issues: A limited range of tongue movement can lead to difficulty pronouncing certain sounds, such as “t,” “d,” “l,” “r,” and “s.” This can cause speech delays or unclear speech, which may require speech therapy to address.
    • Language development: Tongue tie can impact the development of verbal communication, as the child may struggle with sounds that require tongue flexibility. This can delay or hinder the child’s ability to speak properly.
  3. Dental Issues
    • Tooth misalignment: A restricted tongue may contribute to abnormal oral posture (such as the tongue resting at the bottom of the mouth or pushing against the teeth), potentially leading to teeth misalignment, such as overbites, crossbites, or other orthodontic problems.
    • Gum recession: Improper tongue movement can affect the natural development of the mouth and jaw, potentially causing gum recession over time, which can lead to oral health problems.
    • Difficulty with oral hygiene: A restricted tongue might make it harder for a child to clean the roof of their mouth and teeth effectively, increasing the risk of cavities, plaque buildup, and gum disease.
  4. Eating and Swallowing Problems
    • Poor chewing ability: As the child grows and begins to eat solid foods, tongue tie may affect the ability to move food around in the mouth, resulting in difficulty chewing or swallowing.
    • Choking or gagging: The inability to properly move food to the back of the mouth may lead to choking or gagging, particularly during the transition to solid foods.
  5. Postural and Muscular Imbalances
    • Head, neck, and jaw tension: A restricted tongue can affect posture and lead to tension in the jaw and neck muscles. This may cause discomfort or pain in the head and neck area, which could affect overall posture and alignment.
    • Mouth breathing: Tongue tie can lead to difficulty in maintaining the tongue’s proper resting position on the roof of the mouth. This can cause mouth breathing, which may contribute to sleep problems, dry mouth, and even developmental issues related to the teeth and jaw.
  6. Sleep and Breathing Problems
    • Snoring: A restricted tongue can hinder the ability to breathe through the nose, leading to mouth breathing and snoring.
    • Sleep apnea: In severe cases, tongue tie may contribute to sleep disordered breathing or obstructive sleep apnea, where the airway is partially blocked during sleep.
  7. Psychosocial Effects
    • Self-esteem issues: Children with speech delays or difficulties may become frustrated with communication challenges, which can negatively impact their self-esteem and social interactions.
    • Social challenges: A speech impediment due to tongue tie may make it more difficult for children to interact with peers, potentially leading to social isolation or anxiety.
  8. Chronic Pain or Discomfort
    • Jaw pain: The restricted movement of the tongue can lead to tension in the jaw muscles, which may contribute to jaw pain, headaches, or temporomandibular joint (TMJ) dysfunction     There is some evidence to suggest that gastroesophageal reflux (GERD) or acid reflux may be more common in infants with tongue tie (ankyloglossia), though the connection isn’t fully understood. The theory is that tongue tie could interfere with proper feeding and swallowing, leading to complications that contribute to reflux.

Possible ways tongue tie may be associated with reflux:

  1. Ineffective latch and swallowing issues:
    • Infants with tongue tie often struggle to latch properly onto the breast or bottle, leading to inefficient suckling and swallowing. This can cause the baby to swallow air along with milk, leading to gas, discomfort, and potential reflux episodes.
    • Poor swallowing mechanics might also allow milk to flow back into the esophagus, which can result in acid reflux.
  2. Increased swallowing of air (aerophagia):
    • As babies with tongue tie may not latch deeply or correctly, they often swallow more air during feeding. This trapped air can cause bloating and discomfort, which can worsen reflux symptoms.
  3. Digestive inefficiencies:
    • Inadequate tongue movement may make it more difficult for the baby to efficiently move milk to the back of the throat and into the stomach. This could contribute to delayed gastric emptying or increased pressure in the stomach, which may increase the risk of reflux.
  4. Stress during feeding:
    • Feeding difficulties due to tongue tie can cause stress for both the baby and the mother. Stress in the infant may exacerbate symptoms of reflux, as stress can affect the digestive system and increase the likelihood of stomach acid flowing back into the esophagus.

Key symptoms of reflux in infants that may overlap with tongue tie issues include:

  • Frequent spitting up or vomiting after feeding.
  • Irritability or discomfort during or after feeds.
  • Arching of the back or neck during feeding (a common sign of discomfort due to reflux).
  • Poor weight gain or feeding difficulties.
  • Difficulty settling after feeds and excessive crying.

What to do if you suspect a connection:

If your infant has tongue tie and is also experiencing signs of reflux, it is important to consult with both a pediatrician and a lactation consultant. Treating the tongue tie (usually with a simple frenotomy) may improve feeding efficiency, decrease air swallowing, and potentially reduce reflux symptoms. Additionally, a pediatrician can assess whether the reflux is severe enough to warrant other treatments such as medication or feeding modifications.

Ultimately, addressing the tongue tie and improving feeding mechanics can help reduce the chances of reflux, but it’s also important to rule out other causes or conditions that may be contributing to the symptoms

Laser treatment for tongue tie is a modern method of addressing ankyloglossia (tongue tie) that has gained popularity due to its precision and minimal invasiveness. The procedure uses a laser to vaporize tight frenulum (the band of tissue connecting the underside of the tongue to the floor of the mouth). Here’s an overview of how laser treatment works, its benefits, and considerations:

How Laser Treatment Works for Tongue Tie:

  1. Procedure:
    • A focused laser is used to carefully release or cut the frenulum (the restrictive tissue under the tongue). The laser vaporizes tissue with minimal bleeding, as it also cauterizes (seals) blood vessels during the procedure.
    • The procedure typically takes just a few minutes and is usually performed in a healthcare setting (e.g., pediatrician’s office, dentist, or ENT specialist’s office).
    • Laser treatment is done without the need of general or local anesthesia, and does not require sutures. Most release providers use a small amount of numbing gel.

Benefits of Laser Treatment for Tongue Tie:

  1. Precision and Minimal Bleeding:
    • The laser allows for highly precise cuts with minimal damage to surrounding tissues, reducing the risk of bleeding and promoting faster healing.
  2. Quick Recovery:
    • The recovery time is typically very fast, often within a day or two. Infants may be able to breastfeed again almost immediately after the procedure, especially since there is no need for stitches.
  3. Less Pain and Discomfort:
    • Many parents report that their babies experience less pain or discomfort after laser treatment compared to traditional surgical methods, as the laser seals nerve endings and blood vessels, reducing post-procedure irritation.
  4. Immediate Improvement in Feeding:
    • In many cases, babies who undergo laser treatment for tongue tie experience immediate improvement in their ability to latch, suck, and feed more effectively.
  5. Minimal Scarring:
    • Laser procedures usually cause less scarring compared to traditional methods because of the precision of the laser and the reduced tissue trauma.

Treatment for Lip Tie

Lip tie occurs when the frenulum connecting the upper lip to the gums is too tight, which can affect the baby’s ability to latch onto the breast properly. It can lead to challenges with breastfeeding, especially for latch and suction.

Common Treatment Options:

  1. Frenotomy (Snipping the Frenulum):
    • A frenotomy is also the standard treatment for lip tie. The frenulum is snipped to allow the upper lip to move freely.
    • This procedure is usually quick and may be performed using sterile scissors or a laser.
    • The procedure is performed with local numbing gel, and babies can often resume breastfeeding immediately after.
  2. Laser Treatment:
    • Like tongue tie, laser treatment is also an option for releasing lip ties.
    • It is precise, minimizes bleeding, and promotes faster healing.
    • Laser procedures are typically done in a similar way as for tongue tie treatment, and babies can often feed immediately after the procedure.

Aftercare and Follow-Up

Regardless of the procedure, aftercare is essential to ensure proper healing and to prevent the frenulum from reattaching too tightly. Some important aftercare steps include:

  • Gentle stretches: After the procedure, healthcare providers may recommend gentle stretches of the tongue or lip to prevent the frenulum from healing too tightly and reattaching.
  • Breastfeeding or bottle support: It’s often helpful to continue working with a lactation consultant after the procedure to ensure that breastfeeding improves and that the baby is feeding effectively.

Why Bodywork Post-Tongue Tie Release is Important:

  • Preventing Reattachment: Sometimes, the frenulum can begin to heal and reattach in a way that restricts the tongue’s movement again. Performing specific stretches or bodywork can reduce this risk.
  • Increasing Tongue Mobility: The tongue needs to move more freely to support proper feeding, speech, and oral health. Bodywork helps stretch and strengthen the tongue muscles.
  • Improving Oral Function: After the release, babies may need help relearning how to use their tongues properly for sucking, chewing, and speaking.

Post-Tongue and Lip Tie Release Bodywork and Exercises:

  1. Gentle Tongue Stretches:
    • For Infants: The healthcare provider (such as a pediatrician, lactation consultant, or dentist) may recommend that parents gently stretch the baby’s tongue by lifting the tongue up and away from the floor of the mouth. This is done with clean hands, gently holding the tongue and stretching it for a few seconds.
    • Frequency: These stretches are typically recommended several times a day for the first few weeks post-release, depending on the severity of the tongue tie and the provider’s advice.
  2. Lip Exercises:
    • For Infants: Gently lifting the upper lip can help improve lip mobility. This is especially important for babies with a lip tie. The lip exercises may involve gently pulling up on the upper lip to help stretch the frenulum and promote freedom of movement.
  3. Mouth and Jaw Massage:
    • For Infants: Gentle massage around the jaw and the area where the frenulum was released can help reduce tension in the surrounding muscles, allowing for better jaw and tongue movement.
  4. Suckling or Feeding Exercises:
    • For Infants: After a release, babies may need to relearn how to suck effectively during breastfeeding or bottle feeding. The help of a lactation consultant can be invaluable in this process to ensure proper latch and suction.
  5. Posture and Body Alignment:
    • For Infants: Ensuring that the baby is positioned correctly during feeding can help maximize tongue and lip function. A lactation consultant can help parents with proper positioning.

Post-frenotomy bodywork for infants focuses on promoting proper tongue and lip movement, reducing muscle tension, and enhancing feeding efficiency. Working with a lactation consultant, pediatric CFT therapist, or other healthcare providers is essential to ensure the best recovery. These techniques, such as gentle stretches, oral motor exercises, and proper positioning, help to support healing and improve the baby’s oral function.