Tongue Tie in Infants

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Tongue-Tie in Infants
Studies have shown that an infant with ankyloglossia, or tongue tie, can have issues latching, gaining weight, creating suction and staying awake during feeds due to the extra exertion required. This can create delayed speech due to restrictions in tongue movement, as well as poor oral hygeine later in life due to dry-mouth as a natural side-effect of limited tongue mobility.
What is a Tongue-Tie?
The medical term for tongue tie is ‘ankyloglossia’. All babies have a thin band of tissue underneath the tongue called a frenum that anchors the tongue to the floor of the mouth. With a tongue tie, this band of tissue is too tight or thick and affects about 4-10% of babies. This can tether the tongue to the bottom of the mouth and restrict tongue movement. When the tongue can’t move properly, it can interfere with nursing, feeding and swallowing. Some babies can get by ok like this but may grow up with restrictions and compensations related to feeding, speaking, growing and more. We don’t want your baby to just grow up ‘fine’ but want him or her to Breathe.Feed.Thrive!

You can evaluate for a tongue tie by assessing the movement of the tongue. If the tongue is restricted when moved up, out, or side to side it may be tethered. Some tethered tongues appear to have a heart shaped notch at the tip. Sometimes the baby or child might not visually appear to have a tongue tie but they exhibit all the symptoms. In this case the tongue tie might be a variant called a posterior tongue tie and when released, the symptoms improve.

What is a lip tie or a buccal tie?
Just as the tongue has a frenum attaching it to the floor of the mouth, the upper and lower lips have frenums that attach to our gums. A frenum is a normal anatomical finding, but when too tight or restrictive, it’s known as a tethered oral tissue (TOTs). Most babies appear to have a lip tie when inspecting their frenum. Appearances can be deceiving though. Studies show that over 90% of babies have a frenum that inserts close to the gum ridge or palate and this can be considered normal. Just like when evaluating the tongue, we want to be certain the lip tie is restricting function or affecting feeding before deciding to release the tie. Buccal ties and lower ties are rarely addressed with a release, but will still be evaluated during the examination or potentially released if the baby has already had a tongue and lip tie release and still having feeding problems.

Ideally, if the lip tie release is needed, it will be done at the same time as the lip tie.

Older kids may require a lip tie release if the tie is restricting the growth and development of the upper jaw (maxilla) and the face. A tight tie causes a negative force restricting growth and this can alter the way the adult teeth erupt.

Are there other reasons besides feeding to release a tie? How about with older children?
Tongue ties as infants are often overlooked as the root cause to a baby’s feeding symptoms or the mother’s pain. If the tongue and/or lip tie isn’t released as an infant, it can affect the growth and development of the jaw, face, airway and how the teeth erupt. Ties may go unnoticed until later in life when an older child is struggling with speech, sleep, or feeding. A child may develop a gag reflex, ADHD or mouth breathing. A tongue tie tethers the tongue to the floor of the mouth preventing the development of the upper jaw and face. This may cause the child to have extensive orthodontic work or to have teeth removed.

Mouth breathing is of particular concern because it can cause sleep disruption. Sleep apnea in a child can lead to a delay in cognitive and physical development. If a child grinds their teeth, snores, has enlarged tonsils and crowded teeth these are all signs to look for a tongue tie. These are all symptoms that must be addressed as soon as possible because the child is already developing impaired habits that will last throughout their life.

Adults may have tie releases if they’re suffering from TMJ, or have neck, shoulder and back problems.

What are infant tongue tie symptoms?
Some babies with tongue and lip ties may feed just fine. However, many infants exhibit symptoms and mother’s of tongue-tied babies struggle with their health as well. The following signs are common in babies with tongue and lip ties and their mothers.

TONGUE TIED BABIES MAY EXHIBIT:
Poor latch at the breast or bottle | Reflux or colic symptoms | Popping on and off the breast | Poor weight gain | Cries often/Is fussy | Gagging or choking while feeding | Noisy feeding | Short, frequent feedings | Gassy burps | Falls asleep while feeding | Mouth breathing, snoring or noisy breathing | Milk leaking from sides of the mouth

MOTHER’S SYMPTOMS INCLUDE:
Painful nursing | Nipple pain | Cracked, flattened nipples | Bleeding nipples | Prolonged feedings | Poor breast drainage | Decreased milk production | Using a nipple shield | Feeling like feeding the baby is a full-time job

The importance of post procedure care
Mothers often report an immediate relief of pain and a deeper latch after the tongue tie and/or lip tie release. It’s important to note that improvement can take time as the baby is learning a new skill with a tongue that is now free to move. Working with the collaborative care team of lactation consultants and body work specialists also helps to ensure healing and success.

Immediately after the procedure the baby can start feeding. We will provide you with post-op instructions, exercises and information to help guide you with what to expect and what’s required at home to ensure success and prevent re-attachment. Wound healing for the lip tie release and tongue can take about 2-3 weeks when the stretching exercises are properly performed. We encourage all babies to return for a one week follow-up check to evaluate the healing progress and answer any questions parents may have. The return of some initial symptoms can be normal for a day or two, but if symptoms persist, there could be re-attachment, so let us know right away.

What is a lip tie or a buccal tie?
Just as the tongue has a frenum attaching it to the floor of the mouth, the upper and lower lips have frenums that attach to our gums. A frenum is a normal anatomical finding, but when too tight or restrictive, it’s known as a tethered oral tissue (TOTs). Most babies appear to have a lip tie when inspecting their frenum. Appearances can be deceiving though. Studies show that over 90% of babies have a frenum that inserts close to the gum ridge or palate and this can be considered normal. Just like when evaluating the tongue, we want to be certain the lip tie is restricting function or affecting feeding before deciding to release the tie. Buccal ties and lower ties are rarely addressed with a release, but will still be evaluated during the examination or potentially released if the baby has already had a tongue and lip tie release and still having feeding problems.

Ideally, if the lip tie release is needed, it will be done at the same time as the lip tie.

Older kids may require a lip tie release if the tie is restricting the growth and development of the upper jaw (maxilla) and the face. A tight tie causes a negative force restricting growth and this can alter the way the adult teeth erupt.

Are there other reasons besides feeding to release a tie? How about with older children?
Tongue ties as infants are often overlooked as the root cause to a baby’s feeding symptoms or the mother’s pain. If the tongue and/or lip tie isn’t released as an infant, it can affect the growth and development of the jaw, face, airway and how the teeth erupt. Ties may go unnoticed until later in life when an older child is struggling with speech, sleep, or feeding. A child may develop a gag reflex, ADHD or mouth-breathing. A tongue tie tethers the tongue to the floor of the mouth preventing the development of the upper jaw and face. This may cause the child to have extensive orthodontic work or to have teeth removed.

Mouth breathing is of particular concern because it can cause sleep disruption. Sleep apnea in a child can lead to a delay in cognitive and physical development. If a child grinds their teeth, snores, has enlarged tonsils and crowded teeth these are all signs to look for a tongue tie. These are all symptoms that must be addressed as soon as possible because the child is already developing impaired habits that will last throughout their life.

Adults may have tie releases if they’re suffering from TMJ, or have neck, shoulder and back problems.

What are infant tongue tie symptoms?
Some babies with tongue and lip ties may feed just fine. However, many infants exhibit symptoms and mother’s of tongue-tied babies struggle with their health as well. The following signs are common in babies with tongue and lip ties and their mothers.

TONGUE TIED BABIES MAY EXHIBIT:
Poor latch at the breast or bottle | Reflux or colic symptoms | Popping on and off the breast | Poor weight gain | Cries often/Is fussy | Gagging or choking while feeding | Noisy feeding | Short, frequent feedings | Gassy burps | Falls asleep while feeding | Mouth breathing, snoring or noisy breathing | Milk leaking from sides of the mouth

MOTHER’S SYMPTOMS INCLUDE:
Painful nursing | Nipple pain | Cracked, flattened nipples | Bleeding nipples | Prolonged feedings | Poor breast drainage | Decreased milk production | Using a nipple shield | Feeling like feeding the baby is a full-time job

The importance of post procedure care
Mothers often report an immediate relief of pain and a deeper latch after the tongue tie and/or lip tie release. It’s important to note that improvement can take time as the baby is learning a new skill with a tongue that is now free to move. Working with the collaborative care team of lactation consultants and body work specialists also helps to ensure healing and success.

Immediately after the procedure the baby can start feeding. We will provide you with post-op instructions, exercises and information to help guide you with what to expect and what’s required at home to ensure success and prevent re-attachment. Wound healing for the lip tie release and tongue can take about 2-3 weeks when the stretching exercises are properly performed. We encourage all babies to return for a one week follow-up check to evaluate the healing progress and answer any questions parents may have. The return of some initial symptoms can be normal for a day or two, but if symptoms persist, there could be re-attachment, so let us know right away.

Tongue Tie Related Videos

Dr. Herre reviews post-op tongue tie care for infants.
Dr. Herre discusses the aftercare instructions for an infant tongue tie release.
Breathe.Feed.Thrive. Treatment for Infants
Initial Conversation
Dr. Tim understands this can be an emotional and stressful time for new parents and listening to the mother’s story is an important first step. The bond between mother and baby is important and the baby’s ability to breastfeed well is vital to their development and the mother’s health. It’s important to understand the struggles that both mom and baby are experiencing. All babies are born with some degree of a tongue and lip tie, but, for between 4-10% of babies, the tie can be so restrictive that it limits proper function.

Not all ties need release, so it’s important to discuss the issues affecting both mom and the baby. Dr. Tim will perform a functional assessment to gauge the degree of restriction of the tongue and lip tie. Tongue tie is a diagnosis based upon function, so what your baby’s tongue looks like can sometimes be less important than how it can move.

Dr. Herre with his son
Dr. Herre with his infant son
Treatment for Tongue and Lip Ties with a Laser Release
Tie releases (called frenectomies) free up the tight tissue (frenulum) under the lip or tongue to allow for proper movement and function. Dr. Tim uses an innovative LightScalpel (linked to Lightscalpel.com) CO2 laser for a safe and quick procedure that provides the precision necessary for greater tongue and lip mobility.

While the procedure can be done with a laser or scissors, Dr. Tim prefers the laser for infants. Advantages of a CO2 laser include:

  • Minimal discomfort
  • Minimal bleeding during and after the procedure – the laser aids in hemostasis
  • Faster healing
  • Bactericidal properties
  • Increased precision and complete removal of a tie

The day of treatment, we will have a peaceful, quiet space for the baby to practice latching immediately post procedure. Most moms notice an immediate result. We will also teach parents post treatment exercises that they will perform at home to ensure the releases stay stretched out preventing re-attachment of the tissues.

Collaborative Care
The Breathe To Thrive Center relies on a team approach with like minded practitioners that help ensure success of the release by working with mom and baby before and after the tongue tie revision. When communicating with moms pre-treatment, we cannot stress enough the importance of continued lactation support following the frenectomy procedure. It is not only the tongue and jaw that are affected by a tongue tie. Tongue- tied babies often have additional structural tension throughout the body to be addressed by a bodyworker, a licensed professional such as an occupational, craniosacral or physical therapist. Bodywork encourages body awareness and encourages an infant to express postural reflexes and explore natural movement inclinations through the nervous system.

After a tongue tie release, the infant’s tongue will need to adapt to a new and profound range of motion. Some babies need no help at all and immediately breastfeed post-procedure, while other babies may need additional guidance.
Some of the practitioners that provide valuable help include the following:

  • An International Board Certified Lactation Consultant (IBCLC) can help improve latch, provide suck strengthening exercises and develop a feeding plan to address issues of latch, nipple healing, and low milk supply.
  • A speech or developmental feeding therapist can help babies learn to use their tongues for more effective eating and speech.
  • A craniosacral therapist, chiropractor or body-work therapist can help babies to release tight muscles that have compensated for a tight frenulum or improper suck.
  • A Myofunctional therapist to help older kids with therapeutic exercises of the tongue, lips and muscles of the face before and after treatment to prevent re-attachment of the tie.
Breathe.Feed.Thrive. Treatment for Infants
Initial Conversation
Dr. Tim understands this can be an emotional and stressful time for new parents and listening to the mother’s story is an important first step. The bond between mother and baby is important and the babies ability to breastfeed well is vital to their development and the mother’s health. It’s important to understand the struggles that both mom and baby are experiencing. All babies are born with some degree of a tongue and lip tie but for between 4-10% of babies the tie can be so restrictive it limits proper function.

Not all ties need release so it’s important to discuss the issues affecting both mom and the baby. Dr. Tim will perform a functional assessment to gauge the degree of restriction of the tongue and lip tie. Tongue tie is a diagnosis based upon function, so what your baby’s tongue looks like can sometimes be less important than how it can move.

Dr. Herre with his infant son
Dr. Herre with his infant son
Treatment for Tongue and Lip Ties with a Laser Release
Tie releases (called frenectomies) free up the tight tissue (frenulum) under the lip or tongue to allow for proper movement and function. Dr. Tim uses an innovative LightScalpel (linked to Lightscalpel.com) CO2 laser for a safe and quick procedure that provides the precision necessary for greater tongue and lip mobility.

While the procedure can be done with a laser or scissors, Dr. Tim prefers the laser for infants. Advantages of a CO2 laser include:

  • Minimal discomfort
  • Minimal bleeding during and after the procedure – the laser aids in hemostasis
  • Faster healing
  • Bactericidal properties
  • Increased precision and complete removal of a tie

The day of treatment, we will have a peaceful, quiet space for the baby to practice latching immediately post procedure. Most moms notice an immediate result. We will also teach parents post treatment exercises that they will perform at home to ensure the releases stay stretched out preventing re-attachment of the tissues.

Collaborative Care
The Breathe To Thrive Center relies on a team approach with like minded practitioners that help ensure success of the release by working with mom and baby before and after the tongue tie revision. When communicating with moms pre-treatment, we cannot stress enough the importance of continued lactation support following the frenectomy procedure. It is not only the tongue and jaw that are affected by a tongue tie. Tongue- tied babies often have additional structural tension throughout the body to be addressed by a bodyworker, a licensed professional such as an occupational, craniosacral or physical therapist. Bodywork encourages body awareness and encourages an infant to express postural reflexes and explore natural movement inclinations through the nervous system.

After a tongue tie release, the infant’s tongue will need to adapt to a new and profound range of motion. Some babies need no help at all and immediately breastfeed post-procedure, while other babies may need additional guidance.
Some of the practitioners that provide valuable help include the following:

  • An International Board Certified Lactation Consultant (IBCLC) can help improve latch, provide suck strengthening exercises and develop a feeding plan to address issues of latch, nipple healing, and low milk supply.
  • A speech or developmental feeding therapist can help babies learn to use their tongues for more effective eating and speech.
  • A craniosacral therapist, chiropractor or body work therapist can help babies to release tight muscles that have compensated for a tight frenulum or improper suck.
  • A Myofunctional therapist to can help older kids with therapeutic exercises of the tongue, lips and muscles of the face before and after treatment to prevent re-attachment of the tie.
Breathe to Thrive Method
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Amazing care!!! They were able to get me in when I couldn’t get in to see where my Family Dentist referred. That location referred me to Dental Health by Herre. Dr. Herre was extremely thorough and very concerned about my oral health. I would recommend this to anyone!!

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Tracy M.
Leawood, KS

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