Infant Health - Tongue Tie
Many of you asked me about the recent New York Times article titled, “Inside the Booming Business of Cutting Babies Tongues”. I was hoping the NYT would discuss the tongue muscle’s function, diagnosing a tongue tie, treatment protocol and general implications of non-treatment. However, I found the article disappointing; more of a panic piece, instead of helping parents navigate an expensive, and emotionally and physically challenging surgery on their little one.
Tongue tie is NOT a life -threatening condition. Does it have implications? Yes. My intention is to educate. I am NOT an expert, so I defer to those who are and have personal and professional experience.
Note - Dental and orthodontia care are in a new era. Finally, wholeness has come to mouth health: there is an impact of the body on the mouth and there is an impact of the mouth on the body. Read the best selling book, Breath, by James Nestor.
What Is a Tongue Tie and What Causes It?
The medical term for tongue tie is ankyloglossia. During gestation, as a part of its normal course of development, the tongue undergoes a process called apoptosis. Fingers and toes also experience apoptosis. Apoptosis is the dyeing away of cells to enable separation.
The cell webbing between the fingers and toes dies away so that our fingers and toes move independently of each other. The same thing happens under the tongue. The frenulum is a tissue that’s on the underside of the tongue, and connects the tongue to the base of the mouth. The cells on the frenulum die away so that we can lift and move our entire tongue in a wide range of ways. When the frenulum cells do Not die away completely, the tongue gets “tied” closer to the base of the mouth. Only the front portion of the tongue can be lifted up fully and there’s less overall range of mobility.
Any muscular restriction, anywhere in the body, can ripple out to the rest of the body and impact body performance. The same is true for the tongue muscle and the muscles, fascia and bones it is directly and indirectly attached to. A freely moving tongue muscle is needed in eating, nose breathing, speech, facial symmetry, and dental health.
What is the actual procedure?
The frenulum is either cut or lasered to sever a portion of it from the base of the mouth. It is a quick procedure and yes, it’s painful. Yet, not lasting pain. It’s generally recommended to be done in a baby’s first few months. Post procedure wound care and exercises are needed to be done by the caregivers for 6 weeks, several times a day and night, to ensure that the tissue does not grow back and that the tongue heals well.
Craniosacral is often given prior to the procedure for 2 reasons 1) sometimes, releasing the restrictions around and in the mouth, frees up the baby’s muscles and fascia, and what may have been misdiagnosed as a tongue tie, is solved through the gentle work of craniosacral or 2) if it’s truly a tongue tie, pre-procedure craniosacral helps to release any other restrictions, such as in the neck or head compression, that are impacting the nervous system and non-tongue muscles and bones – it’s clearing everything else and calming the baby’s nervous system before the procedure.
All my colleagues, from their personal experience, tell me that for successful outcomes, pre-procedure preparatory craniosacrial treatment, post-procedure wound care for 6 weeks, several times during the day and night, and post procedure craniosacral treatment, to help everything reset, are all vitally important in having a successful outcome.
What Are the Signs and Symptoms of Tongue Tie? What Are the Implications of a Tongue Tie?
“Signs and symptoms of tongue tie include: difficulty lifting the tongue to the upper teeth or moving the tongue from side to side.Trouble sticking out the tongue past the lower front teeth. A tongue tie appears notched or heart shaped when stuck out. See a doctor if your baby has signs of tongue tie that cause problems, such as having trouble breastfeeding, or a speech-language pathologist thinks your child’s speech is affected by tongue tie, or your older child complains of tongue problems that interfere with eating, speaking or reaching the back teeth, (or) you’re bothered by your own tongue tie. Sometime(s) tongue tie may not cause problems. Some cases may require a simple surgical procedure for correction. Tongue tie can affect a baby’s oral development, as well as the way he or she eats, speaks and swallows.”
For accuracy, I am cutting and pasting from the NIH study. In summary, it says a short lingual frenulum (tongue tie) impacts the growth and development of tissues and certain head bones, the related functioning of those, as well as impacting the esthetic of the face (often with a tongue tie there is a recessed chin).It also concludes that there are divergent views on whether or not a tongue tie needs to be cut.
“Objective: To critically examine the existing Brazilian and International scientific literature regarding the influence of short lingual frenulum, over growth and development of the stomatognathic system*, as well as how it impacts the achievement of the shape-function balance.”
“Recently, a law was passed in Brazil that requires the application of the evaluation protocol on the lingual frenulum of babies born in all hospitals and maternities, public and private.”
“It is possible to conclude that, although there are divergences on the indication of the clinical-surgical intervention for the correction of ankyloglossia, there is a consensus in the literature about the negative effect of functional imbalances caused by ankyloglossia on the correct growth and development of the stomatognathic system*. All the researched authors report the need to establish neuromuscular balance in order to achieve stable esthetic-functional goals.”
*Stomatognathic system is comprised of the teeth, jaws, temporomandibular joints, and related muscles. Its functions are chewing, speech, swallowing, breathing, and yawning
Who Can or Cannot Diagnose a Tongue Tie? What Are the Diagnostic Criteria for Tongue Tie Assessment?
Diagnosis of tongue tie is Not within the scope of practice of a lactation consultant, an IBCLC (International Board- Certified Lactation Consultant- a higher level of credential than a lactation consultant), or a bodyworker (massage therapist).
Diagnosis of tongue tie is within the scope of pediatricians, ENT’s, dentists, orthodontists, speech pathologists, occupational therapists, registered nurses, chiropractors, neonatal nurse practitioners, and physical therapists. However, many do Not have the skills, Nor the experience, in diagnosing tongue ties.
Per the NIH’s National library of medicine, “The lack of a universal, unequivocal and commonly accepted definition and objective diagnostic criteria of ankyloglossia (tongue tie) is still an issue”. NYT article refers to Alison Hazelbaker, a long- term craniosacral therapist, IBCLC, and PhD in psychology, who developed her own method of evaluating tongue tie. The Hazelbaker method is often used in tongue tie studies. Hazelbaker’s method is the closest thing there is for a standardized test of tongue tie.
Who does this surgery? The NYT article says it didn’t work for some babies
There are a limited number of doctors who have extensive experience diagnosing, performing the procedure and guiding parents in post - surgery wound care. Dr. Siegal, who serves the NJ, NYC and Long Island area is mentioned in the article. I have no personal experience with Dr. Siegal and am NOT endorsing him. Within my network of craniosacral practitioners though, they trust his judgment, skills and treatment plan.
There is a risk that the procedure won’t be successful. Like all surgeries, not every single one has a positive outcome. Do you know of someone that had surgery, but even after following all the post-op advice completely, they are still struggling with pain or lack of proper functioning? Sometimes, surgeries fail. That’s awful, especially if the surgery is on a baby.
Other Potential Implications of Tongue Tie and/or of Poor Tongue Muscle Functioning
Breastfeeding. Because of compromised mobility and shortened length of tongue, it’s challenging for baby to latch onto a breast. These babies are known to chomp at the breast, not have a tight seal and often break away from the breast, be air swallowers, and have short feeding times because of the extra effort on their little mouth and facial muscles. For mommy that may mean severe nipple pain, long “lipstick” shaped nipples, bleeding and cracked nipples, and feeling (justifiably so!) reluctant to breastfeed because of such pain.
Breathing – obstructed nasal passages
One of the tongue muscle’s functions is to keep the upper mouth palate wide. If the entire tongue cannot reach the upper palate, it cannot keeping suctioning down the upper palate through sucking and eating/swallowing. This results in a high arched upper mouth palate, which then pushes up into the nasal cavities and bones of the face, thereby reducing the amount of room for oxygen to flow in.
Often people with tongue ties, become mouth breathers. Breathing through the mouth results in intake of unfiltered air (susceptible to more bacteria and viruses). Often, people with sleep apnea or snorers are mouth breathers.
Chin not coming forward and facial asymmetry
With the tongue muscle is held back from full extension, the lower jaw bone is also compromised (remember, it’s all attached). As we grow, our lower jaw bones come forward. If there’s restriction here, that can’t happen. The chin is pulled in and potential facial asymmetry can arise from this. This is what the NIH study above is referring to.
Orthodontia/Crooked teeth/Teeth pulled
The result of a high upper palate is a narrowing of the mouth, resulting in teeth being pushed into each other, as there’s just not enough room for them
Yikes! I think I, or my child, might have a tongue tie! Who can help me?
I do NOT have personal experience with these resources. They are from my colleagues, who have worked with these professionals.
Child and Adult orthodontia – more than straightening teeth. They look at the function of the whole mouth. Dr. Barry Raphael
Dr. Philip Memoli - Holistic dentistry. Adult and pediatric dentistry in his practice
Why are there so many tongue tie procedures now?
I don’t have a solid answer for this. From the long term midwives I met, they tell me that folklore is that the midwives would use a fingernail and cut the tongue, if needed. So, we don’t really have statistics on the number of babies that had tongue ties.
Prior to the invention of nipples and bottles, if a baby’s tongue and mouth inhibited it from breastfeeding productively, it wouldn’t thrive. Modern bottles have nipples that allow milk to literally flow into a baby’s mouth.
I hope this Newsletter is helpful in understanding what a tongue tie is and its impact on the development and operation of the body. It’s always the same bottom line - everything is connected and there are reasons for those connections. Bodies are imperfect. I think it’s important to understand what the functions of our body parts are and why their functioning is important to us. That gives us information on what we would like to adjust, if needed and why. I am a strong believer in self agency. Knowledge enables me to make informed decisions on how best to take care of my body.