Treating Tongue and Lip Ties in Babies
Since August is National Breastfeeding Month, we decided this would be the perfect time to share our story about our son Cooper and his lip/tongue tie. We will outline treating tongue ties and lip ties in babies. First, we’d like to start by answering a couple questions.
What is Tongue Tie?
Ankyloglossia or a tongue tie occurs when an excess amount of tissue along the frenulum inhibits the normal motion and function of the tongue. Yes, this tissue normally exists in all of us but is dysfunctional when it limits the tongue’s full ability to move and function properly (ex: difficulties feeding in infants). A tongue tie can occur anteriorly or posteriorly. Additionally people can experience a lip tie or buccal tie.
How Does a Tongue and Lip Tie Affect Breastfeeding?
- In mom or family:
Nipple pain with latching or feeding
- Nipple trauma resulting in blisters, cracks, bleeding, misshapen nipple, scabbing, or blanched nipples (turning white after feeding)
Inefficient latch causing leaking of milk out of baby’s mouth, clicking sounds while baby is feeding, frequently popping on and off of the breast
Frequent clogged ducts or mastitis due to ineffective draining of the breast
Poor milk supply or over milk supply
- In Baby:
Poor weight gain
Poor latch with breastfeeding
Difficulty or inability to bottle feed
Difficulty or inability to use pacifier
Increased gas, colic, reflux or fussiness due to increased air intake with feedings
Gumming or chewing rather than sucking breast, pacifier or bottle
Inability for tongue to rest on the roof of the mouth
Baby falling asleep at the breast, prolonged feedings, frequent feedings, inadequate infant satiation with breastfeeding
How is This Treated?
Working with a lactation specialist we recommend an International Board Certified Lactation Consult (IBCLC)
Manual therapy performed by a trained physical therapist, chiropractor, massage therapist, etc
Surgical revision via Frenotomy to remove the fascia restricting the tongue and improve its overall function. Frenotomy is commonly performed with use of scissors or laser
Does it Need to be Corrected?
Having a surgical correction is a choice made by your family based on healthcare recommendation and efficacy/functionality of baby’s ability to feed. Tongue, lip and buccal ties can be effectively managed conservatively to improve baby’s ability to latch and any other breastfeeding or lactation challenges.
How Can We Help?
Whether you decide to manage a tongue tie conservatively or via surgical correction, we are here to help. We recommend scheduling an appointment within one week of having a frenotomy procedure. We can provide skilled manual therapy and educate you on exercises/stretches to prevent lip and/or tongue from reattaching, desensitize gag reflex, improve musculature of the tongue, jaw, neck and shoulders, improve sucking, and improve overall digestion. Working with a trained manual therapist can be very helpful to improve your baby’s healing and restore normal function.
Back to Cooper's Story...
While still in the hospital, Heather noticed decreased excursion of Cooper’s tongue when he cried causing inability of the tongue to reach the roof of his mouth as well as a more pronounced frenulum attached from his upper lip to the bottom of his gum line. During his in hospital assessment by the pediatrician Heather asked about his possible tongue and lip tie, however was dismissed.
Luckily, Cooper was able to compensate well while breastfeeding with optimal positioning and use of C hold “sandwich hold”. While breastfeeding Cooper frequently popped on and off, had milk leakage from the sides of his mouth, required frequent feedings, and was often gassy with reflux after feedings. He also had a high narrow palate,a recessed jaw line, and had a sensitive gag reflex. Most of this was manageable but our biggest issue with Cooper was that he refused to take a bottle. We tried different positioning, multiple types of bottles, different times of day, various temperatures of milk, mom vs dad feeding, mixture of breast and bottle feeding, and months of manual work to improve head positioning (he initially presented with a slight right torticollis), neck and jaw musculature, palatine sutures, visceral mobility, reduce gag reflex, and increase tongue and jaw strength for suckling. Nothing seemed to make a difference, he still just hated the bottle and became so frustrated everytime we attempted to bottle feed him. This became troublesome as Heather wanted to return to work and would have to be able to send Cooper to daycare for the day.
Despite no official diagnosis by a Pediatrician we decided to seek a second opinion with Dr. Cara Reik and Abbey, IBCLC at Arizona Breastfeeding Medicine & Wellness. They immediately recognized that Cooper had an upper lip tie and midrange tongue tie causing inefficient jaw and tongue movement. This contributed to impaired suckling leading to his difficulties with latching and bottle feeding. Because we had already tried conservative options, we made the decision to move forward and have the frenotomy performed with a CO2 laser. Dr. Cara performed the procedure during the appointment and Cooper was back in Heather’s arms within 5 minutes. He did great and managed his pain the first 24-48 hours with motrin and arnica. Below are the exercises and manual techniques that we used on Cooper.
Cooper is a perfect example to trust your gut and seek additional opinions if you think something isn’t right. Feeding your baby whether it is breastfeeding or bottle feeding should always be a positive experience for you and baby
Granny Cheeks – Perform 3-5x. Gently squeeze baby’s cheeks trying to tent the lips.
Tug of War – Perform for 20-30 sec. Using your finger or a pacifier, let your baby suck on your finger. Slowly try to pull your finger or the pacifier out while they suck it back in like a tug of war. This strengthens your baby’s tongue. You can apply gentle pressure to the roof of your baby’s mouth.
Follow the Finger – Perform 3-5
- Rub along baby’s top and bottom gum lines trying to get their tongue to follow your finger. You can also gently push against the side of their tongue trying to promote their tongue to move to the side (lateralization).
- Starting in the center of your baby’s mouth, put your finger in their mouth and remove it. Again trying to get the baby’s tongue to follow your finger. Repeat to the right and the left side of your baby’s mouth.
Under the Tongue Wound Stretches
- Use your index fingers to lift your baby’s tongue straight up and gently pulse 5 times.
- Gently push tongue up and back and hold for 5 sec. The goal is to avoid the frenulum re-adhering following the procedure.
Lip Wound Stretches
- Lip Lift – Perform 3x. Use your index fingers to lift under the lip to avoid reattachment of the frenulum following the release.
- Sweep under the lip – Perform 1x. Use your index finger to sweep under the upper lip along the gum line. Again, ensuring there is no re-adhesion following the procedure.
Scoops with Cutlery – Perform 3x each. Using a small spoon rub the tongue from back to front 3x. Rub the top of your baby’s mouth along their palate from back to front 3x. Repeat with the fork. The purpose of this exercise is to desensitize your baby’s gag reflex. While performing this exercise your baby may start to gag. This is actually good for your baby and stimulates their rest and digest parasympathetic nervous system. Simply allow them to recover before repeating the exercise.
Baby Yoga – Hold each position for 30 sec to 1 min
- Guppy – “Reverse tummy time”. While in a seated position, lie your baby down perpendicular to your legs so that their head is extending off the side of your leg. You want to make sure your baby is all the way relaxed and their head is in an extended position. Using a toy, lights, or a sound try to have the baby look to the right and to the left. This exercise stretches the muscles along the front of your baby’s neck that attach to their tongue and jaw.
- Inversions – Start with your baby lying on their back. Grab onto your baby’s legs and slowly lift them upside down and hold. Your baby should be able to relax into this position. You can also try to promote them looking to the right and to the left while in this position.
- Modified Inversion – Instead of lifting your baby into a complete upside position you can use your legs to have your baby lay in a declined position.
Exercises for Digestion and Gas – Perform 3-5x
- Belly Scoops – Start with your baby lying on their back. You can use baby lotion, coconut oil, etc for lubrication. Starting at the bottom of your baby’s rib cage rub your hand in a scooping motion down towards their pelvis.
- Bicycles – Start with your baby lying on their back. Bend your baby’s knees to their chest, alternate legs as if you are pedaling a bicycle. You can also perform circles clockwise and counterclockwise with your baby’s legs trying to promote release of your baby’s gas.
- ILU Tummy Massage