TONGUE TIES AND HOW TO HELP WITHOUT SURGERY

Tongue tie or Ankyloglossia is a condition that restricts the tongue's range of motion. It's present at birth and is found in about 10% of the population depending on which study you look at. It is more common in boys and there does seem to be a genetic link. So if it runs in your family or you had an older child affected it would be a good idea to have this checked.

Tongue tie is an ancient condition that has been around as long as humans have. It has been mentioned in ancient Greek medical texts and in the bible. There are even oil paintings and wood carvings of babies having their tongue ties snipped from the middle ages.

You may have seen more media hype about this recently, some biased for or against treatment, or you may have heard friends and family talking about their feeding journey and their baby’s issues.

And you are asking yourself, “Where did all of this tongue tie stuff come from?” “I’ve never heard of it before and suddenly it’s everywhere!” there is a simple explanation. In the eighties and nineties, when more babies were being bottle fed, tongue tie became less of an issue so it fell off the radar. In the last decade there have been more initiatives to encourage breastfeeding and rates of people breastfeeding has risen significantly. This has resulted in tongue tie being more diagnosed and treated than previously. It's always been there, we just forgot about it for a little while.

In practice we see this commonly under diagnosed and over diagnosed. You would think that every baby would be thoroughly checked in the hospital, but this is not always the case. Even if your pediatrician "had a look" and said everything was fine, they may or may not have had any actual training or experience in this issue or in breastfeeding support in general. Just ask them.

Common symptoms of Tongue Tie

persistent nipple pain that doesn't resolve with attachment and positioning support
nipple damage
babies unable to latch on to a breast or bottle
low milk supply
requiring the use of nipple shields
poor weight gain
slipping off the breast during feeds
suck blisters on the lips, clicking, chomping, slurping or excessively dribbling
some cases of excessive or exacerbated reflux and wind can be due to the tongue

Babies who have a tongue tie will have similar traits that you can look for if you’re having symptoms. Things like not sticking out the tongue or lifting up towards the palate when crying, or the shape of the tip of the tongue as well as other traits.

When in doubt, it's best to get expert advice from somebody who actually does this day in and day out and works with tongue tied babies on the regular. If you suspect your baby may have a tongue tie the best course of action is to have a full and proper oral assessment done by an experienced lactation consultant or a doctor who specializes in tethered oral tissue. This is sometimes easier said than done. Some people have limited practitioners in their area or others are facing long wait lists. As a parent with concerns about tongue function today, you can check yourself for signs and symptoms and you can start doing something about it now!

Parents can use the following TABBY TOOL or BTAT TOOL to help identify if their baby may have an issue with their tongue and would warrant further investigation. In each row select the box that most accurately describes your baby and score according to the top of the column. Add up your total score. Any score 6 or below indicates a likely tongue restriction and would warrant a proper assessment in person.

If you suspect your baby has a restrictive frenulum and you're waiting for an appointment, or you really want to avoid the surgical treatment, there are non surgical alternatives that you can try. These are non-invasive suck exercises that can help strengthen your baby's tongue and jaw and can increase the mobility and elasticity of the frenulum. Suck training has been shown in the evidence to improve function scores by a small amount, so it is not a miracle cure, but if your baby has a borderline restrictive tie, this could be just what you need to get over that hump so you don't need oral surgery.

SUCK TRAINING

Do each exercise 5x a session and try to do at least two sessions per day. Make it a game and enjoyable for baby. The last thing we want to do is stress them out. So if baby isn’t into it just park it for a bit and try again later.

SIDE TO SIDE: with a clean finger go into Baby’s mouth and run your finger on the lower gum from side to side, right where the teeth will be one day. Go slow and encourage the tip of the tongue to follow your finger to each corner of the mouth.
TUG OF WAR: now place your clean finger in the mouth pad side up. Stimulate the roof of the mouth to trigger the suck reflex and let them suck on your finger like a pacifier. Once they have you and you can feel that suction, try and pull your finger out of the mouth and test that suction. They will resist and slurp you back in, then you can pull again creating a tug of war. You can also do this with a bottle or pacifier. TOP TIP: if baby wont suckle, try putting some milk on your finger to tempt them.
SLEEPING POSTURE STRETCH: this is best done when baby is sleepy and milk drunk. Follow the instructions in the video below to press the tongue against the hard palate and then gently pull the chin down to challenge this suction.

Here is a great video outlining all of the suck exercises:

If you are struggling with nipple pain or even nipple damage from a suspected tongue tie please see our blog on “Nipple Shields” as a temporary measure to keep you feeding while you wait for assessment or treatment.